Driving Away Fear, Improving Outcomes for Children Receiving Radiation

When Julie Natale, R.N., B.S.N., began working with pediatric patients in Radiation Oncology, she quickly recognized that pivotal moment every family faces.

“The child would be playing in the waiting area, and then the nurse would come out,” Natale says. “There would just be this change. The fear would set in, and the child would cling to the parent or caregiver. It would be a rigid walk to the treatment room, with the child burying their head in the parent or caregiver’s chest.”

Natale would watch them walk stiffly and slowly down the hall, with the parents’ fear growing too. The children would require anti-anxiety medication and sedation for their daily sessions, and it made Natale wonder: How could we make this different?

She turned to the literature and found descriptions of using music therapy, child-life specialists, and other kinds of distractions to help these young patients in various health care settings. While Natale found many descriptions of these strategies, she did not find any studies of their impact on outcomes.

Then one day, she found a video from a dental practice that used a battery-operated, remote-controlled mini car to bring young patients in for their procedures. One of the nurses in the video talked about how using the car had decreased the use of anti-anxiety medications by 75 percent, but the data had never been published.

As a Doctorate of Nursing Practice (DNP) student at St. John Fisher College, Natale saw an opportunity to bring evidence into practice. She presented the idea for using a mini-car to Radiation Oncology leadership. Within a few weeks, a mini white Mercedes arrived — complete with seat belt, lights, a radio and windshield wipers — courtesy of an anonymous donor.

Natale quickly engaged with Facilities, Engineering, Fire Safety, Legal and others to get the car up and running for patients who are 3 to 6 years old. She worked with Anesthesiology to help them prepare, she developed training for the Radiation Oncology staff, and she led practice driving sessions to ensure patient safety. She also created a policy for use that serves as a model for other areas that are looking to implement similar practices.

“From clinical observation, it makes a difference,” Natale says. “The dynamic between the parents, children and staff is different. They look forward to it. They come down the hallway excited to be here. There are smiles and parents and caregivers taking pictures.”

Natale is looking to document more than that, though. As part of her DNP scholarship project, she is just beginning to collect data to evaluate the impact of the car on the use of anti-anxiety, induction and sedation medications, as well as on parent and staff satisfaction. She is also measuring the impact on resources and how potential reductions in the use of sedation may reduce the need for additional staff to help during treatments.

“This is not just about improving Radiation Oncology practices,” Natale says. “No one should have to watch a child go through treatment. If there’s anything we can do to make it better, we have an obligation to do that, and the science needs to back that up.”

She is also interested in the long-term impact of the mini car. Sedation has many side effects, and young children often need sedation as part of their radiation treatments. That sedation can sometimes be required for as many as 36 daily treatments. If the car leads to less use of sedation, that may also mean fewer side effects for these children.

“This has impact not just in the moment,” Natale says. “This is about the child’s wellness.”

It is also attracting interest from other cancer care providers. After presenting this project at ONS Congress in April and after one of the radiation oncologists presented at an international meeting, Natale says she has had calls from programs around the world seeking her insights. Her work has also helped connect Wilmot Cancer Institute with Stanford University to become part of a multi-center study of interventions like the car to help young patients during procedures.

“It’s making a big difference,” Natale says.

See video to learn more about this program.