Pediatric Hemato-Oncology Unit, Azienda Policlinico Vittorio Emanuele, Catania, Italy.
Department "GF Ingrassia", University of Catania, Catania, Italy.
Pediatr Blood Cancer. 2019 May;66(5):e27600. doi: 10.1002/pbc.27600. Epub 2019 Jan 3.
Following diagnosis, children with cancer suddenly find themselves in an unknown world where unfamiliar adults make all the important decisions. Children typically experience increasing levels of anxiety with repeated invasive procedures and do not adapt to the discomfort. The aim of the present study is to explore the possibility of asking children directly about their medical support preferences during invasive procedures.
Each patient was offered a choice of medical support on the day of the procedure, specifically general anesthesia (GA), conscious sedation (CS), or nothing. An ad hoc assessment tool was prepared in order to measure child discomfort before, during, and after each procedure, and caregiver adequacy was measured. Both instruments were completed at each procedure by the attending psychologist.
We monitored 247 consecutive invasive procedures in 85 children and found that children in the 4 to 7 year age group showed significantly higher distress levels. GA was chosen 66 times (26.7%), CS was chosen 97 times (39.3%), and nothing was chosen 5 times and exclusively by adolescents. The child did not choose in 79 procedures (32%). The selection of medical support differed between age groups and distress level was reduced at succeeding procedures.
Offering children the choice of medical support during invasive procedures allows for tailored support based on individual needs and is an effective modality to return active control to young patients, limiting the emotional trauma of cancer and treatment.
诊断后，癌症患儿突然置身于一个陌生的世界，这里的成年人会做出所有重要的决定。由于反复接受侵入性操作，儿童的焦虑水平会逐渐升高，而且他们无法适应这种不适。本研究旨在探讨在侵入性操作过程中直接询问儿童对医疗支持偏好的可能性。
在操作当天，每位患儿都可以选择医疗支持，包括全身麻醉（GA）、镇静（CS）或不接受任何医疗支持。为了测量每次操作前后患儿的不适程度和照顾者的充分性，专门准备了一个评估工具。每次操作时，主治心理学家都会使用这两种工具进行评估。
我们监测了 85 名儿童的 247 次连续侵入性操作，发现 4 至 7 岁儿童的焦虑水平显著更高。66 次（26.7%）选择 GA，97 次（39.3%）选择 CS，5 次（2.0%）选择不接受任何医疗支持，且均由青少年选择，79 次（32.0%）操作中患儿未做出选择。医疗支持的选择因年龄组而异，且焦虑水平在后续操作中会降低。
在侵入性操作中为儿童提供医疗支持选择，可以根据个体需求提供定制化的支持，是将主动控制权交还给年轻患者的有效方式，可以减轻癌症和治疗带来的情绪创伤。
