Faith and Fear on the Operating Table: Spirituality May Calm Open-Heart Surgery Patients

For most people, few medical events carry the psychological weight of open-heart surgery. The chest is opened, the heart is stopped, and a machine temporarily takes over the work of keeping a human being alive. In the days before such an operation, patients often confront a tangle of emotions: fear of dying on the table, dread of postoperative pain, and anxiety about an uncertain recovery. A new cross-sectional study from Türkiye now offers a detailed look at how one group of patients awaiting this formidable procedure manages that fear, and the findings point to an unexpected psychological resource: spiritual well-being, reinforced by religious coping, appears to be associated with lower levels of surgical fear.

The research, published in BMC Psychology by a team of surgical nursing researchers at Atatürk University in Erzurum, set out to quantify the relationship between surgical fear, spiritual well-being, and religious coping in patients scheduled for open-heart surgery. Led by Tülay Kılınç of the Faculty of Nursing’s Department of Surgical Nursing, together with Ayşegül Yayla and Ayşenur Ergün, the study recruited 179 patients from the cardiovascular surgery department of a university hospital in eastern Türkiye. Data were collected during the preoperative period between March and October 2025, using a convenience sampling method in which patients who met the inclusion criteria and agreed to participate were enrolled.

Methodologically, the study is a descriptive correlational design, a common approach in health psychology when researchers want to map how variables relate to one another at a single point in time rather than test an intervention. Each participant completed a personal information form along with three validated instruments: the Surgical Fear Questionnaire, which measures the intensity and content of fear related to surgery; the 3-Factor Spiritual Well-being Scale, which assesses well-being across spiritual dimensions; and the Religious Coping Scale, which distinguishes between positive religious coping, such as seeking comfort and meaning through faith, and negative religious coping, which reflects spiritual struggle, doubt, or a sense of being abandoned or punished by God. The researchers analyzed the data with descriptive statistics, t-tests, and Pearson correlation analysis, and then used stepwise linear regression to identify which factors independently predicted surgical fear.

The demographic profile of the sample reflects the typical population facing cardiac surgery. The average age of the patients was 64.99 years, with a standard deviation of 9.27, meaning most participants were in their late fifties to mid-seventies. This matters because older adults undergoing major cardiovascular procedures often carry additional burdens, including comorbid illnesses, prior hospital experiences, and, in some cases, memories of earlier operations that can color their expectations of the one ahead.

The headline numbers from the questionnaires are striking in their own right. Patients reported a mean Surgical Fear Questionnaire score of 22.69, with a standard deviation of 19.79, indicating that, on average, surgical fear in this sample was low, though the large standard deviation reveals enormous variability from one patient to the next. Meanwhile, the mean score on the 3-Factor Spiritual Well-being Scale was 124.78, with a standard deviation of 12.04, pointing to high levels of spiritual well-being across the group. On the Religious Coping Scale, positive religious coping averaged 26.21, with a standard deviation of 2.87, while negative religious coping averaged just 10.05, with a standard deviation of 3.59. In plain terms, these patients leaned heavily on faith as a source of comfort and rarely experienced religion as a source of distress.

The regression analysis is where the study delivers its most interesting technical insight. Spiritual well-being emerged as the strongest independent predictor of surgical fear, with a standardized beta coefficient of -0.282 and a p-value below 0.001, meaning that higher spiritual well-being was significantly associated with lower surgical fear. The second significant predictor was negative religious coping, with a beta of 0.208 and a p-value of 0.005, indicating that patients who experienced their faith as a struggle or a burden reported more fear. A history of previous non-cardiac surgery was the third significant factor, with a beta of 0.166 and a p-value of 0.019, suggesting that memories of earlier operations, even unrelated to the heart, can amplify apprehension before a cardiac procedure. Notably, positive religious coping did not emerge as an independent predictor in the final model, hinting that the protective effect of faith may operate primarily through the broader sense of spiritual well-being it helps sustain, rather than through specific coping behaviors measured directly.

Why would spiritual well-being buffer surgical fear? The authors frame spiritual well-being and religious coping as important psychosocial resources that can influence how patients cope with fear and anxiety in the face of uncertainty, perceived risk of death, and anticipated pain. Psychological research has long suggested that meaning-making systems help people reframe threatening events within a larger narrative, reducing the sense of helplessness that fuels acute anxiety. For a patient about to undergo open-heart surgery, a strong sense of spiritual well-being may transform the operation from an existential catastrophe into an ordeal embedded within a framework of purpose, trust, and acceptance. Conversely, negative religious coping, in which patients may feel spiritually abandoned, guilty, or punished, appears to add an additional layer of distress on top of the surgical threat itself, and the data here support that association.

The finding about previous non-cardiac surgery deserves particular attention from clinicians. Intuitively, one might assume that patients who have been through an operation before would be less frightened the second time, having survived the experience and learned what to expect. This study suggests the opposite: prior surgical experience was associated with higher, not lower, fear before open-heart surgery. One plausible interpretation is that patients who have endured an earlier operation carry vivid memories of anesthesia, pain, and recovery, and those memories generalize to the upcoming cardiac procedure. Alternatively, patients requiring open-heart surgery may already have a history of health complications that makes them more sensitized to medical threats in general. Whatever the mechanism, the result flags previously operated patients as a group who may benefit from targeted preoperative psychological support.

The clinical implications are straightforward even if the design cannot prove causation. Because this was a cross-sectional study, it captures associations at a single moment and cannot establish whether high spiritual well-being causes lower surgical fear, or whether less fearful patients simply report greater spiritual well-being. Convenience sampling at a single hospital in eastern Türkiye also limits how far the findings generalize to other regions, cultures, or healthcare systems, particularly since religious coping patterns are deeply shaped by cultural and religious context. Still, for perioperative nursing practice, the study suggests that assessing spiritual well-being and religious coping during preoperative evaluation could help identify patients at elevated risk of surgical fear, and that spiritual care, where appropriate and consistent with patient preferences, might be integrated into preoperative preparation alongside standard anxiety management.

What makes the study resonate beyond cardiology is its reminder that the psychological preparation for major surgery is not purely a matter of sedation protocols and informed consent forms. Fear before open-heart surgery is shaped by how patients understand their own lives, their faith, and their past encounters with the operating room. As surgical outcomes continue to improve through technical advances, the inner experience of patients awaiting the scalpel remains a measurable, and modifiable, part of care. This research offers a quantitative foothold for that human dimension, showing that the resources patients bring to the table, spiritual and religious as much as physical, are woven into how bravely, or fearfully, they face one of medicine’s most demanding procedures.

Subject of Research: The relationship between surgical fear, spiritual well-being, and religious coping in patients scheduled for open-heart surgery

Article Title: The relationship between surgical fear, spiritual well-being, and religious coping in patients scheduled for open heart surgery: a cross-sectional study

Article References: Kılınç, T., Yayla, A., & Ergün, A. (2026). The relationship between surgical fear, spiritual well-being, and religious coping in patients scheduled for open heart surgery: a cross-sectional study. BMC Psychology. https://doi.org/10.1186/s40359-026-05697-7

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05697-7

Keywords: open-heart surgery, surgical fear, spiritual well-being, religious coping, cardiac surgery, preoperative anxiety, nursing, psychology, cross-sectional study, Türkiye, BMC Psychology, patient care