Psychosocial or Non-Pharmacological Preoperative Intervention to Reduce Fear of Surgery for Children in Hospital Settings: A Review

Background: Surgery or related medical procedures are often unpleasant experiences. Children in hospital settings might have negative emotional responses (e.g., anxiety, fear, and stress) to forthcoming surgery. Fearful and distressing pain memories caused by surgery and related medical procedures can result in avoiding treatments, traumatic experiences, and also may negatively influence health outcomes. Numerous pharmacological and non-pharmacological methods have been used to help reduce children's fear of surgery or related medical procedures. Given the adverse side effects of pharmacological mechanisms, non-pharmacological interventions are desirable alternative choices. This review examined papers that evaluate psychosocial or non-pharmacological interventions to determine whether there is evidence demonstrating that non-pharmacological interventions can effectively reduce the fear of surgery or related medical procedures for pediatric patients in hospital settings.

Methods: Six databases including Academic Search Complete (EBSCO), CENTRAL, Embase, PsycINFO, Web of Science, and Pubmed were searched. The literature search was initiated on February 23, 2022, and was completed on March 9, 2022. Data including study participants, sample size, the purpose of study, study design, interventions, scale name, fear outcome, and primary findings were extracted. Information of each study, such as authors, publication year, and country, was also extracted.

Results: Five RCT studies published from 2012 to 2021 were located. These studies were culturally diverse, being conducted in Turkey, the United States, Singapore, and Canada. The psychosocial or non-pharmacological interventions of these five studies were finger puppet play, virtual reality, an educational pop-up book, a preoperative education program, and MEDi®. Three studies that used finger puppet play, virtual reality techniques, and an educational pop-up book were found to have statistically significant effects on reducing fear among pediatric patients. The other two studies that used preoperative education and a humanoid robot (MEDi ®) showed no statistically significant effect in improving the fear of surgery for children in the hospital setting.

Conclusions and Implication: This review tentatively indicates that finger puppet play, virtual reality, and educational pop-up books had positive effects in reducing children's fear of surgery. Given the limitations of the included studies in terms of number and quality, solid future evidence is still needed to support the conclusion of this review. This review can inform clinical healthcare professionals to provide interventions that include understandable information in interactive and children-friendly ways for pediatric patients to learn what will happen and what medical procedures they might experience. In addition, providing content that can highly attract children or distract them from fear of surgery are also acceptable ways. Interventions to reduce children’s fear of surgery in hospital settings received global attention from researchers in different countries. Future research should focus more on children undergoing major surgery and using diverse psychosocial or other non-pharmacological interventions.