Student: Valeska Tan
University: National University of Singapore
Coutnry: Singapore

Paediatric patients often feel perioperative anxiety during first experiences with elective surgery. With limited stopgaps such as verbal reassurance and general dismissal of psychosocial wellbeing in hospitals, lack of preparation and unfamiliar environments leave patients helpless and distressed. Patients aged 4-9 and parents are vulnerable to resultant trauma, exacerbating pain and hampering medical compliance.

To understand their overall journeys and pain-points, I conducted interviews with past patients, parents and medical experts. Through collaborating with child life services from two paediatric hospitals, both comprising small teams of two to five therapists who provide behavioural care to distressed patients pre-operation, I also did field observations in paediatric wards.

Currently, sessions are customised for patients with varying conditions, lengthening preparation time. Additionally, tools used are neither reusable nor sustainable. Upon benchmarking and considering monetary and manpower constraints, I formulated design criteria where this service should design for (1) holistic, positive experiences; (2) a sense of autonomy for patients; (3) information empowerment for parents and (4) accessibility of systems in hospitals.

Mapping the patient journey showed where anxiety peaks occur pre-operation, intra-operation and post- operation. After experimenting with probes at each phase, I focused on designing a holistic service that prepares patients and parents pre-operation for what comes after. Intervening after would be too late or requires too much overhaul in the system.

This service comprises two components — ‘Module Builder’: a backend module library for therapists to customise sessions with ease, and 'Operation Paws’: a phygital medical play kit, where patients role-play as ‘Doctor’ to help characters. They are introduced to words and tools used in the hospital, reducing anxiety when encountering something similar upon admission. Therapists select from various modules (co- written with therapists to ensure medical accuracy) in ‘Module Builder’ to formulate each chapter.

User testing began with preliminary usability studies with Group A: four warded patients. I observed how patients used the kit and reflected with therapists to prototype iteratively. The final prototype was tested with Group B: three parent-child pairs (clinical) and two parent-child pairs (home), and trialled in hospitals with Group C: two parent-child pairs going for first-time elective surgery the next day. Clinical testing was
conducted under therapist supervision with relevant guardian consent.

Using quantitative metrics, behavioural improvement was observed for Group B and 100% showed knowledge learning after intervention. For Group C, an adapted version of the Psychosocial Risk Assessment in Paediatrics was used to determine behavioural improvements of patients pre- and post- intervention. Anxiety risks decreased during the actual surgery for both patients, proving the efficacy of the service. With versatility, the service is scalable with usage beyond hospitals to outpatient or dental clinics.