Reducing Children's Preoperative Fear with an Educational Pop-up Book: A Randomized Controlled Trial.

Abstract

Preoperative education empowers children to approach surgery with positive expectations, and providers need efficient, child-focused resources. This study aimed to evaluate an interactive pop-up book as a tool for explaining surgery, managing preoperative anxiety, and strengthening coping strategies. Prospective randomized controlled trial. Pediatric outpatient surgery center. Patients ages 5 to 12 undergoing outpatient surgery read a pop-up book about anesthesia (intervention) or received standard care (control). Patients self-reported their preoperative fear, pain expectations, views of the procedure and preoperative explanations, and coping strategies. Outcomes also included observer-rated behavioral anxiety and caregiver satisfaction. In total, 148 patients completed the study. The pop-up book had a significant, large effect in reducing patients' fear of anesthesia induction (Cohen's <i>d</i> effect size = 0.94; <i>P</i> < .001). Intervention patients also expected less pain than control patients from the anesthesia mask and during surgery (<i>d</i> = 0.60-0.80; <i>P</i> < .001). The book encouraged more positive views of the procedure and preoperative explanations (<i>P</i> < .005). Furthermore, the book prepared patients to cope adaptively: intervention patients were significantly more likely to generate positive active coping strategies, distraction strategies, and support-seeking strategies (<i>P</i> < .001). Observer-rated behavioral anxiety at anesthesia induction did not differ between groups (<i>P</i> = .75). Caregivers in the intervention group were significantly more satisfied with each aspect of the surgical experience (<i>P</i>≤ .02). The educational pop-up book offers a child-focused resource that helps alleviate children's preoperative fears, encourages positive coping, and improves caregivers' perceptions of the experience. This study was registered at ClinicalTrials.gov (NCT04796077).