Gwyneth A. Sullivan , Yao Tian , Willemijn L.A. Schäfer , Kayla M. Giger , Maxwell Joseph Willberding , Audra J. Reiter , Bonnie Essner , Andrew J. Hu , Martha C. Ingram , Salva Balbale , Julie K. Johnson , Jane L. Holl , Mehul V. Raval
{"title":"对接受手术的儿童进行生物行为干预及相关的患者报告结果","authors":"Gwyneth A. Sullivan , Yao Tian , Willemijn L.A. Schäfer , Kayla M. Giger , Maxwell Joseph Willberding , Audra J. Reiter , Bonnie Essner , Andrew J. Hu , Martha C. Ingram , Salva Balbale , Julie K. Johnson , Jane L. Holl , Mehul V. Raval","doi":"10.1016/j.yjpso.2024.100159","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>: Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes.</p></div><div><h3>Methods</h3><p><em>:</em> We conducted an embedded mixed-methods study with a quantitative focus. Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial for children, ages 10–18 years, undergoing elective gastrointestinal surgery. Patients/caregivers were surveyed about preoperative exposure to and postoperative use of biobehavioral interventions. Four semi-structured group interviews with 20 pediatric surgery providers were conducted. Outcomes included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness.</p></div><div><h3>Results</h3><p><em>:</em> 41 % (<em>n</em> = 67) of 164 enrolled patients/caregivers reported preoperative exposure to and 71 % (<em>n</em> = 117) reported postoperative use of a biobehavioral intervention(s). Barriers to incorporation of biobehavioral interventions included lack of standardized workflows, clinician knowledge, and resources. Potential facilitators included media and peer-counseling. After adjusting for individual and hospital characteristics, those who reported using a biobehavioral intervention(s) were 70 % less likely to report worsened postoperative nervousness (95 % CI 0.10–0.91; <em>p</em> = 0.03). Reported use of a biobehavioral intervention(s) was not found to be associated with pain-related functional disability or HRQoL.</p></div><div><h3>Conclusions</h3><p><em>:</em> Use of a biobehavioral intervention(s) may stabilize postoperative nervousness of children undergoing surgery. There is a need for redesign of clinical workflows and clinician training to facilitate integration of biobehavioral interventions.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100159"},"PeriodicalIF":0.0000,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000443/pdfft?md5=a3f602fe152265a0786fd9d56fcd2472&pid=1-s2.0-S2949711624000443-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Use of biobehavioral interventions in children undergoing surgery and associated patient-reported outcomes\",\"authors\":\"Gwyneth A. Sullivan , Yao Tian , Willemijn L.A. Schäfer , Kayla M. Giger , Maxwell Joseph Willberding , Audra J. Reiter , Bonnie Essner , Andrew J. Hu , Martha C. Ingram , Salva Balbale , Julie K. Johnson , Jane L. Holl , Mehul V. Raval\",\"doi\":\"10.1016/j.yjpso.2024.100159\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>: Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes.</p></div><div><h3>Methods</h3><p><em>:</em> We conducted an embedded mixed-methods study with a quantitative focus. Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial for children, ages 10–18 years, undergoing elective gastrointestinal surgery. Patients/caregivers were surveyed about preoperative exposure to and postoperative use of biobehavioral interventions. Four semi-structured group interviews with 20 pediatric surgery providers were conducted. Outcomes included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness.</p></div><div><h3>Results</h3><p><em>:</em> 41 % (<em>n</em> = 67) of 164 enrolled patients/caregivers reported preoperative exposure to and 71 % (<em>n</em> = 117) reported postoperative use of a biobehavioral intervention(s). Barriers to incorporation of biobehavioral interventions included lack of standardized workflows, clinician knowledge, and resources. Potential facilitators included media and peer-counseling. After adjusting for individual and hospital characteristics, those who reported using a biobehavioral intervention(s) were 70 % less likely to report worsened postoperative nervousness (95 % CI 0.10–0.91; <em>p</em> = 0.03). Reported use of a biobehavioral intervention(s) was not found to be associated with pain-related functional disability or HRQoL.</p></div><div><h3>Conclusions</h3><p><em>:</em> Use of a biobehavioral intervention(s) may stabilize postoperative nervousness of children undergoing surgery. There is a need for redesign of clinical workflows and clinician training to facilitate integration of biobehavioral interventions.</p></div>\",\"PeriodicalId\":100821,\"journal\":{\"name\":\"Journal of Pediatric Surgery Open\",\"volume\":\"8 \",\"pages\":\"Article 100159\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-07-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2949711624000443/pdfft?md5=a3f602fe152265a0786fd9d56fcd2472&pid=1-s2.0-S2949711624000443-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Surgery Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2949711624000443\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Surgery Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2949711624000443","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Use of biobehavioral interventions in children undergoing surgery and associated patient-reported outcomes
Background
: Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes.
Methods
: We conducted an embedded mixed-methods study with a quantitative focus. Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial for children, ages 10–18 years, undergoing elective gastrointestinal surgery. Patients/caregivers were surveyed about preoperative exposure to and postoperative use of biobehavioral interventions. Four semi-structured group interviews with 20 pediatric surgery providers were conducted. Outcomes included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness.
Results
: 41 % (n = 67) of 164 enrolled patients/caregivers reported preoperative exposure to and 71 % (n = 117) reported postoperative use of a biobehavioral intervention(s). Barriers to incorporation of biobehavioral interventions included lack of standardized workflows, clinician knowledge, and resources. Potential facilitators included media and peer-counseling. After adjusting for individual and hospital characteristics, those who reported using a biobehavioral intervention(s) were 70 % less likely to report worsened postoperative nervousness (95 % CI 0.10–0.91; p = 0.03). Reported use of a biobehavioral intervention(s) was not found to be associated with pain-related functional disability or HRQoL.
Conclusions
: Use of a biobehavioral intervention(s) may stabilize postoperative nervousness of children undergoing surgery. There is a need for redesign of clinical workflows and clinician training to facilitate integration of biobehavioral interventions.