William H. Redd

Assessment of acute pediatric pain: do child self-report, parent ratings, and nurse ratings measure the same phenomenon?

&NA; The purpose of this study was to determine the factors that are associated with child, parent, and nurse ratings of acute pediatric pain and distress during venipuncture. The behavior of eighty‐five pediatric cancer patients during venipuncture was recorded by trained raters, and their observations were compared with ratings of pain and distress obtained from parents, pediatric patients, and pediatric nurses. Regression analyses indicated that ratings made by the child, parent, and nurse reflect different perspectives. Nurses ratings were based upon overt distress, parents ratings reflected their subjective perception of the childs pain, and the childs self‐report was associated with the childs chronologic age.

Behavioral intervention to reduce child and parent distress during venipuncture.

This study investigated a behavioral intervention incorporating parent coaching, attentional distraction, and positive reinforcement to control child distress during invasive cancer treatment. Children (N = 23) requiring physical restraint to complete venipuncture were alternately assigned to either a behavioral intervention or an attention control condition. Child distress behaviors were recorded, and self-reports of parent, child, and nurse distress were obtained. Parent and nurse also rated child distress. Results of planned comparisons indicate that observed child distress, parent-rated child distress, and parent ratings of his/her own distress were significantly reduced by behavioral intervention and were maintained across the course of three intervention trials. The use of physical restraint to manage child behavior was also significantly reduced. Child self-reported pain and nurse ratings of child distress were not significantly affected.

Imagery in human classical conditioning

Many clinical strategies use patients imagery to explore and treat phobic and posttrauma reactions, however little attention has been paid to the underlying assumption that imagery of relevant stimuli may help maintain conditioned behavior. In this article, the authors examine the premise that mental images can potentiate and substitute for physical stimuli in human classical conditioning. The authors review empirical evidence to detail the role of images of conditioned stimuli (CS) and unconditioned stimuli (US) during pre-exposure to stimuli, the actual pairing of the CS and US, and extinction when the CS is presented alone. The evidence suggests that mental imagery can facilitate or diminish the outcome of classical conditioning in humans and, more tentatively, that mental images can substitute for actual US and CS in autonomic conditioning. They argue that researchers should explore the role of mental imagery in conditioning through the use of advances in the measurement of imagery. Finally, they analyze anxiety and trauma reactions as examples of how applied areas can be used to explore and benefit from developments in this area.

Anticipatory anxiety in women receiving chemotherapy for breast cancer.

This study examined (a) the prevalence and course of anxiety before the 1st 6 infusions of cancer chemotherapy and (b) the contribution of trait anxiety, side effect expectations, and prior occurrence of posttreatment side effects to anxiety before infusions. Fifty-three women receiving adjuvant chemotherapy for breast cancer participated. Anxiety was most prevalent and intense before the 1st infusion. Trait anxiety predicted anxiety before both the 1st and subsequent infusions. Prior occurrence of posttreatment nervousness also predicted anxiety before subsequent infusions, even after accounting for trait anxiety and other posttreatment side effects. Results are discussed in terms of the role that anxiety proneness, response expectancy, and classical conditioning may play in the development of anxiety before repeated chemotherapy infusions.

Development of anticipatory nausea: A prospective analysis.

The development of anticipatory nausea in cancer chemotherapy typically has been viewed in terms of a respondent learning model. Firm support for this etiological model has been precluded by use of retrospective research designs, however. The present study employed a prospective design to identify patientand treatment-related variables characteristic of patients who subsequently develop anticipatory nausea. Seventy-one chemotherapy outpatients were interviewed before and after each chemotherapy infusion during their first 6 months of treatment. Hierarchical multiple regression analysis revealed that patients who developed anticipatory nausea were characterized by more severe posttreatment nausea, more time-consuming treatment infusions, and greater state anxiety relative to patients without anticipatory nausea. In general, results supported a respondent learning conceptualization of the development of anticipatory nausea. Clinical implications of these findings for the prevention of anticipatory nausea are suggested.

