ONS PEP Evidence Summary For Anxiety

For Use as an Intervention For Anxiety

  • Effectiveness Not Established

    Author and Year

    Thrane, S. (2013). Effectiveness of integrative modalities for pain and anxiety in children and adolescents with cancer: A systematic review. Journal of Pediatric Oncology Nursing, 30, 320–332.  

     doi: 10.1177/1043454213511538

    Purpose:

    STUDY PURPOSE: To systematically review the effect of integrative modalities (e.g., hypnosis, acupuncture, massage, virtual reality, folk healing, prayer) on pain and anxiety in children with cancer
     
    TYPE OF STUDY:  Systematic review

    Literature Evaluated:

    TOTAL REFERENCES RETRIEVED: 164 articles were retrieved, 25 underwent full-text review using a systematic approach, and 12 met the criteria.
     

    Sample Characteristics :

    • FINAL NUMBER STUDIES INCLUDED =  12
    • TOTAL PATIENTS INCLUDED IN REVIEW = 358
    • KEY SAMPLE CHARACTERISTICS:  Mean age of 8.4 years, age ranged from 1–19 years; 55% male participants; 120 participants from Greece; 62% Caucasian; majority had hematologic cancer; many studies were conducted during painful procedures such as lumbar puncture and venipuncture.

    Phase of Care and Clinical Applications:

    PHASE OF CARE: Mutliple phases of care
    APPLICATIONS: Pediatrics 

    Results:

    Five studies used hypnosis; one study used mind–body therapy; one used distraction and breathing techniques; one used behavioral intervention; one used virtual reality; one used creative-arts therapy; one used massage; and one used music therapy. Sample size for each study was very small, ranging from 8–59. All studies in this review had at least one statistically significant finding except for one study that examined distraction and breathing techniques. Cohen's d calculations show medium (d = 0.70) to extremely large (8.57) effect sizes for overall integrative intervention. Hypnosis was consistently significantly effective for reduction of pain and anxiety with invasive procedures. Distraction and breathing techniques did not demonstrate effectiveness. Virtual reality in one study did not reduce anxiety. Creative arts therapy in one study of 16 children reduced pain during chemotherapy. Massage showed inconsistent results. Music reduced pain and anxiety before and after lumbar puncture. 

    Conclusions:

    Integrative interventions may be very effective for pain and anxiety in children undergoing cancer treatment. Integrative modalities, however, warrant further study with larger sample sizes to better determine their effectiveness in this population.

    Limitations:

    • No description existed of the time window during which data were extracted.
    • Various interventions were combined and analyzed as a unit.
    • Only included randomized controlled trials and thus reduced literature sample size
    • The sample size for each intervention was small.
    • The effect of each intervention is not clear.

    Nursing Implications:

    This study provided some evidence that complementary modalities can help children undergoing cancer treatment or painful procedures. The usefulness of a particular method should be further examined.