When Children with Cancer have to undergo Radiation Treatment, they often get scared or nervous because they do not have an understanding of the process and the machines involved.
To remedy this, young children are usually given a general anaesthetic, even though the long-term side effects are still unknown.
Instead of relying on anaesthesia, Danielle Crump, BSN, RN, worked to develop the Paediatric Training Program within the Radiation Department of Johns Hopkins Hospital.
This initiative saves time and money while avoiding any risks or complications that might come from administering anaesthesia to a paediatric patient.

The Importance of Avoiding Anaesthesia in Children

The study found that there was no standard; children were just being given anaesthesia because they were anxious, because of the unknowns; there were complications that happened under anaesthesia and radiation; and it was taking up a lot of time, which was time the family did not have to spend with their child.
With this program, the risk and complications that come along with anaesthesia can be totally avoided, and that precious time can be given back to the family.
Children get way too stressed staying in radiation too long, and the long-term effects of a child being given anaesthesia over the course of a six week treatment are unknown.

The Training Program Developed in place of Anaesthesia

Instead of anaesthesia staff go through a paediatric training program during which the patient and the family are acclimated to the whole department, can see what’s going on in the department, and become familiar with what is done.
The family go through the “Mannequin Challenge,” this is, staying still. Anybody can do that if you train them. It’s really acclimating the patient and family: This is what we do, these are the tools we use, these are our machines. Just to get them comfortable.

Some Specific Things Done During the Program

There is a simulation room, where the immobilisation devices are created – If, for instance, a child with brain cancer is being treated, staff will make a hand-mould first, to slow things down.
The staff do a little play, show the child everything that’s in the room, the hot-water bath, where they put the beginning mould into the bath and the child can see how that changes.
Then a hand-mould will be made so the child can feel the sensation on their skin. Sometimes, they’re not ready for it, but there is no rush; staff know that if this is going to be successful, they need to be patient.
Once the child is comfortable with the process and ready to try the face-mould, staff go slowly, explaining what they are doing the whole time.
It can be really warm and wet, so cold towels are utilised to help to dry the mask quicker, and cool it down, so the child does not get so anxious.

The Importance of Having Family There 

Johns Hopkins is really focused on the patient- and family-centered care model, where families go into the room with the patient while they are being readied for the radiation session.
There is a planning session where an immobilisation device for their treatment will be created. Sometimes siblings model first, which helps as the Child with Cancer can see that their brother or sister is doing it and is not in pain or scared.
Having the encouragement of the family right there throughout the whole process is also very helpful.

How Long is a Child Typically in the Program?

Each Child with Cancer is different. The simulation sessions are one hour, but if more time is required then more will be scheduled.
The whole aim is to not get the child upset or stressed, so sometimes the family is sent home with one of the masks so that the patient can get used to it in familiar surroundings.
Parents are generally very up to doing some home-training as they know that it can only benefit their child and avoid complications. They also understand that if their child undergoes anaesthesia, it means spending 2-3 hours in the radiation department Monday through Friday over six weeks.

Outcomes of the Study

When the program started in 2011 — JH was basically just experimenting with some idea — that year 60% of the children, aged 3 – 12, were able to do radiation without anaesthesia; but for 40% were still being given anaesthesia.
In 2012, 90% of the patients were treated without anaesthesia. This meant that only 10% each year were still being given anaesthesia, up until 2016. In 2016 no anaesthesia was given to children!!
The plan is to keep the program going with Johns Hopkins’ Child Life Specialist.

The Main Takeaway of the Program

This is a time-saving initiative, it’s cost-effective, and it also helps the family and lets them feel a sense of autonomy and accomplishment. They’re doing this. This is huge.

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