Abstract
Background and Objective: Children diagnosed with cancer often find hospitalization and medical procedures confusing and distressing due to limited developmental understanding. Hospitalized children frequently experience heightened anxiety, especially during invasive procedures. Among psychosocial interventions, medical clowning has emerged as effective in improving emotional well-being. In Taiwan, past study suggested group-based medical clown services improve children’s emotional well-being, but evidence for individualized services—recently adopted in Taiwan—is limited. In other countries, individualized clown interventions before procedures, such as intravenous insertion or surgery, significantly reduce anxiety and distress. This study aims to evaluate the effectiveness of individualized medical clown services in enhancing the emotional well-being of children undergoing invasive treatment.
Methods: This quasi-experimental study with a pretest–posttest comparison group design will be conducted in pediatric oncology wards of a medical center in Taiwan. The target sample size is 120 children undergoing invasive procedures with G*Power software. Inclusion criteria: (1) age 3 to 18, (2) diagnosed with cancer or hematologic disease, (3) prior experience interacting with medical clowns, (4) scheduled for an invasive procedure.
The night before the procedure (therapeutic intrathecal chemotherapy and/or bone marrow aspiration), children will complete basic information, Symptom Distress Scale, and Pediatric Quality of Life Inventory. On the procedure day, around 30 minutes before it, emotional status will be assessed using the Emotional Scale. The experimental group will then receive individualized medical clown services; the control group will receive routine care. After the procedure, once recovered from anesthesia, children will recall their emotional state upon entering the procedure room—either with or without the presence of medical clowns— using the same scale. Data will be analyzed using descriptive statistics, binary analysis, and generalized estimating equations (GEE).
Expected Results: Children receiving individualized medical clown services are expected to show significantly greater emotional improvement.
Conclusions: This study will evaluate whether individualized medical clown services effectively improve children’s emotions before invasive procedures. Findings will provide valuable evidence to promote child-friendly healthcare services.
Notes
References:
Delvecchio, E., Salcuni, S., Lis, A., Germani, A., & Di Riso, D. (2019). Hospitalized Children: Anxiety, Coping Strategies, and Pretend Play [Original Research]. Frontiers in Public Health, 7. https://doi.org/10.3389/fpubh.2019.00250
Ocak, E., Yozgat, A. K., Kacar, D., Sucakli, I. A., Ozbek, N. Y., Uneri, O. S., & Yarali, N. (2021). Health-related Quality of Life for Children With Leukemia: Child and Parental Perceptions. J Pediatr Hematol Oncol, 43(1), e56-e63. https://doi.org/10.1097/mph.0000000000001959
Könsgen, N., Polus, S., Rombey, T., & Pieper, D. (2019). Clowning in children undergoing potentially anxiety-provoking procedures: a systematic review and meta-analysis. Syst Rev, 8(1), 178. https://doi.org/10.1186/s13643-019-1095-4
Wu, W. W., Lu, F. L., Shiu, C. S., Tang, C. C., Jou, S. T., Chen, J. S., & Liu, Y. L. (2022). The effectiveness of a medical clowning program on improving emotional status among hospitalized children undergoing cancer treatment: A quasi-experimental study. J Nurs Scholarsh, 54(2), 161-168. https://doi.org/10.1111/jnu.12720
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
Quasi-Experimental Study, Other
Research Approach
Quantitative Research
Keywords:
Interprofessional Initiatives, Cancer Patients, Cancer Patients--In Infancy and Childhood, Alternative Therapies, Medical Clowning
Recommended Citation
Pan, Pao-Li; Wu, Wei-Wen; Shiu, Cheng-Shi; Lu, Meng-Yao; and Lu, Leigh, "Effectiveness of Medical Clowns in Improving Emotion for Children Undergoing Invasive Treatments" (2026). International Nursing Research Congress (INRC). 24.
https://www.sigmarepository.org/inrc/2026/posters_2026/24
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-07-24
Effectiveness of Medical Clowns in Improving Emotion for Children Undergoing Invasive Treatments
Toronto, Ontario, Canada
Background and Objective: Children diagnosed with cancer often find hospitalization and medical procedures confusing and distressing due to limited developmental understanding. Hospitalized children frequently experience heightened anxiety, especially during invasive procedures. Among psychosocial interventions, medical clowning has emerged as effective in improving emotional well-being. In Taiwan, past study suggested group-based medical clown services improve children’s emotional well-being, but evidence for individualized services—recently adopted in Taiwan—is limited. In other countries, individualized clown interventions before procedures, such as intravenous insertion or surgery, significantly reduce anxiety and distress. This study aims to evaluate the effectiveness of individualized medical clown services in enhancing the emotional well-being of children undergoing invasive treatment.
Methods: This quasi-experimental study with a pretest–posttest comparison group design will be conducted in pediatric oncology wards of a medical center in Taiwan. The target sample size is 120 children undergoing invasive procedures with G*Power software. Inclusion criteria: (1) age 3 to 18, (2) diagnosed with cancer or hematologic disease, (3) prior experience interacting with medical clowns, (4) scheduled for an invasive procedure.
The night before the procedure (therapeutic intrathecal chemotherapy and/or bone marrow aspiration), children will complete basic information, Symptom Distress Scale, and Pediatric Quality of Life Inventory. On the procedure day, around 30 minutes before it, emotional status will be assessed using the Emotional Scale. The experimental group will then receive individualized medical clown services; the control group will receive routine care. After the procedure, once recovered from anesthesia, children will recall their emotional state upon entering the procedure room—either with or without the presence of medical clowns— using the same scale. Data will be analyzed using descriptive statistics, binary analysis, and generalized estimating equations (GEE).
Expected Results: Children receiving individualized medical clown services are expected to show significantly greater emotional improvement.
Conclusions: This study will evaluate whether individualized medical clown services effectively improve children’s emotions before invasive procedures. Findings will provide valuable evidence to promote child-friendly healthcare services.
Description
This is an ongoing study that evaluates the effectiveness of a medical clown individual companionship program in enhancing the emotional well-being of pediatric cancer patients and their caregivers before their therapeutic intrathecal chemotherapy injection and/or bone marrow aspiration procedure. The study aims to introduce valuable and beneficial interventions that promote child-friendly healthcare services.