Effects of Mobile-based Mindfulness Intervention to Reduce Preoperative Anxiety for Patients Undergoing Elective Surgery: A Pilot Randomized Controlled Trial

Preoperative anxiety is a common phenomenon being reported in 60-80% of patients who are undergoing a surgical procedure and it was shown to be associated with negative postoperative outcomes such as suboptimal pain control, sleep disturbances, delayed wound healing, prolonged length of hospitalization and dissatisfying patients' hospitalization experience as a result. The current practice being adopted to minimize the level of anxiety in preoperative patients includes pharmacological and non-pharmacological approach. Pharmacological interventions include sedative and anti-anxiety drugs can be used before an operation to improve patient's emotion, however, studies have shown that adverse reactions on respiratory and central nervous system may be encountered, leading to a negative outcome of the operation. On the other hand, non-pharmacological interventions such as spiritual support, hypnosis, acupuncture, interview, cognitive behaviour therapy (CBT) and meditation are shown to be an effective strategy to alleviate the preoperative anxiety by anesthesiologists.

Mindfulness is a meditation concept originally introduced from India and has been developed into a structured approach for stress reduction treatment, nowadays commonly being adapted in both clinical and non-clinical setting. Mindfulness-based interventions (MBIs) have demonstrated efficacy in improving various clinical outcomes especially in reducing stress and anxiety. Mindfulness-based stress reduction (MBSR) program is a well-known MBI widely being used in various clinical conditions include the management on chronic pain, cancer, vascular disease and preoperative anxiety. However, traditional MBIs programs are extensive and required face-to-face training conducted by a well-trained qualified instructor. The standard MBSR program is intensive, consists of a 2.5 hours weekly group-based face-to-face classes lasting for 8 weeks plus a one full day retreat at the end of the program. Taking into consideration of the long duration and a certified instructor are required for the standard MBSR training program, delivery of mobile-based mindfulness interventions via the mobile app was introduced as an alternative platform to practice mindfulness making it feasible, accessible, acceptable and inexpensive in reducing psychological distress.

According to the systematic review, positive impact of mobile-based mindfulness interventions with the enhancement on mental health treatment was found and mobile-based mindfulness interventions were also found to be promising as an adjunct intervention only to improve mindfulness skills and depressive symptoms. In view of the inconsistency of clinical outcomes on mobile-based mindfulness interventions among systematic reviews, a randomized controlled trial to examine the effectiveness of mobile-based mindfulness interventions for reduction of preoperative anxiety need to be studied in local context. Furthermore, the effects of mobile-based mindfulness interventions on preoperative anxiety have been understudied in Chinese population and the recent systematic review has not identified in any Chinese study.

The aim of study is to examine the effects of mobile-based mindfulness intervention to reduce preoperative anxiety for patients undergoing elective surgery. We hypothesize that compared to standard care group, delivery of mobile-based mindfulness intervention can reduce preoperative anxiety for patients undergoing elective surgery.

A parallel-arm (mobile-based mindfulness intervention vs. usual care [active control]) randomized controlled trial (RCT) will be adapted in this study as RCT is the best study design to control for confounders.