Reduction of Perioperative Anxiety in Spanish-Speaking Children

Rationale: Pre-operative anxiety is a common phenomenon among children as well as their parents with some studies suggesting it occurs in up to 50% of children who are undergoing surgery in the United States (U.S.). Therefore, the prevalence of this phenomenon within the surgical field represents a solvable problem, the elimination of which would be of added benefit to the surgical experience for patients. Beyond the simple unpleasantness of experiencing anxiety, higher levels of pre-operative anxiety have also been shown to associate with worse post-surgical outcomes including increased pain, agitated emergence from anesthesia (emergence delirium) and maladaptive behavioral change. Indeed, this means that addressing pre-operative anxiety could lead to better overall health outcomes post-operatively.

Demographically, the Hispanic / Latino population is one of the fastest growing in the U.S., with a predicted increase by 240% by the year 2060, meaning that one in three US residents will be Hispanic at that time. Our ever-diversifying US population highlights a need for more personalized and culturally considerate medical care, as research has shown that ethnicity, culture, and language may play a role in decision making as well as the patient experience.

Given the association between pre-operative anxiety and worse post-operative outcomes and the fact that Hispanic children with Spanish-speaking parents experience higher levels of pre-operative anxiety as opposed to their white counterparts, the investigators have thus identified a gap in healthcare that leaves Hispanic populations vulnerable to preventable health disparities. Therefore, the purpose of this project is to create an intervention designed specifically for Hispanic, Spanish-speaking children that will lower rates of pre-operative anxiety and thus improve their post-operative outcomes.

Background: To address the problem of pre-operative anxiety in children, it was paramount to develop a valid metric for accurately assessing anxiety level. To assist with measuring anxiety in children before surgery, the modified Yale Preoperative Anxiety Scale (mYPAS) was developed in 1995 and then modified in 1997. This scale uses 5 items, each of which represent a different domain of child anxiety and is used at 4 distinct timepoints throughout the surgical experience. However, though this metric was reliable and accurate, the inclusion of 5 different domains of assessment over 4 timepoints proved to be somewhat redundant and cumbersome to use in a hectic surgical setting. Therefore, in 2014, Jenkins et al. developed a short form version of the mYPAS, aptly renamed mYPAS-SF through elimination of areas of redundancy and only administered at 2 time points instead of 4. Use of this metric has helped identify characteristics which may correspond to higher levels of anxiety such as younger age, a shyer temperament, an established history of surgery, and miscellaneous parental factors.

Once a reliable metric for assessing pre-operative anxiety in children was established, various experimental interventions were developed and introduced to children pre-operatively like listening to calming music or encouragement of participation in recreation beforehand, both of which had a significant impact on the reduction of pre-operative anxiety. However, an inherent problem with these studies is that most of them are conducted on primarily white, English-speaking children or their parents which limits their generalizability. Indeed, research has confirmed that cultural consideration is necessary; Hispanic children with Spanish-speaking parents experience higher levels of pre-operative anxiety as compared to white children with English-speaking parents. This is not exclusively limited to children, but to their parents as well. Fortier et al., specifically concluded that "Spanish-speaking Hispanic parents exhibited higher levels of anxiety and this correlates to higher levels of preoperative anxiety in their children". These differences represent a gap in healthcare that could be filled through tailored delivery of interventions pre-operatively which reduce Hispanic children's anxiety and will correspond to better outcomes post-operatively.