Integrating Mental Health Into Surgical Care: A Qualitative Study of a Perioperative Mental Health Intervention

Objectives: To explore patient experiences with a perioperative mental health intervention (PMHI), understand its perceived impact on emotional health, and identify factors affecting engagement and feasibility. Background: Depression and anxiety can worsen surgical outcomes in older adults, highlighting the need for perioperative emotional health support. We evaluated a PMHI across 3 linked randomized controlled trials in cardiac, oncologic, and orthopedic surgery. Here, we report qualitative findings highlighting patients' experiences with the PMHI across trials. Methods: The study was conducted across 3 hospitals in a Midwestern healthcare network. 112 semi-structured interviews were conducted with older patients undergoing surgeries (31 cardiac, 39 oncologic, and 42 orthopedic), complemented by 5 periodic reflection focus groups with 9 interventionists (4 social workers/counselors and 5 pharmacist team members). An inductive thematic approach was used for analysis. Results: Patients and interventionists perceived the PMHI positively, identifying numerous beneficial factors such as compassionate care, strong rapport, and thorough medication education. However, patients noted nonbeneficial factors limiting engagement with the PMHI, including fatigue and competing personal priorities. Patients with oncologic or complex cardiac procedures reported the greatest benefit from the PMHI, compared with slightly lower perceived usefulness among orthopedic and simpler cardiac patients. Informed by these findings, we present a conceptual model illustrating beneficial and nonbeneficial factors influencing patient perceptions of the PMHI. Conclusions: Patients' positive perceptions of the PMHI and its impact on alleviating depression and anxiety symptoms underscore the value of integrating psychological and pharmacological support into perioperative care for older adults.