Does the Preoperative Anxiety Decrease With BATHE Method? A Prospective Randomized Study
Phase: NA
Conditions: Anxiety State
Sponsor: Izmir Ataturk Training and Research Hospital

 
 
Cover Page  
Manuscript Title: Does the preoperative anxiety decrease with BATHE method? A prospective 
randomized double blind study 
 
 
We used Bathe method during preoperative evaluation to decrease anxiety. 
We found out that in the group in which BATHE interview was applied, anxiety decrease was 
meaningful statistically. 
 
We observed that patient satisfaction was high in the group that was approached by BATHE 
method, but this was not statistically significant.  
These results encouraged us to use BATHE method as a part of our routine preoperative 
evaluation process at our institution. 
 
 
Sincerely 
Dr Derya Arslan Yurtlu, MD 
E-mail: darslanyurtlu@yahoo.com  
 
 
 

STUDY PROTOCOL                                                                                                Date:26.11.2015 
 
Participants and Procedure 
Before the study, approval from the ethics committee of Katip Celebi University Faculty of Medicine 
was received. 463 patients were included in the prospective randomized double blind study. To accept 
to be involved in the study, being above 18 years old and being literate were the criteria necessary to 
be involved in the study. Exclusion criteria were listed as below: Not to accept to be involved in the 
study, being under 18 years old, being illiterate, having been diagnosed a psychiatric illness, having a 
physical/psychiatric trauma within the last one year, using sedative, antidepressant, antiepileptic 
substances or drugs, having cooperation, understanding or hearing problems, belonging to American 
Society of Anesthesiologists (ASA) physical situation (PS) III and above.  
STAI Analysis 
By randomization using the closed envelope technique, the envelopes have been prepared beforehand 
the patient examination. Sealed envelopes contained a specific number and a patient group defined for 
this number. Thus, patients were divided into two as ‘bathe group’ and ‘control group’ by simple 
randomization method and they were given one of these closed envelopes respectively. 
The demographic data of the patients which included their names-surnames, gender, age, educational 
background, income level, their previous anesthesia experience (no experience, with general 
anesthesia experience, with regional anesthesia experience, with both general and regional anesthesia 
experience) have been questioned. Following this, STAI anxiety questionnaire that was validated to 
Turkish language by Oner et al. has been applied in order to learn the patients’ anxiety levels before 
preoperative evaluation and the result has been recorded as entrance STAI(Appendix 1). Since we 
aimed to decrease operation anxiety of the patients, we only used state anxiety scale at that moment. 
After then, patients have been taken to anesthesia examination room. 
BATHE technique 
 All the patients were evaluated before the anaesthesia. Later, by opening the envelope of the patient, 
his/her group has been learned. Feedback has been given with empathetic statements to those in 

BATHE group after key questions and they have been informed about the possible outcomes 
(Appendix-2). Bathe questions have been modelled by Hepner et al. and have been modified in order 
to be used in perioperative period.  It was validated to Turkish language by Akturan et al. For the 
patients in the control group, the interview ended by routine preoperative evaluation (without applying 
BATHE technique).  
Satisfaction Questionnaire 
 At the end of the examination, the STAI anxiety questionnaire (Exit STAI) was repeated for patients 
to measure their anxiety levels. In addition, satisfaction questionnaire, which was prepared by Leiblum 
et al., was also applied (Appendix-3). Patients have been asked to rate their satisfaction level by using 
five point Likert scale. At the end, the bathe method has also been applied to the patients in control 
group as well. The reason for this procedure was to prevent the discrimination of the control group. 
Obviously, this did not change the results of the study as the satisfaction questionnaire was applied 
before the BATHE technique procedure for the control group.  
The flowchart of the study is shown in Figure 1. 
Statistical Analysis 
Data has been evaluated by SPSS 22. STAI and satisfaction levels are expressed as mean values and 
standard deviations. They are compared by using the Student t test and ANOVA. On the other hand, 
the relationship among STAI, satisfaction level and age is expressed as correlation. 
 
