Bone marrow aspirations (BMA's) are highly painful and aversive procedures for pediatric cancer patients. Previous research by the investigators has indicated the efficacy of a Cognitive Behavior Therapy Package (CBTP) in reducing childrens distress during BMA's. However, the CBTP is not effective for all children nor does it eliminate distress for those children who do fine it helpful.
The aim of the current proposal is to evaluate general anesthesia (nitrous oxide and halothane) as compared to the CBTP in terms of patient, parent, and staff distress; cost/benefit ratio and """"""""consumer preference"""""""". Attitudes of health care providers towards pain in children and towards psychological intervention vs. general anesthesia for BMA's will be evaluated as well. Subjects will be approximately 50 pediatric cancer patients undergoing at least three consecutive BMA's. A pre-test or baseline observation of children's distress during BMA's will be conducted and then children will be randomly assigned to one of two sequence groups. All children will receive both interventions. Assessment measures for the children will include: a) behavioral distress prior to BMA, b) self-reported fear prior to and after BMA, c) pulse rate upon arrival in treatment room, d) parent questionnaire of childrens' behavioral after-effects 24 hours following procedure, e) child mental status after BMA, f) physical side effects (nausea, vomiting, etc.), and g) preference for CBTP vs. general anesthesia at end of study. Parent and staff anxiety will be measured using self-report anxiety measures behavioral observation, and pulse rates. Provider attitudes will be measured by a telephone survey. Data analysis will be conducted using a 2 (sequence group)x2 (intervention condition) repeated measures multivariate analyses of covariance with pretest scores serving as covariates. Analyses will also be conducted to predict which children benefit most from general anesthesia.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA034871-08
Application #
3172696
Study Section
Behavioral Medicine Study Section (BEM)
Project Start
1982-09-30
Project End
1991-11-30
Budget Start
1989-12-01
Budget End
1990-11-30
Support Year
8
Fiscal Year
1990
Total Cost
Indirect Cost
Name
Children's Hospital of Los Angeles
Department
Type
DUNS #
094878337
City
Los Angeles
State
CA
Country
United States
Zip Code
90027
Jay, S M; Elliott, C H; Woody, P D et al. (1991) An investigation of cognitive-behavior therapy combined with oral valium for children undergoing painful medical procedures. Health Psychol 10:317-22
Jay, S M; Elliott, C H (1990) A stress inoculation program for parents whose children are undergoing painful medical procedures. J Consult Clin Psychol 58:799-804
Zeltzer, L K; Jay, S M; Fisher, D M (1989) The management of pain associated with pediatric procedures. Pediatr Clin North Am 36:941-64
Jay, S M; Elliott, C; Varni, J W (1986) Acute and chronic pain in adults and children with cancer. J Consult Clin Psychol 54:601-7