This study investigated a behavioral intervention incorporating parent coaching, attentional distraction, and positive reinforcement to control child distress during invasive cancer treatment. Children (N = 23) requiring physical restraint to complete venipuncture were alternately assigned to either a behavioral intervention or an attention control condition. Child distress behaviors were recorded, and self-reports of parent, child, and nurse distress were obtained. Parent and nurse also rated child distress. Results of planned comparisons indicate that observed child distress, parent-rated child distress, and parent ratings of his/her own distress were significantly reduced by behavioral intervention and were maintained across the course of three intervention trials. The use of physical restraint to manage child behavior was also significantly reduced. Child self-reported pain and nurse ratings of child distress were not significantly affected.

Examined (a) the impact of demographic, medical, and psychological factors on overall child distress during an invasive medical procedure required for pediatric cancer treatment and (b) the relationship of individual parent behaviors to child distress across phases of the procedure. Seventy 3- to 10-year-old pediatric cancer patients receiving outpatient venipuncture and their parents participated. Overall distress was greater in younger children who had fewer previous venipunctures and poorer venous access and whose parents rated them prior to the procedure as less likely to be cooperative. Providing explanations regarding the procedure was the parent behavior most clearly associated with child distress. The impact of parent explanation depended on when the explanation was given and on the child's level of distress at the time.

Factors related to the prevalence, prediction, and course of anticipatory nausea (AN) in women (n = 77) receiving adjuvant chemotherapy for breast cancer were examined. Using a prospective longitudinal research design, patients were interviewed both before and after each chemotherapy infusion. Fifty-seven percent of the patients developed AN. These patients were characterized by more severe gastrointestinal side effects following the initial infusion and greater expectations for experiencing chemotherapy-related nausea. A more rapid development of AN was related to a history of experiencing nausea across a greater variety of situations, higher IV drug doses, and less infusion-related anxiety at the initial infusion. Although AN occurred intermittently across treatment sessions, severity was constant. Results provided strong support for the hypothesis that classical conditioning processes are instrumental in AN acquisition. The role of anxiety in the development of AN is considered as are clinical implications for the prevention of AN and recommendations for future research.

Adult-child interactions during stressful medical procedures were investigated in 43 pediatric patients videotaped during a venipuncture procedure in the course of cancer treatment. Relations among six adult behavior categories (explain, distract, command to engage in coping behavior, give control to the child, praise, and criticize/threat/bargain) and three child behavior categories (momentary distress, cry/scream, and cope) were examined using correlational and sequential analysis. Results indicated that adult distraction resulted in increased child coping and reduced momentary distress and crying. Adult explanations, although a likely response to child distress and crying, did not result in a reduction of these behaviors. Attempts to give the child control reduced child crying. Implications for clinical interventions during painful medical procedures are discussed.

An examination of factors was conducted to determine the effectiveness of the distraction component of a behavioral intervention (use of a party blower). In one condition, parents were instructed to coach children in the use of a party blower and to praise child cooperation. In a second condition, nurses were instructed to assist parents in coaching the child. Parents used the coaching skills they learned and got their children to use the distraction technique. Use of the distraction technique was associated with less crying. Encouragement from a health care professional and intervention early in the procedure did not enhance the intervention's effectiveness. Older children and children who were less distressed during the initial phase of the procedure were less likely to reject the intervention.