Psychological preparation as a method of reducing the stress of surgery

Studies of the preparation of adult patients for surgery are reviewed. While many show that preparation reduces stress, the studies are criticized for methodological and conceptual inadequacies. In particular, studies often fail to measure a range of stress responses, and also fail to provide measures over a sufficient time span to fully assess the effect of preparation on stress responses which are known to have differing rates of responsiveness. The experimental study was specifically designed to overcome these problems. Eighty patients undergoing a minor gynecological operation (laparoscopy for sterilization or infertility investigation) were allocated to one of three groups: routine care only (Control 1); routine care plus a minimally informative preparatory booklet (Control 2); or routine care plus a maximally informative preparatory booklet (Experimental group). Patients in the special preparation condition showed lower stress responses on measures of preoperative anxiety. At both one- and six-week follow ups they showed reduced state anxiety and elevated postdischarge vigor scores. They also showed less pain after surgery and recovered faster in hospital and in the first six days after going home. They returned to normal activities faster than patients in the two control groups. There were no differences on measures of postoperative symptoms, medication use, or reported time to return to normal health. The results are discussed in terms of previous studies of psychological preparation, and current concepts of stress. Suggestions for the design of preparatory interventions are made which match the type and timing of the intervention to the target stress response.