Effectiveness of family-centred educational interventions for anxiety, pain and behaviours of children and adolescents and anxiety of their parents during the perioperative journey: A systematic review and meta-analysis

Abstract

Aim: To evaluate the effectiveness of family-centred educational interventions on the anxiety, pain and behaviours of children and adolescents (three to 19 years old) and their parents’ anxiety during the perioperative journey.

Design: Systematic review of effectiveness and meta-analysis. Data sources were systematically searched from January 2007 to April 2021 for available articles in English, Spanish and Portuguese.

Review methods: This review followed the methodology for systematic reviews of effectiveness from Joanna Briggs Institute (JBI). Included studies were critically appraised using JBI critical appraisal checklists for Randomised Controlled Trials and JBI Critical Appraisal Checklist for Quasi-Experimental Studies. Data was synthesised through meta-analysis, using a random-effects model, and narrative synthesis. Two independent reviewers performed the selection process, critical analysis, and data extraction.

Results: Twenty-eight studies (26 randomised controlled trials (RCTs) and two quasi-randomised controlled trials) were included with a total of 2516 families. In a meta-analysis of ten RCTs with 761 participants, pre‑operative anxiety management was more effective in children and adolescents who received educational interventions (SMD = -1.02; SE = 0.36; 95% CI [-1.73; -0.32]). At the induction of anaesthesia, children and adolescents were significantly less anxious (SMD = -1.54; SE = 0.62; 95% CI [-2.72; -0.36]) and demonstrated better compliance than controls (SMD = -1.40; SE = 0.67; 95% CI [-2.72; -0.09]). Post‑operative pain (SMD = -0.43; SE = 0.33; 95% CI [-1.05; 0.19]) and pre‑operative parental anxiety (SMD = -0.94; SE = 1.00; 95% CI [-2.87; 0.99]) were reduced in favour of the educational interventions.

Conclusion: Family-centred educational interventions probably lead to a considerable reduction of paediatric and parental anxiety and improve paediatric behaviours at induction of anaesthesia. The evidence is very uncertain regarding the effectiveness of these interventions on post‑operative paediatric maladaptive behaviours and pain intensity or parental anxiety levels at the induction of anaesthesia.