Multidisciplinary Intervention to Improve Patient Health Literacy and Postoperative Outcomes in Urological Surgery: A Randomized Controlled Trial of a Preoperative Handbook

Abstract Background: Perioperative anxiety and loss of perceived control are prevalent among urological patients, often worsened by low health literacy. While psychoeducational interventions can improve outcomes, they are rarely tailored to the full spectrum of urological procedures. Methods: This single-centre randomized controlled trial evaluated a comprehensive preoperative handbook in adults undergoing elective urological surgery at a Hungarian tertiary centre. A total of 134 patients were allocated to receive routine care (n = 48) plus the handbook (n = 86). The handbook covers 25 major urological interventions, basic tumour staging, and pharmacological pathways. Psychological distress and positive adaptation were assessed preoperatively and prior to hospital discharge (General Anxiety Disorder-7, Hospital Anxiety and Depression Scale, Perceived Stress Scale-14, Adult Hope Scale, Basic Psychological Need Satisfaction and Frustration Scale). Results: Baseline sociodemographic and psychological profiles did not differ significantly between groups. Postoperatively, the handbook group demonstrated robust, statistically significant improvements compared to controls, including reduced generalized anxiety (GAD-7; p < .001, d = -0.82), hospital-specific anxiety (HADS-A; p = .018, d = -0.43), and perceived stress (PSS-14; p < .001, d = -0.73). Furthermore, the intervention significantly mobilized goal-directed motivation, yielding higher postoperative hope agency (p = .001, d = 0.58). Broader constructs such as depressive symptomatology and generalized competence satisfaction remained unchanged. Conclusions: A targeted preoperative handbook substantially reduces acute postoperative distress and enhances patient agency. By effectively buffering surgical anxiety, this psychoeducational tool offers a highly scalable model to bridge health literacy gaps in routine urological care.