Discussion
ADHD, anxiety, pain
SECONDARY
The objective of this study was to examine whether patient-centric TC positively affects children’s comfort during venipuncture. Comfort is defined as a ''transient and dynamic state characterized by ease from pain, emotional and physical distress and an emerging sense of positivity, safety, strength and acceptance of one’s situation that is underpinned and sustained by feeling valued, cared for, confident and accepting treatment. Patients seek to be as comfortable as they can be, under the circumstances of their healthcare interaction'' [No difference in self-reported pain was found between the SC and the TC group. For the secondary outcomes, however, scores significantly improved for anxiety, time in the room and satisfaction of the medical personnel. For the third research question, namely whether parental anxiety influences the child’s pain via the child’s anxiety, no mediation effect was found. For the fourth research question, we found that TC had the same effect on anxiety as in non-neurodivergent children.The absence of significant self-reported pain results may be attributed to the overall low pain scores (95% CI [1.1, 2.4]), and these low pain scores did not indicate clinically relevant pain according to the optimal cut points for the FPS-R [All anxiety scores for the child (scored by child 8 years or older), parent and medical personnel) were lower in the TC group than in the SC group. The parents also scored lower self-reported NRS anxiety scores when TC was used. NRS anxiety for the parent scored by the medical personnel did not differ significantly between groups. Moreover, this study investigated the influence of parental anxiety on the relationship between the child’s anxiety and pain experience. No mediation effects were found (parental procedural anxiety on child pain via child anxiety) in both groups. This is in contrast with the study results of Bearden et al. (2012) where a mediation effect was found of preprocedural anxiety and procedural pain of the child, which in turn heightened the child’s pain [ Finally, because a large proportion of patient undergoing venipuncture is neurodivergent (28.6% in our sample), and because of the limited research conducted on this topic, we performed a subgroup analysis to find out if TC was also effective in the neurodivergent children (e.g., with ASD or ADHD) in our study. The results showed similar effects in anxiety reduction for neurodivergent children as non-neurodivergent children. However, this result must be interpreted with caution, as this analysis was exploratory and the sample of the subgroup analysis was relatively small (n = 30).One of the strengths of this study was that when examining comfort during venipuncture, this study captured the multi-faceted context of this procedure. Different outcomes were measured (e.g., pain, anxiety, and satisfaction) from different perspectives (children, parents and medical personnel) thereby adopting an overall integrative approach. Moreover, this study aimed to contribute to the scarce literature of venipuncture comfort for neurodivergent children. However, adopting this integrative approach induces bias. Given the large amount of outcome measures, the likelihood of incorrectly rejecting a null hypothesis (i.e., making a Type I error) increases [To conclude, our study found that with just a small change in communication style, the comfort of the child during venipuncture improves. This was mainly reflected by reduced anxiety scores and shorter procedural times, making the use of TC during venipuncture promising for the outpatient setting.
