Nonpharmacological Management of Preoperative Anxiety in Adults: A Systematic Review

This systematic review aimed to synthesize and evaluate the best available evidence on nonpharmacological strategies for managing preoperative anxiety in adults using the Joanna Briggs Institute (JBI) evidence-based framework. Systematic review. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we developed clinical questions and conducted comprehensive searches in guideline repositories, including UpToDate, BMJ Best Practice, American Society of Anesthesiologists, Association of periOperative Registered Nurses, National Guideline Clearinghouse, Registered Nurses Association of Ontario, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, and YimaiTong Clinical Guidelines. Additionally, we searched evidence databases, including the JBI Database, Cochrane Library, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and two major Chinese-language databases: China National Knowledge Infrastructure and Wanfang. Eligible evidence types included clinical guidelines, evidence-based texts, evidence summaries, best practice recommendations, and systematic reviews. The JBI quality appraisal tools, evidence preclassification system, and evidence recommendation grading framework were applied to assess the quality of the literature, extract and synthesize content, and classify the evidence. A total of 38 pieces of best evidence were extracted from 26 studies. The evidence was categorized into five dimensions: basic characteristics of preoperative anxiety, screening and evaluation, nonpharmacological prevention, nonpharmacological intervention, and outcome evaluation. Among them, 26 pieces of evidence were graded as Level I, 1 as Level II, 2 as Level III, and 9 as Level V. Regarding recommendation strength, 24 pieces of evidence were rated as strong (Grade A) and 14 as weak (Grade B). Various nonpharmacological strategies-such as screening, evaluation, patient education, cognitive behavioral therapy, and relaxation techniques-have demonstrated considerable effectiveness in reducing preoperative anxiety and improving patient outcomes. This study recommends that practitioners refer to this evidence summary, conduct a clinical audit of current practices in their institutions, and implement systematic quality improvements based on the best available evidence.