Brady, E.

Cahill, P.

Heary, C.

Kola-Palmer, Susanna

Martin, N.

Moylett, E.

Walsh, Jane C.

English

University of Huddersfield Repository

University of Huddersfield RepositoryWalsh, Jane C., Martin, N., Heary, C., Moylett, E., Cahill, P., Brady, E. and Kola-Palmer, SusannaThe Effectiveness of Parents as Distraction Coaches During Venipuncture: a Randomised Controlled TrialOriginal CitationWalsh, Jane C., Martin, N., Heary, C., Moylett, E., Cahill, P., Brady, E. and Kola-Palmer, Susanna (2014) The Effectiveness of Parents as Distraction Coaches During Venipuncture: a Randomised Controlled Trial. In: 28th Conference of the European Health Psychology Society, 26th – 30th August 2014, Innsbruck, Austria. (Unpublished) This version is available at http://eprints.hud.ac.uk/21507/The University Repository is a digital collection of the research output of theUniversity, available on Open Access. Copyright and Moral Rights for the itemson this site are retained by the individual author and/or other copyright owners.Users may access full items free of charge; copies of full text items generallycan be reproduced, displayed or performed and given to third parties in anyformat or medium for personal research or study, educational or not-for-profitpurposes without prior permission or charge, provided:• The authors, title and full bibliographic details is credited in any copy;• A hyperlink and/or URL is included for the original metadata page; and• The content is not changed in any way.For more information, including our policy and submission procedure, pleasecontact the Repository Team at: E.mailbox@hud.ac.uk.http://eprints.hud.ac.uk/1Jane C.  Walsh1,  Noelle Mart in1,  Caroline Heary1,  Susanna Kola-Palmer2,   Paula Cahill3,  Fiona Brady3 & Edina Moylet t 41 School of Psychology,  Nat ional University of Ireland,  Galway 2 Department  of Behavioural and Social Sciences, University ofHuddersfield 3 Port iuncla Hospital,  Galway   4 University College Hospital,  GalwayThe Effectiveness of Parents as Distraction Coaches during Venipuncture: A Randomised Controlled Trial (Pilot study)2 Venipunctures - one of most common (outpatient) and feared procedures children undergo Addressing fears will reduce childhood negative healthcare experiences preventing future healthcare outcomes Background• Parental behaviour distress-promoting (e.g.  apologies) and coping-promoting behaviours (e.g.  distraction) can influence child distress and anxiety (Taylor et al. ,  2011).  3 Mahoney et al.  (2010) highlight the need for cost-effective interventions targeting parents’ behaviour that can be easily integrated into clinical practice.  One solution?. . . Teach cognitive behavioural strategies (e.g.  distraction) to parents and encourage use in paediatric settingsBACKGROUND4 Increased distraction by parents not always reflected in reduced distress and pain (Kleiber et al. ,  2001) Cochrane review found no evidence for parental coaching plus distraction (Uman et al.  2013).   However,  only 3 trials met inclusion criteria of this review,  so questions remain.Evidence for distraction?• Some evidence distraction reduces children’s pain and distress during needle-related procedures (Birnie et al. ,  2013) To strengthen and extend research assessing the effectiveness of a parent-targeted intervention for children undergoing venipuncture by:1. Distributing intervention materials to parents in advance of the procedure2. Assessing parents’ engagement in distraction.  3. Children aged 3-6 years,  extending previous research by focusing on early childhood.4. Investigating further the use of interactive video games as distractors (Dahlquist et al. ,  2002) (by using an electronic tablet)5STUDY AIMS6It  was expected that in the distraction training group would: 1) Parents would use more distraction techniques than controls2) Children would exhibit more coping behavioursthan the controls3) Children would report less pain than controls.  Study Hypotheses7DESIGN Randomised controlled trial (Pilot): 2  groups; experimental/control, controlling for baseline scores. Dependent variables:  • Child pain• Child coping• Child distressMETHOD8Participants and sample size 44 parents & children aged 36 - 72 months (M=58.07 months, SD=12.99),  Outpatients for venipuncture.  