Video-Assisted Emotional Preparation and Emotional Expression During Subcutaneous Procedures in Children With Cancer

This randomized controlled study aims to evaluate the effect of a video-assisted structured emotional preparation intervention on emotional expression in children aged 3-6 years diagnosed with leukemia who undergo subcutaneous procedures. The study is grounded in atraumatic and child-centered care principles and is based on the idea that developmentally appropriate emotional preparation may help children cope more effectively with stressful medical procedures.

Hospitalization and repeated needle-related procedures are major sources of fear, anxiety, and emotional distress for children with cancer. In particular, preschool children may struggle to understand medical procedures cognitively and tend to interpret experiences through symbolic and imaginative thinking. For this reason, the intervention in this study combines short video-based storytelling with a structured emotional preparation session designed according to children's developmental characteristics. The video presents the subcutaneous procedure through child-friendly metaphors such as "superheroes" and "knights helping the body," aiming to reduce threat perception and support emotional regulation before the procedure.

The study will be conducted in the Pediatric Hematology Clinic of Ege University Children's Hospital with children receiving inpatient leukemia treatment and scheduled for subcutaneous procedures. Participants will be randomly assigned to one of three groups:

• video-assisted structured emotional preparation,
• structured emotional preparation only, and
• routine care control group.

Emotional expression levels, procedure duration, and crying duration will be evaluated across repeated treatment sessions. Emotional responses will be assessed using the Children's Emotional Manifestation Scale (CEMS).

The structured emotional preparation session includes emotional awareness, cognitive reframing, behavioral coping strategies, short behavioral rehearsal, controlled transition, and positive reinforcement. The intervention is designed to be brief, feasible within routine clinical workflow, and easily applicable by pediatric nurses.

By integrating developmentally appropriate visual storytelling and emotional support into pediatric oncology care, this study seeks to contribute evidence regarding non-pharmacological nursing interventions that may reduce distress during invasive procedures and improve children's procedural experiences.

Inclusion criteria

• The child must be between the ages of 3 and 6,
• The child must be receiving inpatient treatment at the Pediatric Hematology Clinic,
• The child must be scheduled to undergo a subcutaneous procedure related to a leukemia diagnosis
• The child and parent must agree to participate in the study and provide written informed consent,
• The child and parent must be able to communicate in basic Turkish,
• At least one parent (mother or father) must be present with the child during the procedure.

Exclusion criteria

• Development of an acute or unstable clinical condition
• The child's discharge or continuation of treatment on an outpatient basis
• A single SC procedure performed based on the child's clinical condition
• The child has received sedation or a medication causing confusion prior to the procedure
• The child has severe vision or hearing problems that prevent video viewing or a structured emotional preparation interview
• Another interventional procedure is scheduled for the same day
• Withdrawal of informed consent by the child or parent during the process
• Difficulty adhering to the study protocol (e.g., discontinuing the procedure or refusing the procedure).
• If communication or cooperation issues prevent the completion of research data, the case will be excluded from the study.