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Evaluating the Effect of Preoperative Provision of Information on Salivary Cortisol in Patients Undergoing Breast Cancer Surgery: A Randomized Controlled Study

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Abstract

Purpose

Surgery is considered to be an anxious experience and most patients experience preoperative anxiety. Preoperative awareness has long been one of the most effective ways to reduce fear and anxiety caused by surgery. The aim of this study was to determine the effect of preoperative provision of information on salivary cortisol in candidates for breast cancer surgery.

Design

This randomized clinical trial was conducted on 80 patients (divided into control group and intervention group; 40 patients in each group) admitted to the surgery department of the Cancer Institute of Imam Khomeini hospital in Iran. Samples were selected using random allocation method with a block size of four. Data were collected on participants' demographic characteristics and salivary cortisol.

Methods

The educational intervention for patients in the control group was routine training and for patients in the intervention group was based on the training booklet approved by cancer specialists. Findings were analyzed using SPSS software version 21.

Findings

The mean age of participants in the intervention and control groups was 44.00 ± 11.45 and 42.62 ± 12.83 years, respectively . The mean score of anxiety in the intervention group was 18.85± 6.19 before intervention, and decreased to 7.40± 3.68 after intervention . The mean score of anxiety in the control group was 19.75 ± 7.26 and significantly decreased to 14.25 ± 5.73 at the end of the study.

Conclusions

The results showed that preoperative anxiety significantly decreased in both groups, but was lower overall in the intervention group. In fact, using an educational booklet to raise awareness about patients' health, surgery knowledge and postoperative care as well as how to adapt to postsurgery physical changes and to promote psychological support can reduce patients' anxiety. Hence, providing education to patients may be integrated as a complementary method in patients' routine education.

Section snippets

Methods

The present study is a randomized clinical trial. The aim of this study was to investigate the effect of preoperative education on salivary cortisol levels of 80 patients divided into two intervention and control groups (40 patients in each group) undergoing breast cancer surgery. Eligibility criteria included: age more than 18 years old, patients with a definitive diagnosis of breast cancer, first surgical experience, without a history of cancer in the family, not medical staff, ability to

Findings

The mean and standard deviation of the age of patients in the control and intervention groups was 44 ± 11.45 years and 42.62 ± 12.83 years, respectively. Also, the duration of disease in the control and intervention groups was14.57 ± 12.12 and 13.57 ± 10.58 months, respectively. Most patients (57.5%) in both groups were married. Also, 37.5% patients in the control group had elementary education and 35% in the intervention group had high school education. About half of the patients in the

Discussion

Evaluation of salivary cortisol level in patients undergoing breast cancer surgery before and after the intervention, and its intra and inter-group comparisons indicated high levels of cortisol in the saliva of participants in both groups before the intervention. The results also showed a significant difference in the mean levels of salivary cortisol in the intervention group before and after the training, while, in the control group, it was not statistically significant. A positive

Limitations

Intervening factors such as emotional support of the family, or economic concerns of the patient were out of the researcher's control. However, we tried to randomly distribute these intervening factors in the two groups in order to overcome this limitation. It should also be noted that there was a possibility of some undiagnosed mental illness or mild levels of depression that could affect the psychological and cognitive health of the patients. These factors could not be controlled by the

Conclusion

The results of this study demonstrated that providing information on patient's health, the surgery and postoperative care, and how to adapt to physical changes after the surgery, as well as psychological support can reduce physiological anxiety, which can be determined by measuring salivary cortisol level. Considering the importance of reducing anxiety in the process of breast cancer treatment, it is obvious that therapeutic interventions performed by nurses for reducing anxiety can play a

Acknowledgments

The researchers would like to express their appreciation to those who participated in this study. This article is a part of a master's degree thesis funded by the Research Deputy of Tehran University of Medical Sciences, Tehran, Iran (no:39582).

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    Conflict of Interest: None to report.

    Funding: This article is a part of a master degree thesis funded by the Research Deputy of Tehran University of Medical Sciences, Tehran, Iran (no:39582).

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