Exclusion criteria: cancer treatment & language barriers.Sample size/power calculations: A sample size of 22 per group yields power of .9 (Kleiber et al., 2001) for medium effect sizes for pain & behavioural distress.METHOD• Staff identified eligible participants • Randomly assigned to conditions• Staff (blinded) sent colour-coded materials to parents at least 3 days in advance of their child’s appointment. 9PROCEDURE10Reasons for venipuncture:Immunology (13.6%) Haematology (15.9%), Respiratory (2.3%), GI (11.4%), Endocrinology (15.9%) Genetic (9.1%), Neurology (6.8%) Renal (2.3%)Rheumatology (2.3%). ReferralsINTERVENTION:• Booklet contained information on distraction, including tips on: positioning, language, staying calm. • Children shown the electronic tablet upon arrival, chose a game, and both given an opportunity to practise with it (3-5 minutes to avoid loss of interest)• Child told tablet would be available to them while they were with the doctor.11INTERVENTIONIntervention Booklet – sample 1213Intervention Booklet –sampleCONTROL GROUP: • Children received standard care and parents received no tips or strategies on distracting their child• No electronic tablet14• 100-mm VAS rating scale (not at all-extremely well) • BEFORE• parental pre-procedural worry, • child pre-procedural worry • parental prediction of child upset• parental confidence in ability to help • AFTER• parental post-procedural upset, • parent rating of child upset • pain during the procedure • parent rating of ability to help 15Measures• Child and Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) (Blount et al., 2001) observational scale: Subscales include: Child coping, Child Distress, Parent Distress-Promoting• Distraction Coaching Index (DCI) (Kleiber et al., 2007) behavioural observation (assessed at 3 time points) (e.g. using distraction, effort, encouragement)• Faces Pain Scale-Revised (FPS-R) (Hicks et al., 2001) (0-10). (NOTE: A video camera recorded the procedure)16Flow of participants through the study17There were no differences at baseline between groups on any of the variablesmeasured.18Randomisation check19Means (SDs) of post-procedural measures in experimental and control groups.Variable Exp Control Effect Size/sigParental rate-Child Pain 31.18 (15.67) 44.95 (25.37) P=.03 Child pain rating 3.27 (3.57) 3.36 (5.46) N.S.Child coping 11.91 (3.04) 8.23 (3.68) LARGEChild distress 6.32 (3.20) 7.68 (3.72) N.S.Parent coping promoting 11.83 (2.82) 8.50 (2.99) LARGEParent distress promoting 4.22(1.93) 5.18 (2.97) N.S.Distraction Coaching  37.99 (12.58) 20.31 (11.22) LARGE, Bonferroni corrections , p value < .006 = Sig20Summary	of	inter‐correlations	between	predictor	variables	and	outcome	variable	(child	distress)		Variable 1 2 3 41. Child pain rating (FPS-R)2. Parent prediction of child upset.133. Parental use of distraction coaching-.17 -.134. Parent distress promoting behaviours.17 .19 -.49***5. Child distress behaviours .43** .36* -.49*** .55***Note. Statistical significance *p < .05; **p < .01; *** p < .00121Hierarchical regression model of child distress behaviour 22 Parents who received the distraction training intervention engaged in significantly more distractionand more coping-promoting behaviours.  Children in the distraction group exhibited significantly more coping behaviours (e.g. non-procedural talk and playing with tablet) No sig differences in child-reported pain However, parent-assessed pain approaching (corrected) significance (p = .03).  Greater use of distraction resulted in lower child distress.Discussion23 Active distraction during procedure reduces child distress during venipuncture Promoting this behaviour should yield positive outcomes.  Simple distraction-coaching training (booklet and tablet) was effective in increasing this behaviour.Conclusion24Jane C.  Walsh1,  Noelle Mart in1,  Caroline Heary1,  Susanna Kola-Palmer2,   Paula Cahill3,  Fiona Brady3 & Edina Moylet t 4THANK YOU!

The Effectiveness of Parents as Distraction Coaches During Venipuncture: a Randomised

Controlled Trial

The Effectiveness of Parents as Distraction Coaches During Venipuncture: a Randomised Controlled Trial

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