Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): formative evaluation and randomized controlled trial.

BACKGROUND: The purpose of this 2-phase project was to conduct a formative evaluation and to test the preliminary efficacy of a newly developed Web-based Tailored Intervention for Preparation of parents and children undergoing Surgery (WebTIPS). METHODS: Phase 1 enrolled 13 children 2 to 7 years of age undergoing outpatient elective surgery and their parents for formative evaluation of WebTIPS. Parent participation focus groups are common in qualitative research and are a method of asking research participants about their perceptions and attitudes regarding a product or concept. In phase 2, children 2 to 7 years of age in 2 medical centers were assigned randomly to receive the WebTIPS program (n = 38) compared with children receiving the standard of care (n = 44). The primary outcome of phase II was child and parent preoperative anxiety. RESULTS: In phase 2, parents reported WebTIPS to be both helpful (P < 0.001) and easy to use (P < 0.001). In phase 2, children in the WebTIPS group (36.2 ± 14.1) were less anxious than children in the standard of care group (46.0 ± 19.0) at entrance to the operating room (P = 0.02; Cohen d = 0.59) and introduction of the anesthesia mask (43.5 ± 21.7 vs 57.0 ± 21.2, respectively, P = 0.01; Cohen d = 0.63). Parents in the WebTIPS group (32.1 ± 7.4) also experienced less anxiety compared with parents in the control group (36.8 ± 7.1) in the preoperative holding area (P = 0.004; Cohen d = 0.65). CONCLUSIONS: WebTIPS was well received by parents and children and led to reductions in preoperative anxiety.

Ethnicity and parental report of postoperative behavioral changes in children.

OBJECTIVES: To examine the role of ethnicity and language in parent report of children's postoperative behavioral recovery. AIM: To compare incidence of new onset negative behavior change in English- and Spanish-speaking White and Hispanic children following outpatient surgery. BACKGROUND: Postoperative behavioral change in children is common; however, it is unknown whether cultural variables including ethnicity and language may influence parent report of children's behavioral recovery. METHODS/MATERIALS: Participants included 288 parents (English-speaking White, English-speaking Hispanic, Spanish-speaking Hispanic parents) of children undergoing outpatient elective surgery. Parents completed the post-hospitalization behavior questionnaire (PHBQ) and parents' postoperative pain measure (PPPM) on postoperative days one, three, and seven at home. RESULTS: Most parents (83%) reported onset of new negative behavioral change in children postoperatively. Generalized estimating equations revealed significant group differences in overall behavior change [Wald χ(2)(12) = 375.69, P < 0.0001] after controlling for demographic and socioeconomic differences. At all three postoperative days, Spanish-speaking Hispanic (SSH) parents reported lower negative behavioral changes in their children compared to English-speaking White (ESW) parents (day 1: P < 0.01; day 3: P < 0.001; day 7: P < 0.10). On postoperative days one and three, SSH parents also reported lower total PHBQ scores than English-speaking Hispanic (ESH) parents [day 1: χ(2)(1) = 6.72, P = 0.01; day 3: χ(2)(1) = 7.98, P = 0.005]. CONCLUSION: The present study provides evidence that parent report of children's postoperative behavioral recovery may be influenced by cultural variables, such as ethnicity and language. The present results contribute to a growing body of evidence that highlights the need for culturally sensitive assessment and care of families in the medical setting. The findings may reflect differences in cultural values such as stoicism; however, future studies would benefit from examination of the factors that may account for the differences in reported behavior change after surgery (i.e., report bias, cultural values).