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Randomized Controlled Trial
. 2025 Jun 19;33(7):599.
doi: 10.1007/s00520-025-09659-4.

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

Noosareena Wanchitnai  1 , Sasima Tongsai  2 , Woraphat Ratta-Apha  3 , Ratree Chimchalong  1 , Suebwong Chuthapisith  4 , Watanachai Klankluang  5
Affiliations
Randomized Controlled Trial

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

Noosareena Wanchitnai et al. Support Care Cancer. .

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.

Keywords: Breast cancer; Expressive writing diary; Mixed methods research; Preoperative anxiety.

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Conflict of interest statement

Declarations. Ethical approval: The study was conducted in compliance with the Declaration of Helsinki (1996) and adhered to all applicable ethical guidelines. Ethical approval was obtained from the Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University (Reference No. Si-594/2021). Consent to participate: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

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