X. Han1, H. VanDerSchaaf1, C. Turnage1, R. Wilson1, J. Calvert1, S. Hecht1, M. Ellenby1, J. Gold2, S. Krishnaswami1 1Oregon Health And Science University, Pediatric Surgery, Portland, OR, USA 2University Of California – Los Angeles, Pediatric Pain Medicine Clinic, Los Angeles, CA, USA
Introduction:
Significant anxiety is experienced by many children undergoing necessary operative interventions. In addition to mental health impacts, this can lead to procedure delays/cancellations, and confusion or non-adherence with subsequent treatment. We aimed to understand the usability and impact of a novel, mobile device-based app (Xploro™) on perioperative anxiety. Xploro enabled children to create their own avatar and explore and learn about the hospital environment through interactive modules and games custom-designed to simulate the perioperative area of our Children’s Hospital.
Methods:
Children 8-14yo undergoing elective (pediatric general surgery, upper endoscopy) and acute-care (appendectomy) procedures were recruited in a randomized controlled pilot study comparing routine pre-operative preparation to routine care plus access to Xploro. Children with audiovisual deficits, developmental delay, or non-English speaking were excluded. Subjects randomized to the Xploro group were given the Xploro app at the time of enrollment.
Participant demographics were collected, and trait anxiety was measured using the child state-trait anxiety index for children (STAI-CH). Perioperative anxiety was measured using the visual analog scale (VAS, 0-10) from the perspective of the patient, guardian, and nurse on entry to the perioperative space and again immediately before separation of patients from guardians. Our pre-specified, primary measure of anxiety was patient-rated VAS before separation from their guardian. App usage and anxiolytic utilization was also measured. This study was approved by our institutional review board (study #23870).
Results:
Sixity subjects were recruited into our pilot study. There was no difference in age (10 vs. 11, control vs. Xploro), gender (56% vs. 54% male), and trait anxiety (STAI-CH, 36 vs. 37) between the control and Xploro groups. There was meaningful engagement with the Xploro App for patients with access based on module access and interactions. Patients with Xploro had a statistically significantly lower level of perioperative anxiety when compared with the control group (3.6/10 vs. 4.2/10, p<0.05). There was no difference in anxiolytic utilization. Staff reported being able to deploy Xploro without difficulty for patients in elective and acute care surgery contexts.
Conclusion:
Our study demonstrates that creation of an interactive mobile app customized to individual patients and perioperative settings and aimed at anxiety reduction is feasible and can be incorporated into the preoperative experience of select patients. Patients with Xploro had less perioperative anxiety. Further study is necessary to understand the implications of this reduction in perioperative anxiety.
