Development of a survey evaluating patient Concerns Over Peri-operative Events (COPE)

Anxiety frequently burdens patients before surgery, potentially leading to poorer recovery. However, standard assessment tools typically quantify the intensity of this distress without understanding its root cause. This often leaves clinicians unaware of the specific fears driving a patient's anxiety. We aimed to address this deficit by developing and validating a questionnaire designed to identify individual pre-operative concerns. An iterative development process resulted in a 14-item questionnaire: Concerns Over Peri-operative Events (COPE). We conducted a prospective evaluation of 52 patients having elective surgery, measuring the questionnaire's performance against the Amsterdam Pre-operative Anxiety and Information Scale. The questionnaire performed well on metrics of validity, reliability and acceptability. Severe pain was the most reported concern. The median (IQR [range]) total COPE score was 30 (22-44 [14-63]). There was a positive correlation between the Amsterdam Pre-operative Anxiety and Information Scale and COPE scores. A classification model to predict Amsterdam Pre-operative Anxiety and Information Scale-positive status demonstrated excellent discrimination with an area under the curve of 0.86. An optimal COPE score of ≥ 34 demonstrated 88% sensitivity and 81% specificity. While future research should focus on generalisability, this novel questionnaire of patient concerns facilitates the identification of specific drivers of pre-operative anxiety. By bridging the gap between clinicians' assumptions and patient experience, the COPE questionnaire may facilitate targeted therapies and improve informed consent.