Research: KAZAK and colleagues,

Listed in Issue 40


KAZAK and colleagues, Department of Pediatrics, University of Pennsylvania School of Medicine and Division of Oncology, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania 191044399 USA compared a combined pharmacologic and psychological intervention (CI) with a pharmacologic-only (PO) approach for reducing child distress for invasive procedures for childhood leukaemia.



The predictors of child distress included age, group (CI, PO) and procedural variables including medications and dosages, technical difficulty, the number of needles required. The authors conducted a randomised, controlled prospective study which compared the PO (n = 45) and CI arms (n 47) at 1, 6 and >12 months following diagnosis of childhood leukaemia. The cross-sectional control group consisted of parents of 70 patients in first remission prior to the prospective study. Questionnaires of parents, staff and parent ratings, data regarding medications administered, the technical difficulty of the procedure and needle insertions were obtained for each procedure. This paper reports on the final data for the project at >12 months.


Compared to the PO group, mothers and nurses in the CI reported lower levels of child distress. CI and PO groups showed lower levels of child and parent distress than did the cross-sectional control groups. Distress decreased throughout the period and the age of the child was inversely associated with distress, i.e. younger children experienced more distress, regardless of group. Child distress was associated with staff perceptions of the technical difficulty of the procedure and with the age of the child, but not with the medications administered.


These data demonstrate that pharmacologic and psychological interventions for reducing procedural distress were effective in reducing child and parent distress and support the integration of the two approaches. Younger children experienced more distress and warranted additional consideration. Perceptions of the staff regarding the technical difficulty of procedures were complex and potentially helpful in the design of the intervention protocols.


Kazak AE et al. Pharmacologic and psychologic interventions for procedural pain. Pediatrics 102 (1 Pt 1): 59-66. Jul 1998.

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