82 Chapter 4 4 Limitations of current interventions While studies show that the above-mentioned coping strategies help to alleviate the pain, stress and anxiety, this relief is often only effective at the moment and thus temporary. Moreover, no single intervention is equally effective on its own. Hence optimal procedural comfort asks for a combination of strategies. However, these multi-strategy interventions also require skilled and trained staff and a favourable family-centred environment. Unfortunately, this is far from reality within daily procedural care with departments facing fast patient turnover, high workload, limited time to explain procedures and limited budget for the training of all the staff (11). Another limitation is the fact that current efforts mainly focus on reducing stress and anxiety experienced within the consultation or treatment room or relatively shortly beforehand (e.g. explain what is going to happen). However, stress and anxiety often build up already at home in anticipation of the visit and the pain induced by the procedure, and can peak during the procedure, causing the child to be distressed and upset. Hence, minimizing this so called pre-hospital and pre-procedural stress and anxiety is important to alleviate feelings of stress and anxiety during the visit. Psychological and educational preparation is an important way to achieve this and happens in an out-patient setting through information leaflets or online information. However, most information and research on the impact of proper preparation is focused on children undergoing surgery (9, 10). Moreover, the available information resources often lack child-centred information, are not easily accessible, are dispersed and vary in quality (11). In addition, there seems to be a mismatch between the current provision of procedural information and children’s and caregivers’ expectations that information will be provided directly to them by healthcare professionals (12). This mismatch is strengthened by the fact that caregivers may, in their gatekeeping role, limit access to preparation materials and thereby unwillingly disempower their child (11, 13). Hence, interventions aimed at reducing pre-procedural stress and anxiety should be child-centred, combining multiple effective strategies and directed at diminishing stress and anxiety already at home. Leveraging potentials of eHealth Digital health technologies such as (health) apps offer the potential to provide a lowcost solution outside of the hospital setting. In addition, multiple procedural comfort strategies can be combined and offered in a way that does not require additional training or disruptions of daily workflows of hospital staff. As such, apps can create engaging, interactive child-appropriate content, including elements of play that can be delivered and accessed in a time-appropriate manner and within the comfort of the child’s own home. Innovations that leverage the potentials of digital health technologies such as “Xploro” (i.e., a platform that provides child-centred healthcare using gameplay and artificial intelligence) demonstrated that procedural knowledge is improved and levels of self-reported anxiety are reduced (14). Also, virtual reality has been shown to be promising in reducing distress during painful procedures (15,
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