Abstract
Aim: To evaluate the effectiveness of family-centred educational interventions on the anxiety, pain and behaviours of children and adolescents (three to 19 years old) and their parents’ anxiety during the perioperative journey. Design: Systematic review of effectiveness and meta-analysis. Data sources: MEDLINE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, SciELO and Sources of unpublished studies OpenGrey, Open Access Theses and Dissertations, and RCAAP – Portugal were systematically searched from January 2007 to April 2021 for available articles in English, Spanish and Portuguese. Review methods: This review followed the methodology for systematic reviews of effectiveness from Joanna Briggs Institute (JBI). Included studies were critically appraised using JBI Critical Appraisal Checklist for Randomised Controlled Trials and JBI Critical Appraisal Checklist for Quasi-Experimental Studies. Data was synthesised through meta-analysis, using a random-effects model in the Stata Statistical Software 16.0, and narrative synthesis. Two independent reviewers performed the selection process, critical analysis, and data extraction. Results: Twenty-eight studies (26 randomised controlled trials (RCTs) and two quasi-randomised controlled trials) were included with a total of 2516 families. In a meta-analysis of ten RCTs with 761 participants, pre‑operative anxiety management was more effective in children and adolescents who received educational interventions (SMD = -1.02; SE = 0.36; 95% CI [-1.73; -0.32]). At the induction of anaesthesia, children and adolescents were significantly less anxious (SMD = -1.54; SE = 0.62; 95% CI [-2.72; -0.36]) and demonstrated better compliance than controls (SMD = -1.40; SE = 0.67; 95% CI [-2.72; -0.09]). Post‑operative pain (SMD = -0.43; SE = 0.33; 95% CI [-1.05; 0.19]) and pre‑operative parental anxiety (SMD = -0.94; SE = 1.00; 95% CI [-2.87; 0.99]) were reduced in favour of the educational interventions Conclusion: Family-centred educational interventions probably lead to a considerable reduction of paediatric and parental anxiety and improve paediatric behaviours at induction of anaesthesia. The evidence is very uncertain regarding the effectiveness of these interventions on post‑operative paediatric maladaptive behaviours and pain intensity or parental anxiety levels at the induction of anaesthesia.
Highlights
Millions of children and adolescents undergo surgery each year.[1]
In a meta-analysis of ten randomised controlled trials (RCTs) with 761 participants, pre‐operative anxiety management was more effective in children and adolescents who received educational interventions (SMD = -1.02; SE = 0.36; 95% confidence interval (CI) [-1.73; -0.32])
The results of our meta-analysis suggest that educational interventions can achieve a large reduction in perioperative paediatric anxiety levels, improve paediatric behaviours at induction of anaesthesia and reduce parental pre‐operative and post‐operative anxiety levels
Summary
Millions of children and adolescents undergo surgery each year.[1] Nearly 50 to 75 per cent of them experience fear and anxiety during the perioperative period,[2] feelings reported as very common in their parents[3,4,5]. Children are vulnerable to the stress and anxiety surrounding surgery due to their cognitive development, experience and knowledge about health care.[8] Parental fear, anxiety and trauma are mirrored by parents’ need for comprehensive information and advice about as well as strategies for coping with their child’s surgery.[5] Higher anxiety levels have been found in mothers,[9] younger parents, parents of younger children, and parents whose children were undergoing their first surgery.[10]
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