Therapeutic clowns for the reduction of anxiety in paediatric patients undergoing surgery

Abstract

Overview of the Topic: Preoperative anxiety in children is a significant and underreported issue. Poor perioperative outcomes may be caused by anxiety that persists during the preoperative period. There are both pharmacological and non-pharmacological modalities to help reduce pre-operative anxiety in children. A non-pharmacological method is the use of therapeutic clowns. This dissertation reviews the research regarding the effectiveness of therapeutic clowns in reducing preoperative anxiety in paediatric patients. The Research Question: Do therapeutic clowns reduce anxiety for paediatric patients undergoing surgery? PICO Elements: Population (P): Paediatric patients undergoing surgery; Intervention (I): Therapeutic clowns; Comparison (C): Usual Care; Outcome (O): Reduced Anxiety. Method: To find relevant studies, a thorough, systematic search of four databases was carried out. Studies that satisfied the subsequent criterion could be included: Populations of patients aged 0 to 16 undergoing surgery; All types of therapeutic clowns as listed in the synonyms table; Exclusion of other age groups that are beyond 16 year olds undergoing surgery; Any other therapy or intervention that does not include therapeutic clowns; Any intervention that excludes usual care; and reduction of any other parameter other than anxiety. Included research were peer-reviewed and from the past 20 years of English-language publication. Using the CASP and JBI tools, a critical appraisal of four key studies, three Randomised Controlled Trials and one Quasi-experimental study was carried out. Results: The results appear to support the use of therapeutic clowns as a means of lowering preoperative anxiety in paediatric patients. However, a firm conclusion could not be formed because of limitations in the reviewed literature and discrepancies in the findings. Implications and Recommendations: The efficacy of therapeutic clowns needs to be established by additional local and international research. To help clinicians choose therapeutic clowning as a strategy to lower preoperative anxiety in appropriate individuals, guidelines should be developed. To recommend therapeutic clowning to their patients as a preoperative anxiety therapy, healthcare professionals must be conscious of its possible benefits through education.