title: Measuring preoperative anxiety in patients with intracranial tumors: the Amsterdam preoperative anxiety and information scale.
abstract: BACKGROUND
  Preoperative anxiety is a major problem in patients with brain tumors and is of high clinical relevance. However, to date no instruments have been validated for the assessment of preoperative anxiety for this patient group. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has shown promising results for the assessment of preoperative anxiety. The aim of this study was to determine its psychometric properties and the optimal cutoff score for patients with intracranial tumors to make it applicable in the neurosurgical setting.
  
  
  METHODS
  The sample totaled 180 neurosurgical patients with intracranial tumors. Patients were administered the APAIS along with the Hospital Anxiety and Depression Scale as the gold standard against which the APAIS was compared. Patients scoring 11 or above in the anxiety subscale of the Hospital Anxiety and Depression Scale were defined as clinical cases having anxiety. The psychometric properties of the APAIS were evaluated for a postulated 2-factor structure, Cronbach α, and correlations.
  
  
  RESULTS
  The postulated 2-factor structure could not be replicated. Instead, we found a 3-factor solution (anxiety about the operation, anxiety about the anesthesia, information requirement). The area under the receiver operating characteristics curve ranged from ≥0.65 to ≥0.77. Optimal cutoff scores were calculated. The cutoff score for the anxiety scale was ≥10 for the whole sample and men only, and was ≥11 for women only. Analysis of the psychometric properties yielded satisfactory results (eg. Cronbach α for the anxiety scale >0.84).
  
  
  CONCLUSIONS
  Despite its brevity, the APAIS is valid and recommendable for the assessment of preoperative anxiety in patients with intracranial tumors. As this is the first validation study focusing on patients with severe diseases and major surgeries, we recommend the application of our cutoff scores also for patients similar to our study population with regard to disease and surgery severity.
authors.affiliation: Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany. goebels@nch.uni-kiel.de
authors.forename: Simone
authors.initials: S
authors.lastname: Goebel
authors.forename: Lea
authors.initials: L
authors.lastname: Kaup
authors.forename: Hubertus Maximilian
authors.initials: HM
authors.lastname: Mehdorn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D001932:Brain Neoplasms / Q000601:surgery*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D057234:Preoperative Period; D025341:Principal Component Analysis; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012727:Sex Characteristics; D011795:Surveys and Questionnaires; D055815:Young Adult