In almost all cases of surgery, the patient will experience some sort of anxiety in the days leading up to their procedure. Fear of the unknown or fear of death and dying, concerns about pain or safety, or a loss of control are believed to be some of the common reasons for preoperative anxiety [1]. While physiological responses may include tachycardia, hypertension, or profuse perspiration, psychological responses may include behavioral changes such as increased tension, apprehension, or unprovoked aggression [1]. To negate, or at least reduce, these manifestations of stress, it is traditionally advised to provide information to the patient about the upcoming procedure and the postoperative process during their preoperative time [2].

However, this ‘one-size-fits-all’ mindset has been challenged by a select sample of research studies. One study conducted in Sweden separated participants into two groups, where the experimental group received detailed written information about surgical complications, and the control group received conventional information. Researchers then measured anxiety and impact of event (surgery) using validated survey instruments. Results indicated participants receiving the intervention were significantly more satisfied after the surgery than those in the control group, but no differences were found for either anxiety, depression, or impact of event. Younger patients (age < 50) were reportedly less satisfied than older individuals (age > 50), regardless of what kind of information they received [3].

Other researchers also found that information provided beyond routine care did not have a reducing effect on anxiety before surgery [4-6]. Psycho-endocrinological measures of stress and anxiety such as salivary cortisol showed the highest increase during transportation to the OR and the first post-operative day [4]. These results were consistent despite different levels of received information (whether a routine pamphlet or the pamphlet and extended oral communication in the study by Bergmann et al.) [4]. Australian researchers Done and Lee [6] reported patients with high trait anxiety (assessed through a validated personality test) recalled less risk information, suggesting an inhibitory effect of anxiety on memory that could diminish the anxiety-reducing power of information. They proposed that while medical workers may be unable to reduce anxiety significantly, due to large gaps in individual differences, they can still offer empathetic support in a time of crisis.

Personalized and well-deliberated communication may be a stronger mediator of anxiety reduction than any generic pamphlet. A correlational study of 261 diabetic patients and their PCPs reported 73-93% of physicians believed their patients’ responses to their diagnosis and treatment were more negative than they really were (as perceived by the patient) [7]. Although the causes for this discrepancy between physician and patient are yet to be identified, the patient’s affective response seems to be an aspect of the medical visit that is generally neglected. Even in cases where affective responses are recorded, societal stigmatization of hospital procedures may induce a negative lens through which physicians fail to read signals of positive affect. In a positive feedback loop, this response in turn contributes to the “climate of negativity” that deepens the original stigma [7]. Accordingly, greater emphasis should be placed on the attending physician to understand the patient well enough to provide personalized information to alleviate their stressors. Information, regardless of depth, is no substitute for a knowledgeable physician with a positive attitude.

References 

1. Pritchard, M. J. (2009). Identifying and assessing anxiety in pre-operative patients. Nursing standard, 23(51). https://www.proquest.com/docview/219897176/fulltextPDF/D63D5CA61774B9APQ/1?accountid=10226  
2. Kiyohara, L. Y., Kayano, L. K., Oliveira, L. M., Yamamoto, M. U., Inagaki, M. M., Ogawa, N. Y., … & Vieira, J. E. (2004). Surgery information reduces anxiety in the pre-operative period. Revista do Hospital das Clínicas, 59, 51-56. https://www.scielo.br/j/rhc/a/pXMXrS7vcnNSRwbSCL434Gs/?format=pdf&lang=en 
3. Ivarsson, B., Larsson, S., Lührs, C., & Sjöberg, T. (2005). Extended written pre-operative information about possible complications at cardiac surgery—do the patients want to know?. European journal of cardio-thoracic surgery, 28(3), 407-414. https://doi.org/10.1016/j.ejcts.2005.05.006 
4. Bergmann, P., Huber, S., Mächler, H., Liebl, E., Hinghofer-Szalkay, H., Rehak, P., & Rigler, B. (2001). The influence of medical information on the perioperative course of stress in cardiac surgery patients. Anesthesia & Analgesia, 93(5), 1093-1099. https://doi.org/10.1097/00000539-200111000-00005  
5. Shuldham, C. M., Fleming, S., & Goodman, H. (2002). The impact of pre-operative education on recovery following coronary artery bypass surgery. A randomized controlled clinical trial. European heart journal, 23(8), 666-674. https://doi.org/10.1053/euhj.2001.2897 
6. Done, M., & Lee, A. (1998). The use of a video to convey preanesthetic information to patients undergoing ambulatory surgery. Anesthesia & Analgesia, 87(3), 531-536. https://doi.org/10.1213/00000539-199809000-00005 
7. Hall, J. A., Stein, T. S., Roter, D. L., & Rieser, N. (1999). Inaccuracies in physicians’ perceptions of their patients. Medical care, 37(11), 1164-1168.