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Parental Anxiety and VCUG Education

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Lisa L. Lachenmyer, CPNP, Lisa A. Trusler, RN, MSN, Jennifer J. Anderson, CPNP, Douglass B. Clayton, MD, John C. Thomas, MD, John C. Pope IV, MD, Mark C. Adams, MD, John W. Brock III, MD and Stacy T. Tanaka, MD, Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN

Purpose: Many parents of children undergoing voiding cystourethrogram (VCUG) report anxiety. Existing studies have shown that children respond to their parents’ anxiety. Our current practices focus on education immediately prior to and during the VCUG. We hypothesized that parent education in the form of a written brochure 1-2 weeks in advance of the procedure would decrease anticipatory parental anxiety. 

Methods: All parents whose children were scheduled for VCUG at least 6 days in advance were eligible for the study. Families were randomized to an experimental or control group. The experimental group was mailed an educational brochure about the VCUG. The control group received our current standard of care (no brochure). Parents were enrolled and consented prospectively. On the day of the VCUG, blinded investigators administered the State-Trait Anxiety Inventory (STAI) to the parent in the Diagnostic Imaging waiting room immediately prior to the procedure. The STAI measures both anxiety about an event and trait anxiety. Scores range from 20-80; higher scores indicate greater anxiety. Parents were also asked what educational sources they used and what could improve their experience. Groups were compared by Mann-Whitney-Wilcoxon test for continuous variables and chi square test for categorical variables. We used univariate linear regression to evaluate factors associated with greater parental anxiety. A p value <0.05 was considered statistically significant.  

Results: A total of 105 families were enrolled (47 experimental, 58 control). Mean patient age was 2.2+/-3.2 years. 77 of 105 (73%) were female. Mean parent age was 30+/-7.0 years. Respondents were mothers in 91 of 105 (87%) families. English was the primary language in 99 of 105 (94%). Child Life Services was present for the VCUG in 29 of 105 (28%). Ordering practitioner was Pediatric Urology in 69 of 105 (66%). None of these factors differed significantly between the control and experimental groups. Average event anxiety score was 37.3+/-10.5 and average trait anxiety was 31.6+/-7.8. Neither event (p=0.010) nor trait (p=0.09) anxiety differed between control and experimental groups. Increased event anxiety was associated with younger parent age (p=0.004). No identifiable factors were associated with increased trait anxiety. In the control group, the three top sources of information for the parents were the doctor’s office, friends/family and the internet. In the experimental group, the three top sources of information were the doctor’s office, friends/family and the brochure. In response to an open-ended question, 9 control group respondents indicated that further advance education would improve their experience; 4 respondents of the experimental group indicated the brochure improved their experience.

Conclusion: In our study, an educational brochure mailed to families prior to VCUG did not decrease parental anxiety. However, the educational brochure can potentially improve patient satisfaction and ensure accurate dissemination of information.