Anxiety, Physiological Parameters, Patient Satisfaction and VR in Gynecological Oncology Surgery

Preoperative anxiety is a common and preventable psychological condition that significantly affects surgical outcomes and patient well-being. Women undergoing gynecologic oncology surgery often face elevated levels of anxiety due to the severity of their diagnosis, potential loss of reproductive organs, and concerns related to survival, body image, and sexuality. These psychological stressors can lead to physiological changes such as increased blood pressure, heart rate, and respiratory distress, which in turn may complicate surgical procedures and recovery. Managing preoperative anxiety effectively is essential not only to minimize surgical risk but also to improve patient satisfaction and postoperative adaptation.

Pharmacological methods used to manage preoperative anxiety can carry risks such as side effects, drug interactions, and delayed postoperative recovery. For this reason, non-pharmacological interventions such as virtual reality (VR) have gained popularity in recent years. VR allows patients to be immersed in a multisensory virtual environment that helps distract their attention away from surgery-related fears and fosters relaxation. Studies in orthopedic, colorectal, and minor gynecologic procedures have shown that VR can reduce anxiety and improve physiological responses before surgery. However, limited evidence exists regarding its use in women undergoing gynecologic oncology surgery-a population that faces unique psychological and physical challenges.

This study is a two-arm randomized controlled trial designed to evaluate the effectiveness of a virtual reality (VR) intervention in reducing preoperative anxiety and stabilizing physiological parameters in women scheduled for gynecologic oncology surgery via laparotomy. A total of 66 participants will be randomly assigned to either the intervention group (VR session) or the control group (standard care). In both groups, anxiety levels and physiological parameters (blood pressure, heart rate, respiratory rate, and oxygen saturation) will be assessed before and after the intervention. Patient satisfaction with preoperative care will be assessed only once, following the intervention or standard care session, immediately before surgery.

Eligibility criteria include adult women (≥18 years) with a confirmed diagnosis of gynecologic cancer who are aware of their diagnosis and scheduled for their first surgical intervention via laparotomy. Participants must have an ECOG Performance Status ≤2 and must not have any cognitive, visual, auditory, or psychiatric impairments that could interfere with communication or VR use. Exclusion criteria include recurrent cancer, motion sensitivity (e.g., vertigo or migraines), or any condition preventing the use of VR headsets.

The study aims to contribute new evidence supporting the use of VR as a nurse-led, low-risk, and effective non-pharmacological approach to improve preoperative experiences and perioperative outcomes in women facing gynecologic oncology surgery.

Inclusion criteria

• The participant must have a confirmed diagnosis of gynecological cancer.
• The participant must be aware of their gynecological cancer diagnosis.
• Participants must be 18 years of age or older.
• Verbal and written informed consent to participate in the study must be obtained.
• The participant must be able to communicate verbally and in writing in Turkish.
• No communication impairments (e.g., visual, auditory, or cognitive) should be present.
• This must be the participant's first surgical intervention related to gynecological oncology.
• Eastern Cooperative Oncology Group (ECOG) Performance Status must not exceed 2.
• The planned surgical procedure must be a laparotomy.

Exclusion criteria

• History of recurrent gynecological cancer.
• Presence of vision problems that prevent the use of VR goggles, including participants who wear glasses or have uncorrected vision impairment.
• Presence of conditions such as migraines, vertigo, active nausea, vomiting, or frequent headaches.
• Sensitivity to motion sickness.
• Diagnosis of a psychiatric condition, whether under pharmacological or non-pharmacological treatment.
• Withdrawal of consent during the study.
• Removal of the virtual reality headset during the intervention.
• Development of any medical complications during the intervention period.