Effect of Buzzy®, Cognitive Behavioral Intervention, and Kaleidoscope During SC Injection in Children With Cancer

June 19, 2026 updated by: Birgul Erdogan, Kocaeli University

Buzzy®, a Cognitive-Behavioral Intervention Package, and a Kaleidoscope for Reducing Pain, Fear, and Anxiety During Subcutaneous Injections in Children With Cancer: A Three-Arm Randomized Controlled Trial

Subcutaneous injections are commonly used in pediatric oncology care and may cause pain, fear, and anxiety in children. Repeated exposure to needle-related procedures may increase procedural distress and affect children's cooperation and coping during treatment. Therefore, simple, safe, and feasible non-pharmacological interventions are needed to improve children's comfort during routine procedures.

This randomized parallel trial was designed to compare three clinically feasible non-pharmacological approaches with different mechanisms during subcutaneous injections in children with cancer. Buzzy® provides cold and vibration as a sensory-based method, the cognitive behavioral intervention package supports preparation and coping, and the kaleidoscope provides visual distraction. By comparing these approaches within the same procedural context, the study aimed to provide practical evidence for pediatric oncology nurses when selecting interventions to reduce procedural distress.

All procedures were conducted in the routine clinical procedure area of a pediatric oncology clinic. The same subcutaneous injection procedure was used for all participants, and standardized assessment time points were applied before and immediately after the procedure.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This study was conducted as a randomized, parallel-group clinical trial in children with cancer undergoing routine subcutaneous injection. Participants were assigned to one of three intervention groups: Buzzy®, a cognitive-behavioral intervention package, or kaleidoscope distraction.

All interventions were delivered in the same clinical setting and within the same procedural context. Before the injection, baseline levels of procedural fear and state anxiety were assessed. The assigned intervention was then applied according to the group allocation during the subcutaneous injection procedure. Pain, fear, and state anxiety were evaluated immediately after the procedure using standardized pediatric assessment tools.

The trial was designed to compare three non-pharmacological strategies that are practical for use in pediatric oncology nursing care. The purpose was to determine whether sensory stimulation, cognitive-behavioral preparation and coping support, or visual distraction differed in their effects on procedural pain, fear, and anxiety during subcutaneous injection.

Study Type

Interventional

Enrollment (Actual)

45

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • İzmit
      • Kocaeli, İzmit, Turkey (Türkiye), 41001
        • Kocaeli University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Children aged 6 to 12 years
  • Diagnosis of cancer
  • Having received chemotherapy at least once
  • Willingness of both the child and parent to participate in the study

Exclusion Criteria:

  • Visual, auditory, verbal, or cognitive impairment preventing participation
  • Terminal stage of disease
  • Use of sedative, analgesic, or narcotic medication within 24 hours before the procedure
  • Baseline pain score of 2 or higher on the Wong-Baker Faces Pain Rating Scale unrelated to the procedure
  • Inability to complete the injection in a single attempt
  • Withdrawal before completion of the study procedures

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Cognitive-Behavioral Intervention Package Group
Children assigned to this group received the cognitive-behavioral intervention package during the subcutaneous injection procedure.
Behavioral: Cognitive Behavioral Intervention Package Group
The Cognitive Behavioral Intervention Package was delivered by the researcher before, during, and after the subcutaneous injection. Before the procedure, the child received brief age-appropriate preparation, selected a preferred distraction or coping strategy, and the parent was guided on how to support the child. During the injection, the researcher provided standardized verbal coaching, encouragement, and coping support, while the parent provided physical and verbal comfort. The child used the selected coping strategy throughout the injection. After completion of the outcome assessments, brief positive reinforcement was provided. The intervention was implemented using a structured checklist to support standardization.
Active Comparator: Buzzy® Group
Children assigned to this group received the Buzzy® intervention during the subcutaneous injection procedure.
Device: Buzzy® Group
The Buzzy® device was used as a cold and vibration intervention during subcutaneous injection. The device was placed at the injection site 60 seconds before needle insertion, and cold and vibration were initiated. Immediately before needle insertion, the device was repositioned approximately 3 cm proximal to the injection site. It remained in place throughout the injection and was removed immediately after the procedure was completed. No additional distraction or cognitive behavioral coaching was provided beyond standard procedural explanations.
Active Comparator: Kaleidoscope Group
Children assigned to this group received kaleidoscope distraction during the subcutaneous injection procedure.
Device: Kaleidoscope Group
The kaleidoscope was used as a visual distraction intervention during subcutaneous injection. The child was shown the kaleidoscope shortly before the procedure and was allowed a brief familiarization period. The kaleidoscope was introduced approximately 1 minute before needle insertion, and the child continued to look through it throughout the injection. The intervention ended when the injection was completed. No additional cognitive behavioral coaching or cold/vibration intervention was provided beyond standard procedural explanations.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Post-Procedural Pain Intensity Assessed Using the Wong-Baker FACES Pain Rating Scale
Time Frame: Immediately after subcutaneous injection
Post-procedural pain intensity will be assessed immediately after subcutaneous injection using the Wong-Baker FACES Pain Rating Scale. This scale ranges from 0 to 5, with 0 indicating no pain and 5 indicating the worst pain. Higher scores indicate greater pain intensity.
Immediately after subcutaneous injection

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Procedural Fear Assessed Using the Children's Fear Scale
Time Frame: Before and immediately after subcutaneous injection
Procedural fear will be assessed before and immediately after subcutaneous injection using the Children's Fear Scale. This scale ranges from 0 to 4, with 0 indicating no fear and 4 indicating extreme fear. Higher scores indicate greater procedural fear.
Before and immediately after subcutaneous injection
State Anxiety Assessed Using the Children's Anxiety Scale-State
Time Frame: Before and immediately after subcutaneous injection
State anxiety related to subcutaneous injection will be assessed before and immediately after the procedure using the Children's Anxiety Scale-State. This scale ranges from 0 to 10, with 0 indicating no anxiety and 10 indicating the highest level of anxiety. Higher scores indicate greater state anxiety.
Before and immediately after subcutaneous injection

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Kocaeli University

Investigators

  • Principal Investigator: Birgül Erdoğan, PhD, RN, Kocaeli University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 1, 2024

Primary Completion (Actual)

February 12, 2025

Study Completion (Actual)

September 24, 2025

Study Registration Dates

First Submitted

June 15, 2026

First Submitted That Met QC Criteria

June 19, 2026

First Posted (Actual)

June 25, 2026

Study Record Updates

Last Update Posted (Actual)

June 25, 2026

Last Update Submitted That Met QC Criteria

June 19, 2026

Last Verified

November 1, 2024

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SCINJ-PAIN-2025-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared because the study includes a small pediatric oncology sample and sensitive clinical data. Study findings will be reported in aggregate form.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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