The effects of a psychological preparation program on anxiety in children and adolescents undergoing gastrointestinal endoscopy.

Abstract

Like adults, children often experience anxiety associated with medical procedures. The purpose of this study was to investigate the effects of a program of psychological preparation for children undergoing endoscopy. Sixty patients aged 6 to 19 years (mean, 12.2 years) were randomized into one of two groups. Group 1 received routine preparation before endoscopy. Group 2 received psychological preparation consisting of demonstration of materials that would be encountered during the procedure, use of a doll as a model, or use of a book with photographs of a child who had previously undergone endoscopy. Patients in both groups completed the Spielberger State-Trait Anxiety Inventory in the clinic and just before endoscopy. The Observational Scale of Behavioral Distress was completed by a blinded observer during each procedure. The attending physician (blinded) assessed patient cooperation. Vital signs were recorded in clinic and just before endoscopy. Parents and patients completed questionnaires after endoscopy. Analysis of the Spielberger State-Trait Anxiety Inventory showed patients in group 2 were significantly less anxious before endoscopy (p < 0.0001). They also required less meperidine (p < eq 0.04) per kilogram body weight and were more cooperative during the examination (p = 0.042). There was significantly less autonomic nervous system stimulation in those who had undergone psychological preparation (change in heart rate, p < 0.001; change in systolic blood pressure, p = 0.04). Statistically significant differences were found in the patients' response to questions after endoscopy regarding perceived anxiety during the procedure (p = 0.003) and the parents' response to questions regarding their own conditions (p = 0.026) and that of their child (p < 0.001). Psychological preparation before endoscopy significantly decreases patient and parental anxiety. Such preparation may allow for a reduction in sedative medications and thereby enhance procedural safety.