Clown Doctors as a Treatment for Preoperative Anxiety in Children: A Randomized, Prospective Study

Abstract

ABSTRACT. Background. The induction of anesthesia is one of the most stressful moments for a child who must undergo surgery: it is estimated that 60% of children suffer anxiety in the preoperative period. Preoperative anxiety is characterized by subjective feelings of tension, apprehension, nervousness, and worry. These reactions reflect the child's fear of separation from parents and home environment, as well as of loss of control, unfamiliar routines, surgical instruments, and hospital procedures. High levels of anxiety have been identified as predictors of postoperative troubles that can persist for 6 months after the procedure. Both behavioral and pharmacologic interventions are available to treat preoperative anxiety in children.Objective. The aim of this study was to investigate the effects of the presence of clowns on a child's preoperative anxiety during the induction of anesthesia and on the parent who accompanies him/her until he/she is asleep.Methods. The sample was composed of 40 subjects (5-12 years of age) who had to undergo minor day surgery and were assigned randomly to the clown group (N ‫؍‬ 20), in which the children were accompanied in the preoperative room by the clowns and a parent, or the control group (N ‫؍‬ 20), in which the children were accompanied by only 1 of his/her parents. The anxiety of the children in the preoperative period was measured through the Modified Yale Preoperative Anxiety Scale instrument (observational behavioral checklist to measure the state anxiety of young children), and the anxiety of the parents was measured with the State-Trait Anxiety Inventory (Y-1/Y-2) instrument (self-report anxiety behavioral instrument that measures trait/baseline and state/situational anxiety in adults). In addition, a questionnaire for health professionals was developed to obtain their opinion about the presence of clowns during the induction of anesthesia, and a self-evaluation form was developed to be filled out by the clowns themselves about their interactions with the child.Results. The clown group was significantly less anxious during the induction of anesthesia compared with the control group. In the control group there was an increased level of anxiety in the induction room in comparison to in the waiting room; in the clown group anxiety was not significantly different in the 2 locations. The questionnaire for health professionals indicated that the clowns were a benefit to the child, but the majority of the staff was opposed to continuing the program because of perceived interference with the procedures of the operating room. The correlation between the scores of the form to self-evaluate the effectiveness of the clowns and of the Modified Yale Preoperative Anxiety Scale is significant for both the waiting room and induction room.Conclusions. This study shows that the presence of clowns during the induction of anesthesia, together with the child's parents, was an effective intervention for managing children's and parents' anxiety during the preoperative period. We would encoura...

Feeling happy and carefree: a qualitative study on the experiences of parents, medical clowns and healthcare professionals with medical clowns

“…Studies have shown positive effects of these activities on the children, and it has been suggested that medical clowns should become an integral part of the health team (Kocherov et al, 2016; Ofir et al, 2016; Tener, Ofir, Lev-Wiesel, Franco, & On, 2016; Wolyniez et al, 2013). However, other studies showed a more negative attitude and suggested that the presence of clowns may interfere with medical routines and that children did not want a clown present during tests or medical procedures (Mansson et al, 2013; Vagnoli et al, 2005; Van Venrooij & Barnhoorn, 2017). In our study, most participants also did not support the idea of medical clowns being present during medical procedures.…”

“…The presence of a clown has been found to reduce the child’s anxiety (Dionigi, Sangiorgi, & Flangini, 2014; Felluga et al, 2016; Goldberg et al, 2014; Kocherov et al, 2016; Meiri, Ankri, Hamad-Saied, Konopnicki, & Pillar, 2016; Messina et al, 2014; Vagnoli, Caprilli, & Messeri, 2010; Vagnoli, Caprilli, Robiglio, & Messeri, 2005; Weintraub et al, 2014) and feelings of boredom, loneliness and sadness (Finlay, Baverstock, & Lenton, 2014; Mansson, Elfving, Petersson, Wahl, & Tunell, 2013; Meiri et al, 2016). Also, a few studies showed that a clown intervention is able to reduce anxiety in parents (Agostini et al, 2014; Fernandes & Arriaga, 2010; Wolyniez et al, 2013).…”

“…Healthcare professionals are also very important in determining whether the clown visit will succeed. For example, in the study of Vagnoli et al (2005), hospital staff opposed the presence of clowns before surgery.…”

L’anxiété préopératoire : manifestations cliniques, évaluation et prévention

“…Chez l'enfant, deux intéressantes études randomisées et contrôlées ont évalué la « clown-thérapie ». La présence de clowns en préopératoire s'est révélée être efficace sur le score d'anxiété dans les deux cas : n = 40, score m-YPAS = 30.75 vs. 50, p < 0.05 [40], n = 55, score m-YPAS = 42 vs 50, p < 0.05 [7].…”

Humor no ensino de química

“…Um estudo feito com crianças, prestes a serem submetidas a uma cirurgia, mostrou que a presença de palhaços provocando o riso (juntamente com os pais) durante a aplicação da anestesia, reduziu os níveis de ansiedade tanto da criança como dos pais durante o pré-operatório (VAGNOLI et al, 2005).…”