Psychological Stress Response and Postoperative Rehabilitation Quality of Intracranial Tumor Patients: Effect of Perioperative Psychological Care

Summary

This study investigates the impact of perioperative psychological care on psychological stress responses, postoperative recovery metrics, and complication rates in patients with intracranial tumors (ICTs). A randomized controlled trial design was employed to compare outcomes between patients receiving standard care and those receiving augmented psychological interventions.

Abstract

The aim of this study was to explore the impact of perioperative psychological care on patients with intracranial tumors (ICTs), so as to offer a reference for clinical practice. A total of 142 ICT patients, who were admitted to Shanxi Provincial People's Hospital from March 2023 to August 2024, were enrolled in this research. Among them, 75 patients received routine perioperative care (control group), while the other 67 patients were provided with perioperative psychological nursing (research group). The Self-rating Anxiety/Depression Scale (SAS/SDS) of both groups before and after nursing was compared, and the Connor-Davidson Resilience Scale (CD-RISC) was employed to assess patients' psychological stress responses. After nursing, the SAS and SDS scores of the research group were significantly lower compared with the control group, whereas the CD-RISC score was notably higher (P < 0.05). Moreover, the Pittsburgh Sleep Quality Index (PSQI), postoperative pain, and quality of life of the two groups were compared. Furthermore, lower Visual Analogue Scale (VAS) scores on postoperative days 3 and 5 were determined in the research group, with superior sleep quality and quality of life (P < 0.05). In conclusion, perioperative psychological care for ICTs can effectively ameliorate patients' negative psychological states and mitigate their psychological stress responses.

Introduction

Intracranial tumors (ICTs), recognized as the most prevalent malignancy in the central nervous system, predominantly originate in regions such as the pituitary gland, meninges, and central tissues. According to relevant statistical data, the average incidence rate of ICTs approximates 24.71 per 100,000 individuals globally¹. Due to their distinctive intracranial growth patterns, ICTs have a high propensity to compress or infiltrate the surrounding brain and nerve tissues. This, in turn, poses substantial challenges to the treatment of ICTs, concomitantly leading to a significant elevation in the risks of mortality and morbidity among patients². Meanwhile, influenced by a confluence of factors, including a series of symptoms like clinical consciousness impairments and psychiatric disorders triggered by nerve compression, coupled with the formidable difficulties in tumor treatment and the less than favorable prognosis, ICT patients commonly exhibit rather pronounced psychological stress issues³. In a survey investigating anxiety and depression among ICT patients carried out by Renovanz et al., it was ascertained that around 41% of the patients manifested overt symptoms of either anxiety disorders or depression⁴. The emergence and spread of these negative emotions yield multifaceted and far-reaching consequences. On the one hand, they will hinder the smooth progress of surgical procedures. On the other hand, they exacerbate postoperative pain experienced by patients, substantially increase the incidence of complications, and seriously delay the postoperative rehabilitation process. What's more, negative emotions may further affect patients' immune functions and inflammatory responses, precipitating a series of pathological alterations that ultimately result in unfavorable prognostic outcomes⁵. This is supported by substantial evidence linking preoperative anxiety and depression to poorer surgical outcomes, including increased postoperative pain intensity and analgesic requirements⁶, higher risk of complications such as infections and delayed wound healing⁷, prolonged hospital stays⁸, and reduced quality of life during recovery⁹. In light of these circumstances, it is emphasized in clinical practice that throughout the treatment of ICT patients, one should not only focus on ameliorating their pathological states but also place a premium on implementing psychological intervention strategies, thereby holistically enhancing both the treatment efficacy and rehabilitation quality of patients¹⁰.

However, conventional nursing models frequently neglected to pay due attention to the mental and psychological well-being of patients, making it difficult to meet the modern treatment requirements of ICTs¹¹. Recently, some researchers have put forward new nursing suggestions for ICTs. For instance, the study by Bao X et al. indicated that evidence-based nursing can enhance the quality of life of ICT patients with heart failure¹². Dağdelen D et al. proposed a family nursing based on the dependency care theory, which can improve the neurological and cognitive functions of ICT patients after surgery¹³. Nevertheless, these studies mainly focus on improving the overall rehabilitation quality of patients through more comprehensive and personalized nursing strategies, while relevant reports on psychological intervention for ICT patients are still relatively scarce.

To address this limitation, this study will conduct a preliminary analysis by examining the impact of perioperative psychological care on ICT patients. The aim is to provide references and guidance for future clinical practice in formulating a nursing model targeted at improving the psychological state of ICT patients, thereby comprehensively improving their prognoses.

