Effects of preparation for children undergoing medical procedures: An umbrella review of systematic reviews

Objective: To synthesize evidence on the effects of preparation for children undergoing medical procedures and assess the methodological quality and certainty of evidence in existing systematic reviews.
Introduction: Medical procedures can be stressful for children and may cause anxiety, fear, and pain. Preparation is widely used in pediatric nursing to reduce psychological distress and support children’s coping during medical procedures. Various approaches have been examined, including information provision, therapeutic play, video-based interventions, and virtual reality (VR). Although several systematic reviews have reported beneficial effects, substantial variation remains in target populations, intervention methods, outcome measures, and medical procedures. In addition, the methodological quality and certainty of evidence across systematic reviews have not been comprehensively evaluated.
Inclusion criteria: This umbrella review included systematic reviews evaluating preparation for children aged 18 years or younger undergoing medical procedures. Preparation was defined as interventions intended to help children understand and anticipate medical procedures, reduce psychological distress, and support active coping. Outcomes of interest included anxiety, psychological distress, and pain. Systematic reviews involving various medical procedures were eligible.
Methods: A literature search was conducted using MEDLINE (Ovid) and Ichushi-Web. Search terms were developed using the PICO framework and combined controlled vocabulary with free-text terms related to children, systematic reviews, preparation, anxiety, psychological distress, and pain. Studies were screened according to predefined inclusion and exclusion criteria. Data were extracted on study characteristics, participants, medical procedures, intervention content, outcomes, assessment methods, effect estimates, and main findings. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Certainty of evidence was assessed using the GRADE approach.
Results: Database searches identified 23 records, and seven systematic reviews met the inclusion criteria. The included reviews examined various preparation and related psychosocial interventions, including VR, technology-based interventions, therapeutic play, and educational or information-based interventions. Overall, these interventions were associated with reduced anxiety, fear, psychological distress, and pain in children, and with improved procedural outcomes. Two reviews conducted meta-analyses and found significant effects of preparation interventions. VR-based preoperative preparation significantly reduced preoperative anxiety and improved anesthesia compliance in children, whereas preparation interventions for day surgery significantly reduced anxiety among parents. Heterogeneity was observed across studies in both meta-analyses. Certainty of evidence was rated Low for one review and Very low for six reviews.
Conclusions: Preparation and related psychosocial interventions may reduce anxiety, psychological distress, and pain, and may improve procedural outcomes in children undergoing medical procedures. However, the certainty of the available evidence was limited by risk of bias, inconsistency, indirectness, imprecision, and possible publication bias. Given the heterogeneity across studies, future systematic reviews should specifically examine the sources and contributing factors of this heterogeneity.