Pinar, G., Kurt, A., & Gungor, T. (2011). The efficacy of preopoerative instruction in reducing anxiety following gyneoncological surgery: A case control study. World Journal of Surgical Oncology, 9, 38–45.

To examine the effects of preoperative instruction on anxiety levels after gynecology oncology surgery

A random sample of patients scheduled for surgery was selected, and patients were assigned to intervention and control groups. Those in the control group received typical preoperative teaching. The intervention group was informed in detail with written information provided in an interactive situation to patients and caregivers. Instruction included anatomical information, routine preoperative preparation (e.g., removal of dentures, medications for the procedure), and postoperative care (e.g., management of pain, Kegel exercises). Instruction also included information on relaxation and imagery techniques. Study measures were obtained prior to surgery and after surgery immediately prior to hospital discharge.

• N = 120    
• AGE = Median and range were not provided. 50% were older than age 49 years.
• MALES: 0%; FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Ovarian, endometrial and cervical cancers
• OTHER KEY SAMPLE CHARACTERISTICS: 61% had no previous surgical experience.

• SITE: Single site  
• SETTING TYPE: Inpatient    
• LOCATION: Turkey

• PHASE OF CARE: Active antitumor treatment

• Nonrandomized two-group comparative quasiexperimental design

• State-Trait Anxiety Inventory (STAI)

Authors reported STAI-I results and STAI-II results, but it is not clear what STAI-II refers to. STAI postoperative results declined similarly in both groups. STAI-II postoperative results were higher in both groups and increased more in the intervention group than the control group. The difference between postoperative study groups showed overall lower anxiety scores in the intervention group (p = .004).  Baseline anxiety was higher in the control group but not statistically different from the intervention group.

No firm conclusions regarding the effects of the preoperative teaching were given, and conclusions on postoperative anxiety cannot be drawn.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition)
• Key sample group differences that could influence results
• Measurement validity/reliability questionable
• Other limitations/explanation: Measurement results as reported are unclear. It is surprising that the difference in anxiety scores was greater between groups at baseline but was not statistically significant. However, smaller differences postoperatively were significant. No subgroup analysis was done based on extent of surgery or stage of disease, which could be expected to influence anxiety.

Study limitations preclude the ability to draw any firm conclusions from this research.