This study investigated whether a clown doctor intervention could reduce preoperative anxiety in children hospitalized for minor surgery and in their parents. A randomized controlled trial was conducted with 77 children and 119 parents: the clown group consisted of 52 children accompanied in the preoperating room by their parents (n = 89) and two clowns while the comparison group consisted of children accompanied by the parents only. The clown intervention significantly reduced the children's preoperative anxiety: children benefited from the clown's presence and showed better adjustment than children in the comparison group. Mothers in Comparison Group showed higher anxiety.

Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient’s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research.

Paediatric staffs may consider using such a combination of strategies in preparing children for anaesthesia induction.

Hospitalized children who undergo painful procedures are more susceptible than others to experiencing iatrogenic effects, such as anxiety, pain, and severe stress. Clowns in clinical setting have been found to be effective in reducing children's experiences of these effects during hospitalization and before procedures. This article provides an overview of clowning in health care settings; reviews major studies conducted on clowning for hospitalized children, discussing evidence that clown interventions decrease pain and distress in pediatric patients; and concludes with a discussion of health care clowning as a profession.

Clowning has a varied tradition and a long history. Recently, clowns have been adopted in the medical setting with the aim of decreasing the negative emotions that can be experienced during hospitalization and medical procedures, as well as inducing positive feelings in patients, their relatives, and the hospital staff. Due to an increase in the number of clowns working in hospitals and the large amount of interest shown in utilizing this approach, an increasing number of studies have focused on testing the efficacy of this complementary and alternative strategy. Here, we provide an overview of the concept of healthcare clowning followed by a literature review of 28 randomized controlled trials (RCTs) drawn from two databases (PubMed and Google Scholar), with the aim of investigating and discussing evidence for the effects of healthcare clowning on children. The search revealed the different settings in which RCTs have been conducted: preoperative areas, during medical procedures, and during hospitalization. The search also revealed the different outcomes that were measured. In general, the results show that clown interventions are effective in decreasing negative emotions and psychological symptoms and in enhancing the well-being of patients and their relatives. Appreciation of clown interventions by healthcare staff has also increased in recent years.