A study on the effectiveness of WeChat-assisted preoperative education to reduce perioperative anxiety in breast cancer patients: a prospective randomized controlled study protocol
Authors: Xiao Xiao , Zuo Yi-Ding , Kuang Shu-Yu , Liu Chu-Yuan , Wang Heng , Yan Si-Yu , Shao Kun , Yu Feng , Xu Yan , Zhou Li , Jiang Chun-Ling 
Published: May 2023

Abstract
Background: Breast cancer is the most prevalent cancer among women globally, and surgical procedures are still evaluated as the primary treatment. Faced with the unknown and fear of surgery, previous evidence highlights that over 50% of patients are trapped with preoperative anxiety. However, preoperative anxiety takes responsibility to a variety of diseases and body dysfunction. While drug therapy is widely recognized to tackle with preoperative anxiety, how it is used is still in heated debate, due to its own side effects. Therefore, non-pharmacological therapies to relieve anxiety, including using different methods to conduct preoperative education, gradually emerge and receive increasing attention. WeChat is a synthetical application integrating social media, instant messaging, mobile payment, and e-commerce functions. It is honored as one of the most popular social media platforms worldwide. And WeChat public platform has earned public's recognition as a handy way to transmit information, but whether it is an effective preoperative education tool has not been reported yet. Consequently, this study intends to use WeChat public platform as a tool to conduct preoperative education for persons undergoing breast surgery.
Methods: This is a prospective, randomized, and controlled trial. A total of 392 adult women undergoing breast cancer resection will be randomly assigned to the WeChat education group and the regular group. In addition to the regular preoperative visits, the WeChat education group will also watch science videos through a WeChat public platform preoperatively. The regular group only received regular preoperative visits and education by ward nurses. The main observation indicator is the incidence of preoperative anxiety defined as the scores of State Anxiety Inventory (SAI) more than 40 points. The secondary outcome indicators are the incidence of severe anxiety (SAI > 44) the day before surgery, incidence of anxiety 72 hours after surgery, incidence of severe anxiety 72 hours after surgery, NRS scores for pain at rest and during activity 24, 48 and 72 hours after surgery, incidence of nausea and vomiting within 24 hours after surgery, subjective sleep score at 1 week postoperatively, quality of life QoR-15 scores at 1 and 3 months postoperatively, incidence of chronic pain at 3 months postoperatively, bowel function recovery, length of hospital stay and hospitalization expenses.
Discussion: This is the first clinical trial attempting to deliver preoperative education on perioperative anxiety through WeChat public platform in breast cancer patients. Our study takes advantage of renowned WeChat public platform to improve the prognosis of patients by providing video education explaining the disease, surgery, and anesthesia preoperatively in a more susceptive way to reduce the incidence of perioperative anxiety. Once our hypothesis is confirmed, this immediate, handy, and flexible non-pharmacological approach may be universally acknowledged as a cost-effective and practical method in clinical care. Its application will also be extended to other fields beyond breast cancer.
Trial registration: ClinicalTrials.gov, NCT05291494. Registered on 29 December 2021.