 
 
 
 
 
 

APPENDIX 
Appendix  1. STAI questionnaire 
  
  
Not 
at all Somewhat Moderately so 
Very 
much 
so 
1 
I feel calm 
  
  
  
  
2 
I feel secure 
  
  
  
  
3 
I am tense 
  
  
  
  
4 
I am regretful 
  
  
  
  
5 
I feel at ease 
  
  
  
  
6 
I feel upset 
  
  
  
  
7 
I am presently worrying about possible 
misfortunes 
  
  
  
  
8 
I feel rested 
  
  
  
  
9 
I feel anxious 
  
  
  
  
10 I feel comfortable 
  
  
  
  
11 I feel self-confident 
  
  
  
  
12 I feel nervous 
  
  
  
  
13 I am jittery 
  
  
  
  
14 I feel "high strung" 
  
  
  
  
15 I am relaxed 
  
  
  
  
16 I feel content 
  
  
  
  
17 I am worried 
  
  
  
  
18 I feel over-excited and rattled 
  
  
  
  
19 I feel joyful 
  
  
  
  
20 I feel pleasant  
  
  
  
  
 

Appendix  2. BATHE method questions 
 
 
 
Original questions 
Modified questions 
B 
Background What is going on in your life? 
What brings you here? 
A 
Affect  
“How do you feel about that?” or 
“What is your mood?” 
How have you felt about the idea 
of having surgery? 
T 
Trouble 
“What about the situation troubles 
you the most?” or “Is there 
anything about that that troubles 
you?” 
What about the surgery worries 
you most? 
H 
Handling 
“How are you handling that?” or 
“How could you handle that?” 
How are you handling that? 
E 
Empathy  
“That must be very difficult for 
you.” 
It’s perfectly normal to be 
nervous about surgery. Let me 
explain what will happen on the 
day of your surgery 
 
 
 
 
 
 
 
 
 
 
 
 

Appendix 3. Satisfaction Questionnaire 
  
  
Very 
bad 
Bad Middle  Good 
Very 
good 
1 
Friendliness/courtesy of your doctor 
  
  
  
  
  
2 
Explanations your doctor provided about any 
problem/condition you may have 
  
  
  
  
  
3 
Concern your doctor showed for your 
questions/worries 
  
  
  
  
  
4 
Your doctor’s efforts to include you in decisions 
about your treatment 
  
  
  
  
  
5 
Information your doctor gave you about your 
medications 
  
  
  
  
  
6 
Instructions your doctor gave you about follow-up 
care 
  
  
  
  
  
7 
Degree to which your doctor talked with you using 
words you could understand 
  
  
  
  
  
8 
Amount of time your doctor spent with you 
  
  
  
  
  
9 
Your confidence in this doctor 
  
  
  
  
  
10 
Likelihood of your recommending this doctor to 
others 
  
  
  
  
  
11 
Please rate your overall satisfaction with today’s 
visit to your doctor 
  
  
  
  
  
 
 
 

 
 
                 Figure 1. Study flow chart 
 
 
 
 
 
 
 
 
 
 

PATİENT DATA 
 
Patient  ID: 
Name:                                             Surname:   
Sex:                                                Age: 
               
Education:   
o 1. First Degree     
o  2. High Shcool      
o  3. University     
o 4. Postgraduate 
Operation Type:  
o 1.General Surgery  
o 2. Neurosurgery  
o 3. Orthopedic Surgery  
o 4. The others 
Level of income:  
o 1. Low                   
o  2. Moderate              
o   3. High 
Marital status :   
o 1. Single:              
o   2. Married:                 
o  3.  Divorced       
Anesthesia Experience:  
o 1. None    
o  2. General Anesthesia    
o 3. Regional Anesthesia    

Doctor experience in occupation:     
o <15 year    
o  >15 year     
      
State Trait Anxiety İnventory Score (30 minute before preoperatif evaluation) 
:…………………….Point 
 
All patients were evaluated preoperatively 
o Bathe group (Bathe method was applied to during evaluation in Bathe group) 
o Non bathe group 
 
State Trait Anxiety İnventory Score (30 minute after preoperatif evaluation) 
:…………………………Point 
 
Satisfaction Questionnaire:  
o 1. Very bad    
o 2. Bad    
o  3. Middle    
o 4. Good   
o   5. Very good