Matching Doses of Distraction With Child Risk for Distress During a Medical Procedure

Abstract

Background Parents often want to provide support to their children during medical procedures, but not all parents are effective in providing distraction after brief training. Objective The aim of this study was to investigate the effects of three doses of distraction intervention for children at high and medium risk for procedure-related distress. Methods Children undergoing scheduled intravenous insertions for diagnostic or treatment purposes and their parents participated. A computerized application, Children, Parents and Distraction, was used to predict distress risk. Doses of intervention were basic (parents trained on providing distraction), enhanced (basic training plus tailored instructions, environmental modifications, and support and guidance from the research assistant), and professional (a trained research assistant provided distraction). Outcome measures were Observational Scale of Behavioral Distress-Revised for behavioral distress, Oucher for self-reported pain, parent report of child distress, and salivary cortisol for physiological distress. Results A total of 574 children, ages 4–10, and their parents participated. The Children, Parents and Distraction predicted that the risk for distress was high for 156 children, medium for 372, and low for 46. Children predicted to have higher risk for distress displayed more behavioral distress (p < .01). Children in the medium-risk group who had the professional intervention displayed significantly less behavioral distress (p < .001). Children in the high-risk group tended to have less behavioral distress when receiving the professional intervention (p = .07). There were no significant group differences for self-report of pain, parent report of distress, or cortisol levels. Discussion Some parents may need additional training in providing distraction to their children during procedures, and some children at medium and high risk for distress may need professional support. Parents should be asked about their preferences in acting as the distraction coach and, if willing, be provided as much training and support as possible in the clinical situation.

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“…The provision of adult support through non-procedural talk and humor as a means of distraction, has been shown to be effective in improving children's coping during painful procedures, whilst reassuring comments, criticism, apologies, and entrusting children with too much control may increase distress (42). Parental coaching requires training of the parents, and children with high levels of fear may also need professional support (43). Research has shown that parents are often given information and supervision immediately before a procedure takes place, when they are distressed (44).…”

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“…It also aimed to investigate the effects of distraction interventions for children at risk for procedure-related distress. The outcomes of this study validated the application for identifying parent-child dyads who were at varying levels of risk for distress during a medical procedure (McCarthy et al, 2014).…”

“…Finally, this dissertation utilizes the data corpus from past research and, in consideration of this, I will provide an overview of those research findings and their implications (McCarthy et al, 2010a;McCarthy et al, 2010b;McCarthy et al, 2014). This will help define the context for the current study and the unique contributions it will provide.…”

“…The data corpus for my research was previously analyzed by two research teams that found a child's level of distress is impacted by the quality of distraction coaching they receive (McCarthy et al, 2010a;McCarthy et al, 2010b;McCarthy et al, 2014).…”

“…The behaviors of the distraction coach and child were recorded from the time the child was positioned on the exam table until two minutes after the IV was secured. Once the video data were collected it was segmented into 10 second intervals and coded later by independent raters to produce scores on the OSBD-R and DCI scales (McCarthy et al, 2010a;McCarthy et al, 2010b;McCarthy et al, 2014). The similarities in these two studies' methodology for data collection and analysis provides an overlap that justifies their amalgamation into a unified data corpus that is appropriate for additional investigations.…”