Protocol

This study has been approved by the ethics committee of Shanxi Provincial People's Hospital (No. 2025521) and was conducted in strict accordance with the Helsinki Declaration.

1. Research subjects

ICT patients admitted to Shanxi Provincial People's Hospital from March 2023 to August 2024 were selected for retrospective analysis. The required sample size was calculated using the formula: N = Z² × [P × (1 - P)] / E². The calculation indicated that a minimum of 96 research subjects were needed (parameter settings: Z = 1.96, E = 10%, P = 0.5). After screening according to inclusion and exclusion criteria, 142 ICT patients were enrolled. Among them, 75 patients who received routine perioperative care were included as the control group, and 67 patients who received perioperative psychological care were included as the research group.

2. Inclusion and exclusion criteria

1. Inclusion criteria
   Patients were included if they had a confirmed diagnosis of intracranial tumors (ICTs), specifically pituitary tumors, based on clinical examination. Additional requirements included normal consciousness with good compliance and the availability of complete clinical data.
2. Exclusion criteria
   Patients were excluded if they had other tumors, a history of previous acute ischemic or hemorrhagic stroke, secondary cerebral hemorrhage following surgery, or if they were pregnant or lactating.

3. Procedure

1. Control group
   Before surgery, patients were guided and assisted in completing routine examination items. Health education on surgical knowledge, including surgical procedures and postoperative precautions, was conducted two days before surgery. One day before surgery, family members were instructed to prepare surgical items. On the day of surgery, preoperative preparation was verified, and patients were transferred from the ward to the operating room and handed over to the operating room nurse. Postoperatively, after regaining consciousness, patients received clinical interventions such as vital sign monitoring, body position management, pain management, and rehabilitation nursing in accordance with the standardized nursing protocol until discharge.
2. Research group
   In addition to routine care, the research group received enhanced perioperative psychological care. Two days before surgery, the attending physician and the responsible nurse provided health education in the ward. Each session lasted approximately 30 min. The physician explained disease knowledge and surgical procedures, supplemented with animated video demonstrations, while the nurse provided guidance on postoperative rehabilitation. Patients were encouraged to narrate their experiences, emotional changes, and attitudes toward surgery. Mindfulness meditation training was introduced to relieve negative emotions prior to surgery. Postoperatively, individualized pain management was implemented. Along with routine NSAID use (e.g., parecoxib 40 mg IV twice daily for 48 h), pain intensity was assessed hourly using the Visual Analogue Scale (VAS). For VAS ≥4, additional analgesics (e.g., tramadol) were administered as prescribed, and non-pharmacological interventions (abdominal breathing, soothing music, cold compress, or psychological comfort) were applied immediately, with intervention effects recorded¹⁴.
   Postoperative rehabilitation included family-assisted brain function assessment, education on rehabilitation training, and emotional support. Vital signs were monitored hourly for the first 24 h, then every 4 h. Pivot reversal was initiated 6 h postoperatively with nursing guidance. Rehabilitation training began on postoperative day 1 with passive/active in-bed movements, and ambulation was introduced on postoperative day 2.
   Psychological support included mindfulness meditation (20 min standardized recorded session focusing on breath awareness and body scanning) to alleviate anxiety¹⁵. Daily preoperative psychological interventions were conducted from admission until surgery. From the second postoperative day, patients were encouraged to engage in 10-15 min of peer communication in the ward if physically permitted¹⁶.
   In cases of significant negative emotions (continuous crying, refusal to communicate, high VAS scores without a physiological cause), in-depth family-centered communication was conducted within 24 h to develop support plans. Ward rounds were increased to once every 2 h for the first three postoperative days, with each round including at least 5 min of active communication to address patient and family concerns.

4. Questionnaire survey

Psychological and quality-of-life assessments included the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)¹⁷, Connor-Davidson Resilience Scale (CD-RISC)¹⁸, and Pittsburgh Sleep Quality Index (PSQI)¹⁹. Assessments were conducted at admission and discharge. Pain assessment was performed using the VAS²⁰on postoperative days 1, 3, and 5. Quality of life was evaluated with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)²¹, covering eight dimensions: Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role-Emotional (RE), and Mental Health (MH). Nursing satisfaction was assessed with an anonymous 100-point questionnaire. Scores ≥80 indicated high satisfaction, scores between 65-79 indicated moderate satisfaction, and scores <65 indicated dissatisfaction. Total satisfaction = highly satisfied cases + moderately satisfied cases.

5. Sample collection and detection

Fasting venous blood samples were collected before and after nursing interventions. Norepinephrine (NE), cortisol (Cor), and epinephrine (E) were measured using an automated chemiluminescence analyzer.

6. Statistical analysis

Data were analyzed using SPSS 22.0. Measurement data were expressed as mean ± standard deviation (x̄ ± s) and compared using the t-test. Count data were presented as rates (%) and compared using the χ² test. A P-value < 0.05 was considered statistically significant.

Results

Psychological status
The two groups were not markedly different in the SAS, SDS, and CD-RISC scores before nursing (P > 0.05). After nursing, both groups exhibited a reduction in the SAS and SDS scores, with those of the research group being even lower compared to the control group (P < 0.05). Moreover, in the control group, the scores for optimism and the total score of the CD-RISC increased after nursing (P < 0.05), whereas the scores for resilience and strength remained unaltered (P > 0.05). In the research group, the scores of all the CD-RISC dimensions elevated after nursing and were also higher than those of the control group (P < 0.05, Table 1).

Stress response
Before nursing, there was likewise no difference in the detection result of NE, Cor, and E between the two groups of patients. After nursing, the levels of NE, Cor, and E in both groups were elevated, with those in the research group being lower than those in the control group (P < 0.05). Additionally, there was no difference in the VAS score between the two groups on the first day after surgery (P > 0.05). However, on the third and fifth days after surgery, the VAS of the research group was lower than that of the control group (P < 0.05, Table 2).

Sleep quality
The PSQI survey results indicated that the scores for sleep quality, sleep efficiency, daytime dysfunction, and sleep medication in the control group decreased after nursing (P < 0.05). In contrast, the scoring results of all the PSQI items in the research group decreased; moreover, the scores of all dimensions, except for the sleeping medication score, were lower in the research group than in the control group (P < 0.05, Table 3).

Quality of life
After the nursing intervention, there was no significant difference in the comparison of the RP and BP scores obtained from the SF-36 questionnaires between the two groups (P > 0.05). However, the research group showed higher PF, GH, VT, SF, RE, and MH scores than the control group (P < 0.05, Figure 1).

Postoperative safety
Upon counting postoperative complications, it was determined that the overall incidence rate was 10.45% in the research group and 24.00% in the control group. The incidence rate of postoperative complications in the research group was significantly lower than that of the control group (P < 0.05, Table 4).

Nursing satisfaction
Finally, the results of the nursing satisfaction survey demonstrated that the total satisfaction rate of the research group was 91.04%, which was substantially higher than the 74.67% of the control group (P < 0.05, Table 5).

DATA AVAILABILITY:
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Figure 1: Comparison of quality of life. Results of the SF-36 questionnaire after surgery in both patient groups. P < 0.05; ns = not significant (P > 0.05). Please click here to view a larger version of this figure.

Figure 2: Impact of perioperative psychological care on patients with ICTs. Please click here to view a larger version of this figure.

Table 1: Comparison of psychological status. Compared with before nursing, ^aP < 0.05. Please click here to download this Table.

Table 2: Comparison of stress response. Compared with before nursing, ^aP < 0.05; compared with 1 day after surgery, ^bP < 0.05; compared with 3 days after surgery, ^cP < 0.05. Please click here to download this Table.

Table 3: Comparison of sleep quality. Compared with before nursing, ^aP < 0.05. Please click here to download this Table.

Table 4: Comparison of postoperative safety. Please click here to download this Table.

Table 5: Comparison of nursing satisfaction. Please click here to download this Table.

Discussion

In this research, perioperative psychological care was found to effectively improve the psychological state of patients with ICTs and enhance postoperative recovery (Figure 2). These findings provide a more reliable safety guarantee for the future treatment of ICTs.

First, the psychological status of patients was analyzed. After nursing, the SAS and SDS scores of the research group decreased while the CD-RISC score increased, consistent with the findings of Song et al.²². The reason is that psychological care intervention, as a comprehensive nursing approach, not only provides targeted psychological counseling but also enables diversified psychological care interventions on the basis of continuously improving nursing concepts. In addition, various methods can be flexibly applied to deliver care according to the actual situation and to carry out targeted nursing services based on individual differences^23,24. Psychological care embodies humanistic values by addressing social knowledge, thereby ensuring a good mental state, enhancing treatment confidence, significantly boosting treatment enthusiasm, and effectively ameliorating adverse psychological conditions and disease symptoms.

From a physiological perspective, the body's stress response typically stimulates the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal medullary endocrine axis, thereby raising Cor levels and accelerating catecholamine production²⁵. Psychological care mitigates this stress through relaxation training, effectively reducing anxiety, fear, and tension. Such negative emotions often stem from a limited understanding of the condition and the upcoming surgery. Relaxation techniques promote physical and mental calmness, reduce sympathetic nervous system activity, and may increase levels of natural pain-relieving substances such as enkephalin. Consequently, stress tolerance improves, patients approach surgery more positively, and stress responses are effectively reduced^26,27.

According to Peters M, psychological care, through collective intervention and counseling, helps release internal stress, eliminate negative mental states, and reduce psychological pressure. As a result, patients' confidence in overcoming the disease strengthens, their mental state is stabilized, and disease management becomes more active²⁸. Furthermore, family and social support provide patients with care from relatives and friends, create a sense of familial warmth, and ensure access to social assistance. This not only facilitates early reintegration into society but also regulates emotions, promotes psychological resilience, and enhances sleep quality^29,30. Such assistance maintains a positive treatment mentality and reduces psychological stress responses both psychologically and physiologically.

In the quality-of-life survey after nursing, the SF-36 questionnaire results of the research group were superior. Perioperative psychological care thus established a more reliable foundation for the postoperative rehabilitation of ICT patients. Implementation of perioperative psychological care can mobilize inner resilience through diverse psychological activities and remove psychological barriers through various counseling measures, thereby enhancing the clinical intervention effect and improving prognosis. In a study on psychological care for advanced cancer patients, Xu S et al. reported a similar view³¹. Meanwhile, the increased nursing satisfaction observed in the research group also confirms that perioperative psychological care has a remarkable effect on perioperative nursing for ICTs. This effect is not only reflected in improvements in pathology, physiology, and psychology but also in positive feedback from patients to medical staff. Such outcomes are of substantial significance for realizing the clinical goal of comprehensively optimizing the quality of ICT-associated medical services.

The decreased incidence of postoperative complications in the research group further indicates that perioperative psychological care is beneficial for the postoperative safety of ICT patients. This may be attributed to the ability of psychological care to address inducing factors of negative emotions, alleviate postoperative pain, optimize the guiding effect of rehabilitation training, and regulate postoperative emotions, thereby providing a psychological foundation for active rehabilitation interventions and reducing the risk of surgery-related complications. The findings of Pidd et al., showing that psychological care for pregnant women after traumatic childbirth can effectively prevent postpartum complications³², provide additional support for these results.

The advantages of this nursing program lie in its structured framework and relatively clear process, which makes it suitable for promotion in hospitals with basic psychological nursing resources. Core interventions (such as standardized health education, mindfulness recording guidance, and VAS assessment) can be delivered by trained nurses without reliance on psychotherapists throughout the process, thereby reducing the threshold for implementation. Key training needs include nurses' mastery of basic communication skills, mindfulness guidance, VAS assessment, non-drug analgesia methods, and guiding principles of family support. Doctors are expected to be familiar with the main points of psychological education related to the disease and surgery.

The program also demonstrates adaptability. Health education materials can be adjusted according to patients' education level, the duration of mindfulness training can be fine-tuned, and the intensity of family intervention can be tailored to the family support system. The major challenges involve ensuring sufficient staff time commitment and continuity of intervention, which can be addressed by optimizing workflow and strengthening team collaboration (e.g., psychological specialists supporting nurses).

As this study is a single-center retrospective analysis with a limited number of cases and observation indicators, the representativeness and comprehensiveness of the results are inevitably limited. Increasing the sample size and conducting randomized controlled trials are necessary to further validate the impact of perioperative psychological care on ICTs. Prognosis also represents a crucial aspect that requires attention. Because prognostic follow-up was not conducted in this study, the impact of psychological care on long-term outcomes of ICTs could not be assessed. Extending the study period in future work will be essential to evaluate the effects of psychological care on long-term prognosis.

In conclusion, this study validated the impact of a perioperative care program integrating multi-dimensional, structured psychological interventions on patients with ICT. Implementing perioperative psychological care effectively alleviates negative psychological states and stress responses while enhancing postoperative rehabilitation and safety. Through its structured design, multi-component integration, and emphasis on patient support systems, this program provides an innovative and scalable nursing model for improving the quality and safety of perioperative rehabilitation in ICT patients.

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Automatic chemiluminescence analyzer	Cobas	5800	The cobas 5800 System is a compact, fully automated molecular system that balances a broad menu and testing efficiency with flexible workflows and ease-of-use.
GraphPad Prism	GraphPad Software	v9.0.0	Drawing software
SPSS	IBM	v23.0	Statistical analysis software