Chan, C.W., Cheng, K.K., Lam, L.W., Li, C.K., Chik, K.W., & Cheung, J.S. (2008). Psycho-educational intervention for chemotherapy-associated nausea and vomiting in paediatric oncology patients: A pilot study. Hong Kong Medical Journal, 14(5 Suppl.), 32–35. 

To assess the feasibility of using relaxation and patient education

Patients were placed in group 1 or 2 (no randomization information provided). Group 1 received training in progressive muscle relaxation (PMR) and guided imagery (GI) using audiotapes daily. Training was provided daily on days 0-5, then patients practiced the techniques daily for two months. Group 2 received two 30-minute patient/parent education sessions on days 0 and 2, focusing on risk assessment, antiemetic use, and meal planning. All subjects completed instruments at baseline (prior to chemotherapy) then daily for seven more days. One and two months after the intervention, anxiety, compliance with PMR and GI (group 1 only), satisfaction with care, and quality of life was assessed. Pulse and blood pressure were reported in the findings but not listed in the procedure. A third group was comprised of 10 historical control cases who matched the characteristics of group 1.

• The study consisted of 20 participants.
• Mean age was 8.6 years with a range of 4–11 years.
• Gender was not reported.
• The majority of children had acute lymphocytic leukemia, and 12 children had osteosarcoma. Remaining diagnoses were not reported.

The study was conducted at a single site hospital in Hong Kong.

All patients were pediatric and in active treatment.

This was a clinical trial with pre- and post-test design.

• The following instruments were used.
  • The Morrow Assessment of Nausea and Emesis (MANE)
  • Chinese version of A-State scale of the State-Trait Anxiety Inventory
  • Play performance scale for children
  • Physiological indices of caloric intake and changes in body weight 
• Use of antiemetics and satisfaction with care (rated on a 4-point Likert-type scale ranging from 0 = unsatisfactory to 3 = extremely satisfactory) were recorded.
• A self-rating of intervention usefulness (rated on a 6-point Likert-type scale ranging from 0 = not at all useful to 5 = extremely useful) was obtained.
• Health diaries were used to record PMR and Gi practice.

At baseline, group 1 had significantly lower anxiety than group 2 (p = 0.032). Group 1 had less vomiting on day 3 compared to the control group (p = 0.036). No significant difference was found in antiemetic use between the intervention and control groups. No significant difference was found in body weight, CINV, antiemetic use, quality of life, or caloric intake between groups 1 and 2. Health diaries indicated that patients practiced PMR three to four times weekly at home with no significant changes in blood pressure or pulse. Patients and parents reported the interventions as moderately useful.

This study was poorly designed, and findings should be used cautiously. Although the authors reported that PMR and education can reduce CINV, no conclusions should be made except that further research is warranted.

• The sample size was small.
• No information was provided about randomization.
• The authors did not report how the historical control cases were identified or what information was collected.
• No discussion was provided on how the intervention was performed in younger children.
• No report was provided on how blood pressure, pulse, body weight, and caloric intake was measured and recorded.
• Whether data was provided by the children or parents was not made clear.
• Parents’ anxiety and satisfaction of care was discussed in the findings but not described in the procedure.
• No discussion of missing data was included.

The quality of this study is too poor to provide any implications for nurses. Well-designed research in this area is needed.