The Effect of a Caregiver Preparation Video (Take5) on Child Anxiety During Anesthetic Induction: A Randomized Controlled Trial.

BACKGROUND

A general anesthetic can be an anxiety-provoking experience, and children who experience perioperative anxiety are more likely to have negative outcomes such as emergence delirium, increased analgesic requirements, and maladaptive behaviors. Parental presence at the induction of anesthesia can help reduce anxiety; however, only if the parent does not feel anxious themselves and can support their child in a positive way. The aim of this study was to test the efficacy of a short preparation video aimed at caregivers prior to the child's induction of anesthesia.

METHODS

We conducted a randomized controlled trial of the Take5 video compared to standard care. The Take5 video was developed by pediatric anesthetists, child psychologists and a consumer panel of parents of children who had lived experience of surgery and anesthesia. The Take5 video is a 5-min, animated video that prepares caregivers for what to expect during the anesthetic induction. It also provides the caregiver with suggested behaviors that will positively support the child during the induction and psychological coping strategies to manage personal distress. Participants were randomized to the standard preparation group or the intervention group, which consisted of standard preparation plus the caregiver being shown the Take5 video in the preoperative waiting area prior to accompanying their child to the operating room. The primary outcome was child anxiety at induction measured using the Modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary outcomes were caregiver procedural behavior, child postoperative pain, emergence delirium, time to discharge, caregiver satisfaction and caregiver and child psychological wellbeing at 3 months.

RESULTS

One-hundred children and their caregivers were recruited to the trial. There was good to excellent inter-rater reliability with all of the observer scales (intraclass correlation coefficient = 0.81 for the mYPAS-SF). For the primary outcome of child anxiety at induction of anesthesia, there was good evidence for no difference between groups. For the secondary outcomes, the video intervention did not show any effect on parental behavior. There was a statistically significant difference in pain scores between groups, with children in the control group rated as having more pain on the Faces, Legs, Activity, Cry and Consolability (FLACC) scale (mean difference 0.6, 95% CI 0.04-1.16, p = 0.037). There was no difference shown in any of the other secondary outcomes including emergence delirium, time to discharge or caregiver satisfaction. There were also no differences in any of the 3-month psychological wellbeing outcomes: Child health-related quality of life, child behavioral difficulties or parent depression and anxiety scores. Despite this, in semistructured interviews, caregivers reported the video to be acceptable and beneficial, but many would have preferred to see it in the days prior to their child's procedure.

DISCUSSION

The Take5 video, shown to caregivers immediately prior to surgery, did not have any demonstrable effect on child anxiety at induction or on a range of postoperative outcomes; however, caregivers reported a perceived benefit to the child's induction experience. The results of this study did not show a measurable benefit of the Take5 video; however, this may be due to the timing of delivery. Providing this resource to families prior to coming into the hospital may be of benefit; however, further studies would be required to confirm this.

TRIAL REGISTRATION

This study was registered in https://www.anzctr.org.au/ (ACTRN12621001337864; October 5, 2021).