The real experience and coping styles of emergence delirium in patients after radical lung cancer surgery: a qualitative study

Emergence delirium (ED) is a prevalent and complex complication in the post-anesthesia care unit (PACU) that significantly impacts patients undergoing radical lung cancer surgery. Despite its high incidence, the subjective experience of ED, along with patients' coping strategies and support needs, remains insufficiently understood. This study aims to address this gap by exploring the real experiences of patients who develop ED following radical lung cancer surgery.

To gain an in-depth understanding of the real experience of emergence delirium in patients after radical lung cancer surgery, a qualitative descriptive phenomenological study was conducted at a tertiary hospital in Sichuan, China. Semi-structured in-depth interviews were performed with 15 patients who experienced ED after radical lung cancer surgery. Data were analyzed using Colaizzi's seven-step method to extract significant statements and formulate themes.

Participants described ED as a distressing experience characterized by intense perceptual disturbances, including audiovisual hallucinations, temporal-spatial and situational disorientation, and uncontrollable behavioral abnormalities. Participants described complex emotional responses during the episode: most reported intense fear, anxiety, and anger during the acute phase, followed by persistent feelings of shame and guilt after the episode, while a minority exhibited neutral or even euphoric moods. Coping patterns diverged: some chose to avoid and forget the experience, while others actively sought to understand its causes. Furthermore, ED episodes resulted in significant lasting consequences, including varying degrees of memory impairment, damaged self-esteem, and fear of recurrence. Finally, participants consistently expressed unmet support needs, primarily family companionship, psychological counseling, and clear explanations about ED from healthcare providers.

ED is experienced by patients as a complex event marked by intense perceptual disturbances, loss of bodily control, and profound negative emotions including fear and shame. Patients mobilize both avoidant and positive meaning-seeking coping strategies. These findings underscore the urgent need for systematic ED screening, acute-phase acceptance-based bedside care, clear post-episode communication, family involvement, and individualized follow-up to support comprehensive psychological and physical recovery.