Subcutaneous injections are commonly used in pediatric oncology care and may cause pain, fear, and anxiety in children. Repeated exposure to needle-related procedures may increase procedural distress and affect children's cooperation and coping during treatment. Therefore, simple, safe, and feasible non-pharmacological interventions are needed to improve children's comfort during routine procedures. This randomized parallel trial was designed to compare three clinically feasible non-pharmacological approaches with different mechanisms during subcutaneous injections in children with cancer. Buzzy® provides cold and vibration as a sensory-based method, the cognitive behavioral intervention package supports preparation and coping, and the kaleidoscope provides visual distraction. By comparing these approaches within the same procedural context, the study aimed to provide practical evidence for pediatric oncology nurses when selecting interventions to reduce procedural distress. All procedures were conducted in the routine clinical procedure area of a pediatric oncology clinic. The same subcutaneous injection procedure was used for all participants, and standardized assessment time points were applied before and immediately after the procedure.
This study was conducted as a randomized, parallel-group clinical trial in children with cancer undergoing routine subcutaneous injection. Participants were assigned to one of three intervention groups: Buzzy®, a cognitive-behavioral intervention package, or kaleidoscope distraction. All interventions were delivered in the same clinical setting and within the same procedural context. Before the injection, baseline levels of procedural fear and state anxiety were assessed. The assigned intervention was then applied according to the group allocation during the subcutaneous injection procedure. Pain, fear, and state anxiety were evaluated immediately after the procedure using standardized pediatric assessment tools. The trial was designed to compare three non-pharmacological strategies that are practical for use in pediatric oncology nursing care. The purpose was to determine whether sensory stimulation, cognitive-behavioral preparation and coping support, or visual distraction differed in their effects on procedural pain, fear, and anxiety during subcutaneous injection.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
45
The Cognitive Behavioral Intervention Package was delivered by the researcher before, during, and after the subcutaneous injection. Before the procedure, the child received brief age-appropriate preparation, selected a preferred distraction or coping strategy, and the parent was guided on how to support the child. During the injection, the researcher provided standardized verbal coaching, encouragement, and coping support, while the parent provided physical and verbal comfort. The child used the selected coping strategy throughout the injection. After completion of the outcome assessments, brief positive reinforcement was provided. The intervention was implemented using a structured checklist to support standardization.
The Buzzy® device was used as a cold and vibration intervention during subcutaneous injection. The device was placed at the injection site 60 seconds before needle insertion, and cold and vibration were initiated. Immediately before needle insertion, the device was repositioned approximately 3 cm proximal to the injection site. It remained in place throughout the injection and was removed immediately after the procedure was completed. No additional distraction or cognitive behavioral coaching was provided beyond standard procedural explanations.
The kaleidoscope was used as a visual distraction intervention during subcutaneous injection. The child was shown the kaleidoscope shortly before the procedure and was allowed a brief familiarization period. The kaleidoscope was introduced approximately 1 minute before needle insertion, and the child continued to look through it throughout the injection. The intervention ended when the injection was completed. No additional cognitive behavioral coaching or cold/vibration intervention was provided beyond standard procedural explanations.
Kocaeli University
Kocaeli, İzmit, Turkey (Türkiye)
Post-Procedural Pain Intensity Assessed Using the Wong-Baker FACES Pain Rating Scale
Post-procedural pain intensity will be assessed immediately after subcutaneous injection using the Wong-Baker FACES Pain Rating Scale. This scale ranges from 0 to 5, with 0 indicating no pain and 5 indicating the worst pain. Higher scores indicate greater pain intensity.
Time frame: Immediately after subcutaneous injection
Procedural Fear Assessed Using the Children's Fear Scale
Procedural fear will be assessed before and immediately after subcutaneous injection using the Children's Fear Scale. This scale ranges from 0 to 4, with 0 indicating no fear and 4 indicating extreme fear. Higher scores indicate greater procedural fear.
Time frame: Before and immediately after subcutaneous injection
State Anxiety Assessed Using the Children's Anxiety Scale-State
State anxiety related to subcutaneous injection will be assessed before and immediately after the procedure using the Children's Anxiety Scale-State. This scale ranges from 0 to 10, with 0 indicating no anxiety and 10 indicating the highest level of anxiety. Higher scores indicate greater state anxiety.
Time frame: Before and immediately after subcutaneous injection
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