Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol

Background: Burns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children's procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns. Methods: An observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children's hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e. fidelity in delivery), reach, potential effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes. Discussion: Ethical approval was obtained from the Queensland Children's Hospital and Health Service ethics committee. Results will be published in peer-reviewed publications and conference proceedings. The findings will guide the design of future trials on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns.