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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 56-59

Understanding preoperative anxiety in patients before elective surgical intervention


1 Department of Hospital Administration, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
2 College of Nursing, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
3 Department of General Surgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
4 Department of Statistics, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
5 Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
6 Director Integrated Emergency & Surgical Care Program, Geneva Foundation of Medical Education and Research, Geneva, Switzerland

Date of Submission13-Jun-2017
Date of Acceptance31-Oct-2017
Date of Web Publication23-Apr-2018

Correspondence Address:
Dr. Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_58_17

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  Abstract 


Background: Understanding the preoperative fears and anxieties in patients who are planned for surgical procedure is of paramount importance.
Objective: To know the preoperative levels of anxiety in patients who received versus who did not receive The World Health Organization (WHO) tool before undergoing elective surgical intervention.
Materials and Methods: The present study was conducted in the departments of surgical disciplines of Narayana Medical College and Hospital, Nellore. For the project, a total of 100 (50 in each group) adult patients (>18 years and <60 years) who were planned for elective surgical intervention were included in the study. Informed consent was obtained from the patients. The WHO's “Patient Communication Tool: What you need to know before and after surgery” which helps the surgical patients to ask the questions related to their surgery and related events was used to provide information. “The Amsterdam Preoperative Anxiety and Information Scale” which is a 6-item questionnaire with the scores ranging from 4 (not anxious) to 20 (highly anxious) was used to measure the preoperative anxiety. The patients were divided in two groups: Group A (those who did not receive the questionnaire) and Group B (those who received the questionnaire). SPSS (version 24.0 for Macintosh) was used for data analysis.
Results: Median age of all the participants was 49 years. Age, gender, and education status, both the groups were not statistically significant. Based on the analysis, it was found that in Group A, patients had slighter higher response score than that of Group B. However, mean difference between both the groups was not found to be statistically significant. Mean response score of individual question, between both the groups, were significantly different in half questions, while not significant in remaining half of the questions. Among six questions, statistically significant (P = 0.017) difference was found in anesthesia-related responses. While for procedure-related responses, difference in mean responses was not statistically significant (P = 0.331).
Conclusion: Effective physician–patient communication is the key in establishing trust, resulting in delivering a satisfactory care to the patient. There is a need to carry out further studies with an inclusion of a larger number of participants with a more precise tool to impart the knowledge about the surgical intervention and to ameliorate the peri-operative anxiety in patients who are undergoing surgical intervention.
The following core competencies are addressed in this article: Patient care, Communication skills, Practice based learning and improvement.

Keywords: Anxiety, information, patient communication, physician–patient relationship, surgery


How to cite this article:
Ramamohan D, Indira S, Sateesh S, Kumar S S, Bhandarkar P, Sahana Bhat N R, Gorantla R, Jahnavi M, Cherian MN, Agrawal A. Understanding preoperative anxiety in patients before elective surgical intervention. Int J Acad Med 2018;4:56-9

How to cite this URL:
Ramamohan D, Indira S, Sateesh S, Kumar S S, Bhandarkar P, Sahana Bhat N R, Gorantla R, Jahnavi M, Cherian MN, Agrawal A. Understanding preoperative anxiety in patients before elective surgical intervention. Int J Acad Med [serial online] 2018 [cited 2019 Dec 14];4:56-9. Available from: http://www.ijam-web.org/text.asp?2018/4/1/56/230847




  Introduction Top


Understanding the preoperative fears and anxieties in patients who are planned for surgical procedure is of paramount importance.[1] Communication is crucial in establishing trust with patients, gathering information, addressing patient emotions, and assisting patients in decisions about care and relieving the anxiety.[1] Several studies have highlighted the role of effective communication in clinical settings.[2],[3],[4],[5] The present pilot study was conducted to know the preoperative levels of anxiety in patients who received versus who did not receive the WHO tool “What you need to know before and after surgery,” before undergoing elective surgical intervention.


  Materials and Methods Top


The null hypothesis was that there was no difference in the levels of anxiety between two groups, and the alternate hypothesis was that there is a difference in the levels of anxiety between two groups. The present study was conducted in the departments of surgical disciplines of Narayana Medical College and Hospital, Nellore. For the present pilot study, a total of 100 (50 in each group) adult patients (>18 years and <60 years), who were planned for elective surgical intervention were included. All possible biases were avoided while formulating these groups. Informed consent for participation was taken from the patients. The demographic details and details of diagnosis and planned surgical procedure were recorded in a predesigned pro forma. The WHO's “What you need to know before and after surgery” patient communication tool [6] was given to the patients in Telugu or English language to the patients in Group A to make aware about the questions to be asked to the surgical management team. The Amsterdam Preoperative Anxiety and Information Scale (APAIS)[1] was used to assess the level of preoperative anxiety in the two groups. The patients were divided into two groups: Group A (those who did not receive the questionnaire) and Group B (those who received questionnaire). A checklist of the questions was maintained to keep a track of the questions which were asked by the patients to the treating surgeons.

Statistical analysis

IBM SPSS Statistics for Macintosh, Version 24.0. Armonk, NY: IBM Corp. was used for data analysis. Data were expressed using descriptive statistics such as median and interquartile range for continuous variables and frequency and percentage for categorical variables. Chi-square test was used among categorical variables. At 95% confidence interval, P < 0.05 was considered statistically significant. Responses for individual test score as well as anesthesia subtotal, procedure subtotal, and total score were compared between both the study groups using Mann–Whitney U-test.


  Results Top


Median age of all the participants was 49 years. Participants were divided in both the groups in such a way that there should not be statistically significant difference with respect to age, gender, education, comorbidity, and surgical management specialties (P > 0.05). Based on the analysis, it was found that in Group A, patients had slight higher response score than that of Group B. There was no significant difference between comorbidity of the participants as well as surgical specialties of both groups [Table 1].
Table 1: Background characteristics across both the groups

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After comparing the mean response score of both the groups using Mann – Whitney U test, statistically significant difference was found for anesthesia related subgroups (P = 0.026), while for procedure related responses it was not found statistically significant (P = 0.125). As seen towards the overall mean response of all the questions, statistically no significant difference was recorded among both the group (P = 0.411). Two out of total six questions had recorded statistically significant responses in both the study groups (P< 0.05) [Table 2].
Table 2: Comparison of mean response across the study groups

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  Discussion Top


Medical professionals depend on their ability to communicate with patients and to understand their existing problems (for which the patients are usually unaware).[7],[8],[9] The WHO's “Patient Communication Tool” helps the surgical patients to ask questions related to their surgical procedure and related events, “What you need to know before and after surgery.”[6] In the literature, the incidence of preoperative anxiety ranges from 60% to 92%.[10],[11],[12] Various authors have reported that the gender (female more than male), increasing education level, increasing income, and increasing age are associated with increase in the level of anxiety; however, this was not statistically significant.[10],[11],[13],[14],[15] Communication is a bilateral process which is meant to give or exchange the information between physicians and patients.[16] Communication helps in gathering the information, identifying the patient's emotions and needs, and helping them to decide about care while developing the trust with the patient.[2],[17] It has been emphasized that a good communication leads to better management of the stress, overcome the uncertainty, understanding of complex information, and better coping with life-altering medical decisions.[18],[19]

While planning the patients for surgical intervention, detailed information regarding the proposed surgical intervention and related events can help not only to relieve the anxiety in patients but also facilitate the recovery as well.[1],[3],[20],[21],[22] The “APAIS” is a simple tool which is available to measure the preoperative anxiety.[1] The APAIS is a 6-item questionnaire which is recommended to use for both clinical and for research purposes and the scores on the APAIS anxiety scale range from 4 (not anxious) to 20 (highly anxious).[1] Any major change in life can cause anxiety, this is true for hospitalization (regardless of the underlying problem) and if there is anticipated surgical procedure.[13],[23],[24] It has been reported that up to two-thirds (70.3%) of patients who are planned for surgical intervention had preoperative anxiety.[17] A number of factors affect the level of preoperative levels of anxiety in patients who are admitted for surgical innervation and include female gender, level of education, any history of prior psychiatric disorders, self-perception, depression, trait-anxiety level, pain, history of smoking, the proposed surgical procedure, physical status of the patient,[24] marital status,[25] fear of complications,[14],[17],[26] socioeconomic status,[26] and fear of death.[17]


  Conclusion Top


It can be said that a good communication can help physicians to better understand patient expectations. The level of education, type of surgery required, and previous negative hospital admission experiences can affect the levels of preoperative levels of anxiety.[27] Management of preoperative anxiety needs a balance between the concerns of the patients and the demands of their treatment to help to allay fears and anxiety.[28] The major limitation of this pilot study was that it was conducted in a single hospital with a small sample size. There is a need to carry out further studies with an inclusion of a larger number of participants with a more precise tool to impart the knowledge about the surgical intervention and to ameliorate the peri-operative anxiety in patients who are undergoing surgical intervention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) Anesth Analg 1996;82:445-51.  Back to cited text no. 1
    
2.
Baile WF, Aaron J. Patient-physician communication in oncology: Past, present, and future. Curr Opin Oncol 2005;17:331-5.  Back to cited text no. 2
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Richards J, McDonald P. Doctor-patient communication in surgery. J R Soc Med 1985;78:922-4.  Back to cited text no. 3
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Pellegrino ED. Editorial: Medical ethics, education, and the physician's image. JAMA 1976;235:1043-4.  Back to cited text no. 4
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Klopfenstein CE, Forster A, Van Gessel E. Anesthetic assessment in an outpatient consultation clinic reduces preoperative anxiety. Can J Anaesth 2000;47:511-5.  Back to cited text no. 5
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6.
WHO. What you need to know Before and After Surgery. Available from: http://www.who.int/surgery/publications/patients_communication_tool.pdf. [Last accessed on 2017 Mar 01, 12:35:24].  Back to cited text no. 6
    
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Levy MH. Doctor-patient communication: The lifeline to comprehensive cancer care. ASCO Educational Book. Alexandria; 1998. p. 195-202.  Back to cited text no. 7
    
8.
Parle M, Jones B, Maguire P. Maladaptive coping and affective disorders among cancer patients. Psychol Med 1996;26:735-44.  Back to cited text no. 8
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Roberts CS, Cox CE, Reintgen DS, Baile WF, Gibertini M. Influence of physician communication on newly diagnosed breast patients' psychologic adjustment and decision-making. Cancer 1994;74:336-41.  Back to cited text no. 9
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Guo P, East L, Arthur A. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: A randomized controlled trial. Int J Nurs Stud 2012;49:129-37.  Back to cited text no. 10
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Perks A, Chakravarti S, Manninen P. Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol 2009;21:127-30.  Back to cited text no. 11
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Frazier SK, Moser DK, Daley LK, McKinley S, Riegel B, Garvin BJ, et al. Critical care nurses' beliefs about and reported management of anxiety. Am J Crit Care 2003;12:19-27.  Back to cited text no. 12
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Jafar MF, Khan FA. Frequency of preoperative anxiety in Pakistani surgical patients. J Pak Med Assoc 2009;59:359-63.  Back to cited text no. 13
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Ebirim L, Tobin M. Factors responsible for pre-operative anxiety in elective surgical patients at a university teaching hospital: A pilot study. Internet J Anesthesiol 2010;29:1-6.  Back to cited text no. 14
    
15.
Kiyohara LY, Kayano LK, Oliveira LM, Yamamoto MU, Inagaki MM, Ogawa NY, et al. Surgery information reduces anxiety in the pre-operative period. Rev Hosp Clin Fac Med Sao Paulo 2004;59:51-6.  Back to cited text no. 15
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Frenkel M, Ben-Arye E, Cohen L. Communication in cancer care: Discussing complementary and alternative medicine. Integr Cancer Ther 2010;9:177-85.  Back to cited text no. 16
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17.
Nigussie S, Belachew T, Wolancho W. Predictors of preoperative anxiety among surgical patients in Jimma University specialized teaching hospital, South Western Ethiopia. BMC Surg 2014;14:67.  Back to cited text no. 17
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Epstein RM, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. Reducing Suffering. National Cancer Institute, NIH Publication No. 07-6225. Bethesda, MD, 2007.  Back to cited text no. 18
    
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Pincus HA, Patel SR. Barriers to the delivery of psychosocial care for cancer patients: Bridging mind and body. J Clin Oncol 2009;27:661-2.  Back to cited text no. 19
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Devine EC. Effects of psychoeducational care for adult surgical patients: A meta-analysis of 191 studies. Patient Educ Couns 1992;19:129-42.  Back to cited text no. 20
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Suls J, Wan CK. Effects of sensory and procedural information on coping with stressful medical procedures and pain: A meta-analysis. J Consult Clin Psychol 1989;57:372-9.  Back to cited text no. 21
    
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Webber GC. Patient education. A review of the issues. Med Care 1990;28:1089-103.  Back to cited text no. 22
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Goebel S, Kaup L, Mehdorn HM. Measuring preoperative anxiety in patients with intracranial tumors: The Amsterdam Preoperative Anxiety and Information scale. J Neurosurg Anesthesiol 2011;23:297-303.  Back to cited text no. 23
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Yilmaz M, Sezer H, Gürler H, Bekar M. Predictors of preoperative anxiety in surgical inpatients. J Clin Nurs 2012;21:956-64.  Back to cited text no. 24
    
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Aalouane R, Rammouz I, Tahiri-Alaoui D, Elrhazi K, Boujraf S. Determining factors of anxiety in patients at the preoperative stage. Neurosciences (Riyadh) 2011;16:146-9.  Back to cited text no. 25
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Jawaid M, Mushtaq A, Mukhtar S, Khan Z. Preoperative anxiety before elective surgery. Neurosciences (Riyadh) 2007;12:145-8.  Back to cited text no. 26
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Karanci AN, Dirik G. Predictors of pre- and postoperative anxiety in emergency surgery patients. J Psychosom Res 2003;55:363-9.  Back to cited text no. 27
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Pritchard M. Measuring anxiety in surgical patients using a visual analogue scale. Nurs Stand 2010;25:40-4.  Back to cited text no. 28
    



 
 
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