A pharmacobehavioral intervention to reduce child cancer distress
Posner, Kelly Layne
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This study evaluated the efficacy of a combined behavioral and pharmacologic/topical anesthetic (EMLA) intervention, as compared with the topical anesthetic alone, in reducing children's distress during venipuncture procedures. The subjects were 20 patients with pediatric cancer who ranged in ages from 3 years to 10 years. Dependent outcome measures included behavioral distress scores, child self-reported anxiety and pain scores, parent and nurse reports of child distress, and heart rate. To insure against experiment wise error, a .001 significance level was chosen. Results were most robust in the domain of anxiety and indicated that the children who received the combined treatment reported experiencing significantly less anxiety than children who received only the anesthetic. Data trends also revealed that nurses reported that children who received the combined treatment experienced less anxiety than children who received only EMLA. Furthermore, a strong data trend revealed an interaction effect which indicated that children who received only EMLA experienced increased levels of anxiety during the procedure in which it was used for the first time (compared to baseline), whereas children who received the combined treatment reported experiencing less anxiety; Data also evidenced that IV experience significantly mediated the relationship between type of treatment and a child's self-reported anxiety. Significant group differences were not found for observed distress, heart rate, ratings of child pain, and parent and nurse anxiety. Child and parent expectancies of pain before the procedure, however, were improved with the use of EMLA, regardless of which treatment was received.