Introduction

Needle procedures in relation to cancer disease and treatment are often experienced as frightening and painful for children. To assess fear a proxy report by nurses or parents are often clinically used.

Objective

To investigate fear levels experienced by children in connection with needle procedures and use findings to optimise the recurring needle process.

Aim

The aim was to determine if child self-report and proxy report of needle fear levels are in agreement.

Methods

Data was collected during 90 needle insertions in children 7 to 18 years of age, included consecutively when undergoing routine needle insertion into a subcutaneously implanted intravenous port following topical anaesthesia. Fear in connection with the needle procedure was independently assessed on a 100 mm Visual Analogue Scale (VAS) with anchors at the extreme ends (no fear - worst possible fear) by the child, nurse and parent and investigated with one-way ANOVA within subjects and post hoc with Bonferroni correction.

Results

The reported fear level differed between children’s self-reports (VAS mean 14 mm), nurse ratings (VAS mean 21 mm), and parents ratings (VAS mean 21 mm) during a needle insertion in a subcutaneously implanted port (F(2, 178)= 6.211, p=0.002). Post hoc tests revealed differences between (i) children’s self-reports and nurses reports (p=0.017) and (ii) children’s self-reports vs. parents reports (p=0.006) but showed no differences between nurses reports and parents reports (p=1).

Conclusion

Nurses and parents significantly overestimated the child’s fear level of the needle procedure. Therefore children, as far as possible, should be (i) more actively involved as partners throughout the needle procedures and (ii) encouraged to self-report their fear level in connection with needle procedures for improved analysis and treatment.