Reducing Children’s Preoperative Fear with an Educational Pop‐up Book: A Randomized Controlled Trial
Holly Cordray, Chhaya Patel, Kara K. Prickett
Abstract
Objective Preoperative education empowers children to approach surgery with positive expectations, and providers need efficient, child‐focused resources. This study aimed to evaluate an interactive pop‐up book as a tool for explaining surgery, managing preoperative anxiety, and strengthening coping strategies. Study Design Prospective randomized controlled trial. Setting Pediatric outpatient surgery center. Methods Patients ages 5 to 12 undergoing outpatient surgery read a pop‐up book about anesthesia (intervention) or received standard care (control). Patients self‐reported their preoperative fear, pain expectations, views of the procedure and preoperative explanations, and coping strategies. Outcomes also included observer‐rated behavioral anxiety and caregiver satisfaction. Results In total, 148 patients completed the study. The pop‐up book had a significant, large effect in reducing patients’ fear of anesthesia induction (Cohen’s d effect size = 0.94; P <. 001). Intervention patients also expected less pain than control patients from the anesthesia mask and during surgery ( d = 0.60‐0.80; P <. 001). The book encouraged more positive views of the procedure and preoperative explanations ( P <. 005). Furthermore, the book prepared patients to cope adaptively: intervention patients were significantly more likely to generate positive active coping strategies, distraction strategies, and support‐seeking strategies ( P <. 001). Observer‐rated behavioral anxiety at anesthesia induction did not differ between groups ( P =. 75). Caregivers in the intervention group were significantly more satisfied with each aspect of the surgical experience ( P ≤. 02). Conclusion The educational pop‐up book offers a child‐focused resource that helps alleviate children’s preoperative fears, encourages positive coping, and improves caregivers’ perceptions of the experience. This study was registered at ClinicalTrials.gov (NCT04796077).