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Journal of Pediatric Psychology, Vol. 27, No. 7, 2002, pp. 553-563
© 2002 Society of Pediatric Psychology

The Influence of Appraisals in Understanding Children's Experiences With Medical Procedures

Robyn Lewis Claar, PhD1, Lynn S. Walker, PhD2,3 and Craig A. Smith, PhD2

1 Duke University Medical Center, 2 Peabody College of Vanderbilt University, 3 Vanderbilt University School of Medicine

Address all correspondence to Robyn Lewis Claar, Duke University Medical Center, Department of Psychiatry and Behavioral Science, DUMC-3119, Durham, North Carolina 27710.

Objective: To examine the influence of cognitive appraisals on anticipatory anxiety, procedural distress, and postprocedural evaluations in 100 children (ages 8-17) undergoing esophagogastroduodenoscopy (EGD).

Method: Children's knowledge about the procedure, appraisals of the procedure's aversiveness, coping ability, and state anxiety prior to the procedure were assessed by self-report. Distress during the EGD was assessed by observer ratings. Postprocedural evaluations were assessed by self-report 1 hour after the procedure.

Results: Structural equation modeling indicated that children who knew more about the EGD appraised it as less threatening, and, in turn, children who appraised the procedure as less threatening experienced less anxiety. Decreased anxiety was associated with decreased distress, which, in turn, was associated with decreased pain, evaluations of less aversiveness, and less negative attitudes toward future procedures.

Conclusions: This study has implications for how children are prepared for EGDs and supports the utility of an appraisal-based model in understanding children's experiences with medical procedures.

Key words: appraisals; pediatric medical procedures; preparation; anxiety; pain; endoscopy.


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