The effectiveness of a standardised preoperative preparation in reducing child and parent anxiety: a single-blind randomised controlled trial

Aims. To evaluate the effect of a structured preoperative preparation on child and parent state anxiety, child behavioural change and parent satisfaction. Background. It is estimated that around 50-70% of hospitalised children experience severe anxiety and distress prior to surgery. Children who are highly anxious and distressed preoperatively are likely to be distressed on awakening and have negative postoperative behaviour. Although education before surgery has been found to be useful mostly in North America, the effectiveness of preoperative preparation programme adapted to the Australian context remains to be tested. Design. This single-blind randomised controlled study was conducted at a tertiary referral hospital for children in Western Australia. Methods. Following ethics approval and parental consent, 73 children and one of their carers (usually a parent) were randomly assigned into two groups. The control group had standard practice with no specific preoperative education and the experimental group received a preoperative preparation, including a photo file, demonstration of equipment using a role-modelling approach and a tour. Results. The preoperative preparation reduced parent state anxiety significantly (-2.32, CI -4.06 to -0.56, p = 0.009), but not child anxiety (-0.59, CI -1.23 to 0.06, p = 0.07). There was no significant difference in child postoperative behaviour or parent satisfaction between the groups. There was a significant two-point pain score reduction in the preoperative preparation group, when compared with the control group median 2 (IQR 5) and 4 (IQR 4), respectively (p = 0.001). Conclusions. Preoperative preparation was more efficient on parent than child. Although the preoperative preparation had limited effect on child anxiety, it permitted to decrease pain experience in the postoperative period. Relevance to clinical practice. Parents should be actively involved in their child preoperative preparation.