Preparing Children for Anesthesia With an Educational Pop-Up Book

Study Overview
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Brief Summary
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The study evaluated an educational pop-up book about general anesthesia induction as an interactive, child-focused preoperative education resource for pediatric patients undergoing outpatient surgery. The study's objectives were to evaluate the book as an educational tool and to understand the book's effects on patient and caregiver perceptions of the surgical experience. The study's hypotheses were that preoperative education from the pop-up book, compared to standard care, would more effectively reduce children's fear and expected pain, facilitate more positive views of the procedure and preoperative explanations, encourage adaptive coping strategies, reduce behavioral anxiety at anesthesia induction, and increase caregiver satisfaction with the surgical experience.

Official Title
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Efficacy of an Educational Pop-Up Book in Preparing Children for Anesthesia: A Randomized Controlled Trial

Conditions
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Pediatric Preoperative Anxiety, Pediatric Coping

Intervention / Treatment
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* Other: Pop-Up Book


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Ages 5-12 (inclusive) Undergoing outpatient medical procedures under general anesthesia with inhalation induction English-speaking Able to provide electronic consent/assent (legal guardian) Exclusion criteria: Patients with severe developmental disabilities Unable to obtain electronic consent/assent from a legal guardian

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patients were allocated via a block-randomized list to either the intervention arm (the educational pop-up book) or the control arm (standard care).
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pop-Up Book<br>Patients read an interactive pop-up book about general anesthesia induction in addition to standard consultation with an anesthesia provider. | Other: Pop-Up Book<br>* Patients spent 5-10 minutes reading an illustrated pop-up book that promoted active learning about the process of general anesthesia induction.<br>|
| No Intervention: Standard Care<br>Patients received standard consultation with an anesthesia provider (standard care). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Observer-Rated Behavioral Anxiety at Anesthesia Induction as assessed by the modified Yale Preoperative Anxiety Scale-Short Form | Patients' behavioral anxiety at anesthesia induction was assessed relative to baseline using the observer-rated modified Yale Preoperative Anxiety Scale-Short Form. The scale ranges from 22.92-100; higher scores indicate greater anxiety (worse outcomes). Raters were preoperative nurses and circulating nurses blinded to group assignments. | Baseline anxiety was rated upon initial entry into the preoperative holding area; anxiety at induction was rated while patients received inhalational induction via an anesthesia mask. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fear of Anesthesia Induction as assessed by the Children's Fear Scale | Patients self-reported their fear of anesthesia induction using the Children's Fear Scale. The scale ranges from 0-4; higher scores indicate greater fear (worse outcomes). | Fear was rated after education and before premedication was administered. | 
| Expected Pain from the Anesthesia Mask and During Surgery as assessed by the Faces Pain Scale-Revised | Patients self-reported how much pain they expected (1) from the anesthesia mask and (2) while asleep for the surgical procedure using the Faces Pain Scale-Revised. The scale ranges from 0-5; higher scores indicate greater expected pain (worse outcomes). | Expected pain was rated after education and before premedication was administered. | 
| Expectations about the Procedure, Attitudes about Anesthesia, and Views of Preoperative Explanations as assessed by a Likert-Scale Questionnaire | Patients self-reported their perceptions of the procedure and preoperative explanations (the pop-up book or provider consultation) using a 9-item Likert-scale questionnaire. The questionnaire was scored from 1-5; higher scores indicated more positive views (better outcomes). | The outcomes were rated after education and before premedication was administered. | 
| Self-Reported Coping Strategies for Managing the Stress of Anesthesia Induction | In a prospective interview, patients reported coping strategies for managing the stress of anesthesia induction. Greater frequencies of adaptive coping strategies indicated better outcomes. | Patients were interviewed after education and before premedication was administered. | 
| Caregiver Satisfaction with the Surgical Experience as assessed by a Likert-Scale Questionnaire | Caregivers reported their satisfaction with the surgical experience using a 10-item Likert-scale questionnaire. The questionnaire was scored from 1-5; higher scores indicated more positive views (better outcomes). | The questionnaire was administered after the patient underwent anesthesia induction. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Preoperative education, Patient education, Preoperative anxiety, Pediatric outpatient surgery, Pediatric anesthesia