title: Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research.
abstract: Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.
authors.affiliation: a Department of Psychology , University of Guelph , Guelph , Canada.|b Pediatric Chronic Pain Program, McMaster Children's Hospital , Hamilton , Canada.|c Children's Health Research Institute , London , Canada.|d Department of Paediatrics , Schulich School of Medicine & Dentistry, Western University , London , Canada.
authors.forename: C Meghan
authors.initials: CM
authors.lastname: McMurtry
authors.affiliation: e Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Canada.|f The Hospital for Sick Children , Toronto , Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Taddio
authors.affiliation: g Department of Psychology , University of Calgary , Calgary , Canada.|h Alberta Children's Hospital Research Institute , Calgary , Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Noel
authors.affiliation: i Department of Psychology , Ryerson University , Toronto , Canada.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Antony
authors.affiliation: j Department of Pediatrics, Department of Psychology and Neuroscience , Dalhousie University , Halifax , Canada.|k The Centre for Pediatric Pain Research, IWK Health Centre , Halifax , Canada.
authors.forename: Christine T
authors.initials: CT
authors.lastname: Chambers
authors.affiliation: l Department of Psychology, Faculty of Arts , University of Regina , Regina , Canada.
authors.forename: Gordon J G
authors.initials: GJ
authors.lastname: Asmundson
authors.affiliation: f The Hospital for Sick Children , Toronto , Canada.|m Department of Psychology , York University , Toronto , Canada.|n Department of Psychiatry , University of Toronto , Toronto , Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Pillai Riddell
authors.affiliation: o Mount Sinai Hospital , Toronto , Canada.|p Faculty of Medicine , University of Toronto , Toronto , Canada.
authors.forename: Vibhuti
authors.initials: V
authors.lastname: Shah
authors.affiliation: q Department of Pediatrics , Dalhousie University , Halifax , Canada.|r IWK Health Centre , Halifax , Canada.|s Canadian Center for Vaccinology , Halifax , Canada.
authors.forename: Noni E
authors.initials: NE
authors.lastname: MacDonald
authors.affiliation: u Centre for Effective Practice , Toronto , Canada.|v Institute of Health Policy, Management, and Evaluation, University of Toronto , Toronto , Canada.
authors.forename: Jess
authors.initials: J
authors.lastname: Rogers
authors.affiliation: w Immunize Canada , Ottawa , Canada.|x Canadian Public Health Association , Ottawa , Canada.
authors.forename: Lucie M
authors.initials: LM
authors.lastname: Bucci
authors.affiliation: y College of Family Physicians of Canada , Toronto , Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Mousmanis
authors.affiliation: z Alberta Health Services and the Cumming School of Medicine , University of Calgary , Calgary , Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.affiliation: q Department of Pediatrics , Dalhousie University , Halifax , Canada.|r IWK Health Centre , Halifax , Canada.|s Canadian Center for Vaccinology , Halifax , Canada.|t Department of Microbiology & Immunology , Dalhousie University , Halifax , Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Halperin
authors.affiliation: aa College of Pharmacy , Dalhousie University , Halifax , Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Bowles
authors.affiliation: ab Immunization Programs and Vaccine Preventable Diseases Service , BC Centre for Disease Control , Vancouver , Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Halpert
authors.affiliation: f The Hospital for Sick Children , Toronto , Canada.|ac Faculty of Medicine, Department of Paediatrics , University of Toronto , Toronto , Canada.
authors.forename: Moshe
authors.initials: M
authors.lastname: Ipp
authors.affiliation: ad Departments of Paediatrics, Physiology & Pharmacology and Medicine, Schulich School of Medicine & Dentistry , Western University , London , Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rieder
authors.affiliation: ae Canadian Family Advisory Network , Toronto , Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Robson
authors.affiliation: af Uleryk Consulting , Toronto , Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Uleryk
authors.affiliation: ag Science Directorate, Canadian Psychological Association , Ottawa , Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Votta Bleeker
authors.affiliation: ah Toronto Public Health , Toronto , Canada.
authors.forename: Vinita
authors.initials: V
authors.lastname: Dubey
authors.affiliation: ai Communicable Disease Control, Alberta Health Services , Edmonton , Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Hanrahan
authors.affiliation: aj Bodhi Seed Center for Healing and Conscious Living , Milton , Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Lockett
authors.affiliation: ak Department of Emergency Medicine , IWK Health Centre , Halifax , Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Scott
mesh_terms: D000328:Adult; D002648:Child; D005239:Fear / Q000523:psychology*; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D009339:Needles; D010698:Phobic Disorders / Q000523:psychology / Q000628:therapy*
keywords: Fear; blood–injection–injury; clinical practice guideline; exposure; needle; phobia