Adult-child interaction during invasive medical procedures.

Adult-child interactions during stressful medical procedures were investigated in 43 pediatric patients videotaped during a venipuncture procedure in the course of cancer treatment. Relations among six adult behavior categories (explain, distract, command to engage in coping behavior, give control to the child, praise, and criticize/threat/bargain) and three child behavior categories (momentary distress, cry/scream, and cope) were examined using correlational and sequential analysis. Results indicated that adult distraction resulted in increased child coping and reduced momentary distress and crying. Adult explanations, although a likely response to child distress and crying, did not result in a reduction of these behaviors. Attempts to give the child control reduced child crying. Implications for clinical interventions during painful medical procedures are discussed.

An analysis of a behavioral intervention for children undergoing venipuncture.

An examination of factors was conducted to determine the effectiveness of the distraction component of a behavioral intervention (use of a party blower). In one condition, parents were instructed to coach children in the use of a party blower and to praise child cooperation. In a second condition, nurses were instructed to assist parents in coaching the child. Parents used the coaching skills they learned and got their children to use the distraction technique. Use of the distraction technique was associated with less crying. Encouragement from a health care professional and intervention early in the procedure did not enhance the interventions effectiveness. Older children and children who were less distressed during the initial phase of the procedure were less likely to reject the intervention.

Coping with chemotherapy for breast cancer

Relations among coping, physical symptoms, and affect were investigated in 43 women undergoing adjuvant chemotherapy for breast cancer. Patients were assessed at the same point in their treatment so that the time for which coping was reported would be equivalent across individuals. Patients were asked how they coped specifically with chemotherapy, rather than how they coped with cancer in general, to make the domain specific. Positive and negative affect were assessed separately, using a scale free of somatic content. Relations between coping and affect were consistent with prior studies that have employed a general approach to assessing coping. Coping correlates of positive and negative mood differed. When the relations between physical symptoms and affect were examined, physical symptoms were related to negative affect but not to positive affect. Findings are discussed in terms of their implications for coping with cancer as well as their implications for the general coping literature.

Prevalence, predictors, and course of anticipatory nausea in women receiving adjuvant chemotherapy for breast cancer

Factors related to the prevalence, prediction, and course of anticipatory nausea (AN) in women (n = 77) receiving adjuvant chemotherapy for breast cancer were examined. Using a prospective longitudinal research design, patients were interviewed both before and after each chemotherapy infusion. Fifty‐seven percent of the patients developed AN. These patients were characterized by more severe gastrointestinal side effects following the initial infusion and greater expectations for experiencing chemotherapy‐related nausea. A more rapid development of AN was related to a history of experiencing nausea across a greater variety of situations, higher IV drug doses, and less infusion‐related anxiety at the initial infusion. Although AN occurred intermittently across treatment sessions, severity was constant. Results provided strong support for the hypothesis that classical conditioning processes are instrumental in AN acquisition. The role of anxiety in the development of AN is considered as are clinical implications for the prevention of AN and recommendations for future research.

Nonpharmacologic factors in the development of posttreatment nausea with adjuvant chemotherapy for breast cancer

A prospective, longitudinal design was used to determine the role of nonpharmacologic factors in the development of posttreatment nausea (PTN). Forty‐five women with no previous chemotherapy experience who were receiving a single regimen of adjuvant chemotherapy for breast cancer were interviewed before and after their first six infusions. Seventy‐one percent of patients developed PTN. The PTN was related to the following: patients physical status at the onset of treatment; heightened anxiety during infusions; susceptibility to nausea and vomiting after eating certain foods; and expectations of developing chemotherapy‐related nausea. Anxiety during infusions, susceptibility to nausea and vomiting, and expectations of side effects also accounted for differences in the frequency, intensity, and severity of PTN. These findings offer strong support for the view that nonpharmacologic factors contribute to individual differences in gastrointestinal responses to chemotherapy.