title: The influence of appraisals in understanding children's experiences with medical procedures.
abstract: OBJECTIVE
  To examine the influence of cognitive appraisals on anticipatory anxiety, procedural distress, and postprocedural evaluations in 100 children (ages 8-17) undergoing esophagogastroduodenoscopy (EGD).
  
  
  METHODS
  Children's knowledge about the procedure, appraisals of the procedure's aversiveness, coping ability, and state anxiety prior to the procedure were assessed by self-report. Distress during the EGD was assessed by observer ratings. Postprocedural evaluations were assessed by self-report 1 hour after the procedure.
  
  
  RESULTS
  Structural equation modeling indicated that children who knew more about the EGD appraised it as less threatening, and, in turn, children who appraised the procedure as less threatening experienced less anxiety. Decreased anxiety was associated with decreased distress, which, in turn, was associated with decreased pain, evaluations of less aversiveness, and less negative attitudes toward future procedures.
  
  
  CONCLUSIONS
  This study has implications for how children are prepared for EGDs and supports the utility of an appraisal-based model in understanding children's experiences with medical procedures.
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Science, Durham, North Carolina 27710, USA.
authors.forename: Robyn Lewis
authors.initials: RL
authors.lastname: Claar
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Walker
authors.forename: Craig A
authors.initials: CA
authors.lastname: Smith
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001007:Anxiety / Q000517:prevention & control* / Q000523:psychology; D002648:Child; D002652:Child Behavior; D016145:Endoscopy, Digestive System / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D010146:Pain / Q000517:prevention & control / Q000523:psychology; D010353:Patient Education as Topic; D002666:Psychology, Child; D012057:Reinforcement, Verbal