Preoperative identity Threat and Illness Perception in Patients Undergoing Resection of Intracranial Tumours: A Multidimensional Cross-sectional Study Using Validated Psychometric Instruments

Abstract

Objective: Patients awaiting intracranial tumour resection frequently experience substantial psychological distress that may influence treatment-related decision-making. Although illness perception and psychological distress have been investigated but evidence regarding their association with preoperative decisional conflict remains limited. We aimed to evaluate preoperative illness perception, psychological distress, perceived social support, and decisional conflict in patients undergoing intracranial tumour resection, and to determine the associations between them using validated psychometric instruments.

Methods: The initial results of an on-going prospective cross-sectional analytical study being conducted at the Department of Neurosurgery, Unit-1 at Punjab Institute of Neurosciences, Lahore from May to June 2026 are presented. Radiologically confirmed patients, scheduled for elective craniotomy for intracranial tumours with age >18 years were recruited. Informed consent was obtained and in-person interviews using validated psychometric instruments were conducted along with a standardized clinical and demographic data sheet. Descriptive analysis was done using measures of central tendency. With an anticipated prevalence of 21.7%, calculated sample size was 262. As the results submitted in abstract were preliminary, the data collection is ongoing and we have recruited 45 patients till now.

Results: A total of 45 patients between the ages 18 - 73 years (mean age 44.13 ± 15.51 years,) with 37(82.2%) being married, were included. Participants demonstrated high psychological distress, with mean Hospital Anxiety and Depression Scale of 15.69 ± 2.56 and 14.60 ± 2.73, respectively. The adapted Decision Conflict Scale showed excellent internal consistency (Cronbach's Alpha = 0.956). Spearman's rank correlation was performed to analyze decisional conflict. Illness perception demonstrated a significant negative correlation with decisional conflict (p = -0.443, p = 0.002), indicating that stronger illness perceptions were associated with lower decisional conflict. Perceived social support (MOS-SSS) demonstrated a weak negative and non-significant relationship with decision conflict (Spearman's p = -0.065, p = .673). When anxiety and depression symptoms were combined into a total HADS score, no significant association was found with decision conflict (Spearman's p = -0.155, p = 0.310)

Conclusion: Among patients undergoing intracranial tumour resection, stronger illness perception was associated with lower preoperative decisional conflict. However, anxiety, depression, perceived social support were not significantly related to decisional conflict.