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Paediatrics
Protocol
Systematic review protocol examining the effectiveness of hospital clowns for symptom cluster management in paediatrics
  1. Luís Carlos Lopes-Júnior1,
  2. Regina Aparecida Garcia Lima1,
  3. Karin Olson2,
  4. Emiliana Bomfim3,
  5. Eliane Tatsch Neves4,
  6. Denise Sayuri Calheiros da Silveira5,
  7. Michelle Darezzo Rodrigues Nunes6,
  8. Lucila Castanheira Nascimento1,
  9. Gabriela Pereira-da-Silva1
  1. 1 WHO Collaborating Centre for Nursing Research Development. Ribeirão Preto, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirao Preto, Brazil
  2. 2 Faculty of Nursing, University of Alberta, Edmonton, Canada
  3. 3 Department of Medicine, University of Saskatchewan, College of Medicine, Saskatoon, Canada
  4. 4 Nursing Department, Federal University of Santa Maria, Santa Maria, Brazil
  5. 5 University of São Paulo at Ribeirão Preto Medical School, Ribeirao Preto, Brazil
  6. 6 Rio de Janeiro State University, Rio de Janeiro, Brazil
  1. Correspondence to Dr Luís Carlos Lopes-Júnior; luisgen{at}usp.br

Abstract

Introduction Clown intervention may playing an important complementary role in paediatric care and recovery. However, data on its utility for symptom cluster management of hospitalised children and adolescents in acute and chronic disorders are yet to be critically evaluated. As clinicians strive to minimise the psychological burden during hospitalisation, it is important that they are aware of the scientific evidences available regarding clown intervention for symptom management. We aim to provide quality evidence for the effectiveness of clown intervention on symptom cluster management in paediatric inpatients, both in acute and chronic conditions.

Methods and analysis A systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted. MEDLINE, Web of Science, Cochrane Library, Science Direct, PsycINFO, CINAHL, LILACS and SciELO databases will be searched from January 2000 to December 2018. Primary outcomes will include measures related with the effect of clown intervention on symptom cluster of paediatric inpatients (anxiety, depression, pain, fatigue, stress and psychological, emotional responses and perceived well-being). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Jadad Scale as well as Cochrane Risk-of-Bias Tool for RCTs, and Risk-of-Bias In Non-Randomized Studies Tool for NRCTs. A narrative synthesis will be conducted for all included studies. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges’ g score for both fixed and random effect models. I2 statistics will be used to assess heterogeneity and identify their potential sources.

Ethics and dissemination As it will be a systematic review, without human beings involvement, there will be no requirement for ethical approval. Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia.

Trial registration number CRD42018107099.

  • clown intervention
  • symptom management
  • symptom clusters
  • child
  • adolescent
  • pediatrics

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-026524

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors LCL-J, RAGL and KO conceptualised and designed the protocol, drafted the initial manuscript and reviewed the manuscript. LCL-J, EB and ETN defined the concepts and search items, data extraction process as well as methodological appraisal of the studies. DSCdS and MDRN planned the data extraction and statistical analysis. LCN and GP-dS, provided critical insights. All authors have approved and contributed to the final written manuscript.

    • Funding This research was funded by the Coordination for the Improvement of Higher Education Personnel (CAPES), Process number: BEX 9321/14-4.

    • Disclaimer The views of the authors do not necessarily reflect those of the NHS, NIHR or the Department of Health.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.