Children with cancer who were asked to choose the type of medical support received during invasive procedures were found to be empowered and to experience reduced levels of distress, according to a study published in Pediatric Blood & Cancer.

A total of 85 children (average age, 7.6 years) with cancer who were scheduled to undergo invasive procedures (n=247 consecutive procedures; average of 2.9 per patient) were followed. Prior to treatment, patients were asked to choose between receiving general anesthesia, conscious sedation, or nothing. Caregiver adequacy was evaluated, and level of discomfort before, during, and after the procedure was assessed.

Children in the cohort were preverbal (ie, 0-3 years; 24.7%), of elementary school age (ie, 4-7 years; 23.5%), preadolescents (ie, 8-11 years; 24.7%), and adolescents (ie, 12 years; 27.1%). The majority of procedures were bone marrow aspiration (n=101) and lumbar puncture (n=101).

Children opted for general anesthesia for 66 procedures (mostly adolescents and preadolescents), conscious sedation for 97 procedures (mostly preadolescents and elementary school-aged children), and nothing for 5 procedures (all adolescents). For I the remaining 79 procedures, participants did not formulate a choice (mostly preverbal and elementary school-aged children).

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Elementary school-aged participants vs preadolescents indicated higher average levels of distress during the procedure (6.24 vs 3.88, respectively; P <.001). Distress levels were found to decrease in subsequent procedures.

Although no correlation was established between caregiver behavior and patient distress level, caregivers of those in the younger age groups were found to display a more adequate attitude during the procedure (preverbal children vs preadolescents, P <.03; preverbal children vs adolescents, P <.001).

Study limitations include the use of a nonvalidated scale for the evaluation of distress and the assessment of caregiver behavior.

“It is possible to tailor medical and psychological support to each individual patient during painful procedures,” noted the researchers. “Patients could not avoid the procedure, but they could regain control by choosing the type of medical support and lower the distress.”

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Reference

Maslak K, Favara-Scacco C, Barchitta M, et al. General anesthesia, conscious sedation, or nothing: decision-making by children during painful procedures [published online January 3, 2019]. Pediatr Blood Cancer. doi: 10.1002/pbc.27600