Background: How children cope with minor or major surgery is influenced by their attention focus appraisals. Although factors that predict children's coping with surgery have been identified (i.e., age, locus of control, parent-doctor information, worry), it still is not known whether the type of surgery per se affects the coping strategies used and influences previously established predictors of coping. Furthermore, questions remain concerning the relation among type of surgery, attention focus, and coping. Objectives: The purpose of this study was to determine whether the type of surgery (minor vs. major) would have a differential effect on coping, and whether coping can be predicted better if it is known what type of attention focus (appraisal) the child has. Methods: Data from three studies of children (n = 189) undergoing minor or major surgery were combined to examine the effects that type of surgery and attention have on coping. Measures included the Preoperative Mode of Coping Interview, Locus of Control Scale for Children, Parent-Doctor Information Interview, and a measure for worry. Results: The results showed that the factors previously found to predict coping were upheld in the combined sample and accounted for 50% of the variance in coping. Type of surgery was significantly associated with coping: Children undergoing minor surgery were somewhat more vigilant than children undergoing major surgery. The inclusion of attention in the analysis significantly improved the variance explained in coping (66%), and children who had a concrete-objective focus of attention were found to be more vigilant. Significant interactions were found between attention focus and type of surgery, locus of control, and age. Type of surgery also had a significant interaction with worry. Children who focused on the concrete-objective aspects of the situation were more vigilant if they were having minor rather than major surgery. Also, children who had an internal locus of control and a concrete-objective focus of attention were more vigilant in coping. Regardless of age, children who had a concrete-objective focus of attention were more vigilant. Furthermore, at low levels of worry, children undergoing major surgery were more vigilant than children undergoing minor surgery. Conclusions: Coping with surgery is influenced by multiple factors. Children's ability to focus attention on the concrete-objective aspects of surgery may help to reduce feelings of threat that could impede their use of vigilant coping.
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