Effect of Medical Clown Intervention on Anxiety and Perceived Pain Levels in Pediatric Patients Undergoing Venous Blood Draw

The scientific aim of this project is to determine the effect a medical clowning intervention may have on perceived pain levels and anxiety levels with patients, their families, and the medical staff during routine blood draw procedures in the Pediatric Oncology Hematology Clinic of LAC + USC.

We are investigating the following claims: First, the physical, play-based, non-verbal based forms of communication that a clown implements is effective in creating playful distraction during the procedure. The presence of the clown in this capacity can meaningfully reduce perceived pain levels in patients during venipuncture and reduce the duration of crying. Second, the clown intervention decreases anxiety levels in the trial participants and families leading up to and during blood draw which supports the patient as well as increases efficiency for hospital staff. Third, the presence of the clown will significantly reduce physical restraint (i.e. medical stabilization board, known as a papoose board) usage during venipuncture. Lastly, we aim to prove that coulrophobia does not play a factor in medical clowning interventions.

The USC School of Dramatic Arts Medical Clowning Program is the first academic and research program of its kind in the country, offering a groundbreaking opportunity to develop a new model for patient healing and wellness. While research studies have proven its effectiveness internationally, USC hopes to become a leading player by applying, proving, and advocating for the transformational impact of clowning in healthcare. Medical Clowns, Zachary Steel and Caitlyn Conlin, have both been clowning at LAC + USC County Hospital for the past two years. The practice, as perceived by the clown practitioners, staff and family members, has been extremely effective in lowering anxiety, reframing the hospitalization experience, and as a distraction tool. We are hoping to elevate the practice as a vital paramedical profession by proving the efficacy of the practice in this specific setting.

Internationally, the practice of medical clowning has becoming increasingly prevalent in hospital and community settings. The efficacy of the practice continues to be proven, all without undue risk to human subjects, when applied to a large spectrum of populations and settings. At Carmel Medical Center in Haifa, Israel, a study on the effect of medical clowning on reducing pain, crying, and anxiety in children aged 2 to 10 years old undergoing venous blood drawing proved the clowns were effective, safe, and had less negative effect on future blood draw examinations compared with control or use of topical anesthetic. Furthermore, integration of medical clowns in physical examination was shown to improve the overall experience of the child and the caregivers and help the pediatrician to perform a complete physical examination, with shorter duration of discomfort (0.2 +/- 0.6 minutes vs 1.6 +/- 2.0 minutes, p = 0.001); in the medical clown group, 94% of pediatricians reported that the medical clown improved their ability to perform a complete physical examination. Clowning has also successfully been used as a psychological distress buffer during anogenital examinations of sexually abused children.

While the international community has successfully studied the efficacy of the practice, the practice of medical clowning varies from country to country as the patient's response to different forms of humor and play varies. Culturally, clowns play a different role in the United States than they do elsewhere due to coulrophobia (fear of clowns) that has surfaced in the U.S. due to blockbuster movies. In 2017, an Israeli group published a study that showed that only 1.2% of hospitalized children were afraid of clowns. In contrast, according to a poll conducted by Morning Consult 42% of Americans said they were, in some capacity, afraid of clowns.