心理社会干预减少儿童白血病在骨髓抽吸和腰椎穿刺时的痛苦。

Psychosocial interventions for reduction of distress in children with leukemia during bone marrow aspiration and lumbar puncture.

机构信息

Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.

出版信息

Pediatr Neonatol. 2019 Jun;60(3):278-284. doi: 10.1016/j.pedneo.2018.07.004. Epub 2018 Jul 21.

DOI:10.1016/j.pedneo.2018.07.004

PMID:30100518

Abstract

BACKGROUND

Children with cancer undergo many invasive medical procedures that are often painful and highly distressing, including bone marrow aspiration (BMA) and lumbar puncture (LP). Psychosocial interventions have been demonstrated to reduce children's distress resulting from invasive medical procedures. The aim of the study is to assess the efficacy of psychosocial interventions to reduce distress in children with cancer undergoing BMA and LP in a pediatric cancer center in Taiwan.

METHODS

Children with cancer who received treatment between March 2015 and December 2016 at Chang Gung Memorial Hospital, Linkou, Taiwan were eligible for the study. The psychosocial intervention comprised preparation and cognitive behavioral intervention and was provided by a certified child life specialist. The assessment instrument was the revised version of the Observational Scale of Behavioral Distress (OSBD-R). The behavioral distress of patients who underwent psychosocial interventions for BMA and LP was compared with patients without interventions. We also analyzed the difference of behavioral distress in patients' pre- and post-psychosocial intervention for BMA and LP.

RESULTS

Eighteen patients were enrolled into this study. The mean age of diagnosis of leukemia was 6.6 years old (range: 3-11 years). Fifteen patients were diagnosed with acute lymphoblastic leukemia, and 3 were diagnosed with acute myeloid leukemia. The mean of OSBD-R total scores in 7 patients with psychosocial intervention was significantly lower than the mean score in 6 patients without intervention (0.65 vs. 4.81, p = 0.002). Pre- and post-psychosocial intervention for BMA and LP behavioral distress were evaluated for the remaining 5 patients. Consistently, there was a significant reduction of the OSBD-R score following interventions (3.04 vs. 7.81, p = 0.025).

CONCLUSION

Psychosocial interventions provided by a certified child life specialist have a significant potential to reduce children's distress during BMA and LP in pediatric healthcare settings in Taiwan.

摘要

背景

癌症患儿需要接受许多有创的医疗程序，这些程序常常既痛苦又令人高度痛苦，包括骨髓穿刺（BMA）和腰椎穿刺（LP）。心理社会干预已被证明可减轻儿童因有创医疗程序而产生的痛苦。本研究的目的是评估心理社会干预在降低台湾一家儿科癌症中心接受 BMA 和 LP 的癌症儿童的痛苦方面的疗效。

方法

在台湾林口长庚纪念医院接受治疗的 2015 年 3 月至 2016 年 12 月期间患有癌症的儿童符合研究条件。心理社会干预包括准备和认知行为干预，并由经过认证的儿童生活专家提供。评估工具是行为困扰观察量表（OSBD-R）的修订版。比较接受 BMA 和 LP 心理社会干预的患者与未接受干预的患者的行为困扰。我们还分析了 BMA 和 LP 患者进行心理社会干预前后行为困扰的差异。

结果

本研究共纳入 18 例患者。白血病的平均诊断年龄为 6.6 岁（范围：3-11 岁）。15 例患者被诊断为急性淋巴细胞白血病，3 例患者被诊断为急性髓系白血病。7 例接受心理社会干预的患者的 OSBD-R 总分均值明显低于 6 例未接受干预的患者（0.65 对 4.81，p=0.002）。对其余 5 例患者进行了 BMA 和 LP 前后的心理社会干预行为困扰评估。一致的是，干预后 OSBD-R 评分显著降低（3.04 对 7.81，p=0.025）。