Sullivan Gwyneth A, Tian Yao, Schäfer Willemijn L A, Giger Kayla M, Willberding Maxwell Joseph, Reiter Audra J, Essner Bonnie, Hu Andrew J, Ingram Martha C, Balbale Salva, Johnson Julie K, Holl Jane L, Raval Mehul V
Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA.
J Pediatr Surg Open. 2024 Oct;8. doi: 10.1016/j.yjpso.2024.100159. Epub 2024 Jul 10.
Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes.
We conducted an embedded mixed-methods study with a quantitative focus. Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial for children, ages 10-18 years, undergoing elective gastrointestinal surgery. Patients/caregivers were surveyed about preoperative exposure to and postoperative use of biobehavioral interventions. Four semi-structured group interviews with 20 pediatric surgery providers were conducted. Outcomes included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness.
41 % ( = 67) of 164 enrolled patients/caregivers reported preoperative exposure to and 71 % ( = 117) reported postoperative use of a biobehavioral intervention(s). Barriers to incorporation of biobehavioral interventions included lack of standardized workflows, clinician knowledge, and resources. Potential facilitators included media and peer-counseling. After adjusting for individual and hospital characteristics, those who reported using a biobehavioral intervention(s) were 70 % less likely to report worsened postoperative nervousness (95 % CI 0.10-0.91; = 0.03). Reported use of a biobehavioral intervention(s) was not found to be associated with pain-related functional disability or HRQoL.
Use of a biobehavioral intervention(s) may stabilize postoperative nervousness of children undergoing surgery. There is a need for redesign of clinical workflows and clinician training to facilitate integration of biobehavioral interventions.
包括放松、分散注意力和正念冥想练习在内的生物行为干预已被证明可降低围手术期的压力、焦虑和疼痛。我们的目标是：1）量化儿科手术患者报告的术前接触和术后使用生物行为干预的情况；2）了解将生物行为干预纳入临床实践的障碍和促进因素；3）评估相关的患者报告结局。
我们进行了一项以定量研究为主的嵌入式混合方法研究。数据收集是作为针对10至18岁接受择期胃肠手术儿童的18家医院的“儿童手术增强康复（ENRICH-US）”临床试验的一部分。对患者/护理人员进行了关于术前接触和术后使用生物行为干预的调查。对20名儿科手术提供者进行了四次半结构化小组访谈。结局包括疼痛相关的功能障碍、健康相关生活质量（HRQoL）和围手术期紧张情绪。
164名登记患者/护理人员中，41%（n = 67）报告术前接触过生物行为干预，71%（n = 117）报告术后使用过生物行为干预。将生物行为干预纳入临床实践的障碍包括缺乏标准化工作流程、临床医生知识和资源。潜在的促进因素包括媒体和同伴咨询。在对个体和医院特征进行调整后，报告使用生物行为干预的患者术后紧张情绪恶化的可能性降低了70%（95%CI 0.10 - 0.91；P = 0.03）。未发现报告使用生物行为干预与疼痛相关的功能障碍或健康相关生活质量有关。
使用生物行为干预可能会稳定接受手术儿童的术后紧张情绪。需要重新设计临床工作流程并开展临床医生培训，以促进生物行为干预的整合。
