The effectiveness of an expressive writing diary on preoperative anxiety in breast cancer patients undergoing surgery: a mixed methods intervention design

Abstract

Purpose: This study examined the effectiveness of an expressive writing diary (EWD) in reducing preoperative anxiety among breast cancer patients awaiting surgery. It also explores patient experiences in both EWD and the relaxing diary (RD) groups, with an emphasis on anxiety levels and writing engagement. Methods: We employed a mixed methods intervention design in a randomized controlled trial of 30 breast cancer patients. The participants were assigned to either the EWD (intervention) or RD (control) group. Preoperative anxiety levels were measured via the State-Trait Anxiety Inventory before and after in both groups. Qualitative data were then analyzed to investigate patient experiences. Results: The EWD and RD significantly reduced preoperative anxiety. However, the EWD yielded a greater reduction (mean difference = 5.1; 95% CI − 1.7, 11.9). The qualitative findings indicated that the EWD offered a structured outlet for emotional expression. This approach fostered heightened emotional awareness, personal growth, and transformation. In contrast, RD participants reported difficulty engaging, largely because of insufficient structure and guidance. Conclusion: Both the EWD and RD effectively reduced preoperative anxiety in breast cancer patients, although the EWD had stronger effects. Moreover, the EWD increased patients’ emotional well-being and quality of life prior to surgery. Thus, an EWD may serve as a valuable supplement to preoperative care.