THE EFFECTS OF A PSYCHOLOGICAL PREPARATION PROGRAM ON ANXIETY IN CHILDREN AND ADOLESCENTS UNDERGOING GASTROINTESTINAL ENDOSCOPY

Abstract

Purpose: To investigate the effects of a psychological preparation program prior to gastrointestinal endoscopy on: patient self-reported anxiety, parental self-reported anxiety, observed patient anxiety, patient autonomic nervous system stimulation and dosage of medication required for procedural sedation. Methods: Sixty patients ages 5-19 yrs (mean=12.2 yrs) were randomized into one of two groups. Group 1 received routine preparation prior to endoscopy. Group 2 received psychologic preparation provided by a Child Life Specialist. Preparation consisted of demonstration of materials that would be encountered during the procedure, use of a doll as a model or book with photographs of a child who had previously undergone endoscopy. Patients in both groups completed the Spielberger State Anxiety Inventory (STAI) at the time of their clinic appointment and just prior to endoscopy. The Observational Scale of Behavioral Distress was completed by the same blinded observer during each procedure. Vital signs were recorded in clinic and just prior to endoscopy. The attending physician (blinded) assessed patient cooperation. Parents and patients completed post-endoscopy questionnaires. Results: Analysis of the STAI showed patients in Group 2 were significantly less anxious prior to endoscopy (p<0.0001). They also required less mg/kg of meperidine (p=0.04) and were more cooperative during the exam (p=0.042). There was significantly less autonomic nervous system stimulation just prior to the procedure compared to baseline in patients who had undergone psychologic intervention (change in heart rate:p<0.001; change in systolic blood pressure: p=0.040). There was no significant difference between Group 1 and Group 2 with respect to observed behavioral distress during the procedure or mg/kg of midazolam administered. Statistically significant differences were found in the patients' response to post-endoscopy questions regarding perceived procedural anxiety (p=0.003) and the parents' response to questions regarding their own condition (p=0.026) and their children's (p<0.001). Conclusion: We conclude that psychological preparation prior to endoscopy significantly decreases patient and parental anxiety. Such preparation may allow for a reduction in sedative medications and thereby enhance procedural safety.