Psychological interventions helping pediatric oncology patients cope with medical procedures: A nurse-centered approach

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Abstract

Purpose of the research

This study explored whether psychological interventions are currently used by pediatric oncology nurses to help children cope with their treatment and, if so, which interventions were considered by oncology nurses to be the most effective.

Methods and sample

A web-based survey was developed to assess pediatric oncology nurses' impressions of psychological care for pediatric patients during their medical treatment. A sample of 88 pediatric oncologic nurses from twelve leading pediatric oncology departments in the US participated in the survey. The closed questions were analyzed through quantitative methods with statistics. The open questions were examined through qualitative methods with report narratives and discourse analysis.

Key results

Pediatric oncology nurses identified three psychological interventions to reduce suffering: educating children by explaining the procedure; providing emotional support to children by listening, answering children's worries, or holding their hands; and distracting children through passive and active forms. The survey further showed that nurses spent on average 3 h per day providing emotional support, would be willing to be trained in additional interventions (93%), and could devote at least 10 min per treatment to provide support (77%).

Conclusions

This work demonstrates the central role nurses play as emotional support caregivers. Since nurses would be willing to provide emotional support during treatments, training may be an approach to incorporate the use of psychological interventions.

Introduction

Today, thanks to improvements in the treatment for cancer, most children survive. From 1975 to 2003, the five-year survival rate increased by over 20 percentage points and is over 80% today (Ries et al., 2007). While the survival rate has increased substantially, treatment is still quite intense and difficult to endure. In fact, some studies show that children with cancer struggle more with the procedures of treatment than with the illness itself (Manne et al., 1999; Zernikow et al., 2005). For example, a child can undergo numerous hospitalizations and medical procedures including an initial catheter implant, regular implant cleanings, multiple lumbar punctures, bone marrow aspirations and biopsies, and continuous IV therapies and venipunctures.

Many researchers have developed specific psychological interventions to help children deal with cancer treatment. These psychological interventions have been effective in reducing pain and anxiety, along with enhancing acceptance of medical treatments. Controlled experiments have been conducted to support evidence of the efficacy of psychological interventions. Cognitive-Behavioral Therapies (CBT) have been considered as a well-established intervention (Powers, 1999), effective in reducing distress of childhood cancer during painful medical procedures (Ellis and Spanos, 1994; Jay et al., 1985; Dahlquist et al., 1985; Kazak et al., 2007; Mulhern and Butler, 2006). CBT produces better results in reducing behavioral distress than pharmacological interventions alone (Jay et al., 1987; Ries et al., 2007). Hypnosis has shown efficacy in reducing pain and anxiety during medical procedures such as lumbar punctures or bone marrow aspirations for leukemia patients (Accardi and Milling, 2009; Liossi, 1999; Liossi et al., 2009). Distraction techniques can help children perceive less pain and display less behavioral distress during venipunctures, lumbar punctures and catheter implants (Gershon et al., 2004; Nilsson et al., 2009; Sander et al., 2002). In this study, we will explore whether these psychological interventions are currently used to help children cope with their treatment, and which interventions are considered by oncology nurses to be the most effective.

Some previous work focused on the nurse's role in being a supportive caregiver to children with cancer (Bryant, 2003; Grealish et al., 2000; McCarthy et al., 1996; Rheingans, 2008). Some psychological interventions, such as providing information before procedures and positive reinforcement after procedures, are already offered by nurses in pediatric oncology centers (McCarthy et al., 1996). McCarthy's study emphasized that nurses are the main providers of daily interventions, whereas most of psychologists' and psychiatrists' therapies with children are available on an “as needed” basis (McCarthy et al., 1996). Furthermore, pediatric nurses can be cost-effective targets to provide interventions. Some studies showed the efficacy of nurses using distraction to reduce children's distress during immunization. This approach can be more economical than training parents or children, or using local anesthetics (Cohen et al., 1997; Cohen et al., 1999). Based on these conclusions, one way to implement psychological interventions for children during cancer treatment is to use the medical staff, specifically nurses, who are already in contact with children and can give them spontaneously support. Additionally, because of the familiarity that nurses have with their patients, they may be in the best position to assess the child and customize a strategy to decrease their pain and psychological distress.

Moreover, training can be an effective way to improve nurses' knowledge of psychological interventions and their ability to implement them. For example, MacLaren et al. (2008) highlighted the lack of cognitive–behavioral pain management curricula during nurses' training. They found that on average, only 2.9 h of coursework were devoted to non-pharmacological techniques (MacLaren et al., 2008). Nursing students who were trained on distraction and guided imagery techniques were able to use them in a better way than a control group (MacLaren et al., 2008). Based on these findings, this study will explore if nurses will be willing to be trained and implement new strategies in a hospital setting.

These research questions will be explored though this study:

  • Which psychological interventions do nurses report using and which interventions do they consider to be the most effective to reduce symptoms?

  • Are nurses willing to be trained in and implement effective psychological interventions during children's medical treatment?

Section snippets

Overview

A survey questionnaire was developed to obtain information in a non-experimental research design. The data were collected by a self-developed questionnaire, and administered to pediatric oncology nurses who work in hospitals in the United States. The University of West Georgia Institute Review Board (IRB) approved this study. The type of design in this research in terms of the time dimension is cross-sectional.

Sample

The participants of this study were pediatric oncology nurses who are practicing in

Preliminary analyses

In general, 80% of nurses reported spending an average of three hours daily answering questions, explaining treatments, and calming patients. Results also indicated that nearly all the nurses felt that their patients trusted them (97%, N = 88)) and shared their fears and concerns with them (90%, N = 88). In addition, 93% (N = 88) of the nurses reported that they provided psychological support before, during, and after a medical procedure.

Current psychological interventions in use

Three themes appeared to be crucial to help children

Discussion

The survey demonstrates that nurses are focusing on simple interventions and on the patient–nurse relationship, which is effectively the essence of their role. They are spontaneously spending time with children, explaining their treatment, developing trusting relationships with patients, and listening to children's fears. The majority of nurses spend over three hours per day providing emotional support. This acknowledges that nurses play a crucial and central role as an everyday caregiver

Conflict of interest statement

None declared.

Acknowledgements

The authors would like to thank Dr. Tobin Hart and Dr. Krystal Perkins from the University of West Georgia and Dr. Randy Weinstein for their helpful advice and guidance throughout this research project.

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