Effects of education of paediatric patients undergoing elective surgical procedures on their anxiety - a systematic review

Aims and objectives: To identify and critically appraise studies addressing the implementation of education for children aged 2-12 years undergoing elective surgical procedures and to determine whether education is associated with improvements in children's anxiety and other emotions.

Background: Children undergoing surgery often experience anxiety, which may lead to negative health outcomes, such as increased pain, feeding difficulties and sleeping problems. Education of children about their condition according to their individual needs may be correlated with reduced anxiety.

Design: Systematic review.

Methods: A database search in MEDLINE, PsycInfo, Cochrane Library and CINAHL was carried out during February 2011. Using the PICOS acronym, the query was organised into a searchable foreground question: the studies should evaluate (Objective) the effects of education (Intervention) compared with the standard preparation (Control) for children aged 2-12 years old undergoing elective surgeries (Population). The results would be based on randomised controlled studies (Study design). In total, 475 articles were yielded, from which 45 full-text articles were assessed for eligibility, and finally, 16 studies were included in the review.

Results: In 12 of the 16 studies, children in the education groups reported lower anxiety scores. In two studies, no statistically significant effect of education was reported on anxiety. Moreover, education had an age-related effect in two studies, by being more effective to children older than four to six years and having a negative effect on younger children's anxiety. Parents of children in the education groups experienced lower anxiety.

Conclusions: Education seems to be especially effective in the reduction in older children's anxiety and to have a negative effect on younger children's anxiety.

Relevance to clinical practice: Education can be incorporated into the care provided to children aged four to six years or older undergoing elective surgical procedures, according to their individualised needs.