Psychological Distress and Support Shape Thyroid Cancer Discharge Readiness

Researchers at Peking Union Medical College Hospital in Beijing have identified key psychosocial factors influencing how prepared thyroid cancer patients feel when leaving the hospital after surgery. Published in Frontiers in Psychology, the cross-sectional study examined 154 patients who underwent thyroid cancer surgery under an Enhanced Recovery After Surgery (ERAS) protocol. The findings indicate that psychological distress and the level of perceived social support are significantly associated with a patient’s readiness for hospital discharge. This study provides new insights into the non-physiological aspects of postoperative care, suggesting that addressing mental health and social resources is crucial for a successful transition from hospital to home.

The study was conducted between December 2025 and July 2026 in the Department of General Surgery at Peking Union Medical College Hospital. The researchers selected a convenience sample of 154 patients with pathologically confirmed thyroid cancer who had undergone surgical treatment. All participants were managed under the ERAS concept, which includes standardized preoperative education, early postoperative mobilization, early oral intake, and multimodal pain management. It is important to note that the study was designed to investigate discharge readiness within this specific clinical context, rather than to evaluate the overall effectiveness of the ERAS protocol itself compared to standard care. The sample size was determined using Green’s rule of thumb for multiple linear regression, ensuring adequate statistical power for the planned analysis.

To assess the participants’ status, the research team utilized three validated questionnaires: the Readiness for Hospital Discharge Scale (RHDS), the Hospital Anxiety and Depression Scale (HADS), and the Social Support Rating Scale (SSRS). The RHDS measures a patient’s physiological, psychological, and social preparedness for leaving the hospital, with higher scores indicating better readiness. The HADS screens for anxiety and depression symptoms, while the SSRS evaluates objective support, subjective support, and the utilization of social support. Data were collected within four hours of the discharge decision, allowing for a timely assessment of the patients’ immediate state of mind and perceived capabilities.

The results revealed that the total RHDS score for the cohort was 95.25 with a standard deviation of 13.21. Among the three dimensions of the RHDS, the “expected support” dimension had the highest mean item score, while the “personal status” dimension had the lowest. This suggests that while patients felt confident in the support they would receive after discharge, they had less confidence in their own personal ability to cope with post-discharge conditions. The mean anxiety score on the HADS was 8.12, which was notably higher than the mean depression score of 6.41. This indicates that postoperative thyroid cancer patients in this cohort were more likely to experience anxiety than depression, potentially due to concerns about disease recurrence, long-term prognosis, and the impact of surgery on their daily lives.

Statistical analysis demonstrated a strong negative correlation between the total RHDS score and the total HADS score, with a Pearson correlation coefficient of r = -0.777 (P < 0.01). This means that as anxiety and depression scores increased, discharge readiness scores decreased significantly. Conversely, there was a strong positive correlation between the total RHDS score and the total SSRS score, with r = 0.729 (P < 0.01). Patients who reported higher levels of social support also reported higher levels of readiness for discharge. These correlations highlight the intertwined nature of psychological well-being, social resources, and the ability to manage the transition out of the hospital.

Multiple linear regression analysis was employed to identify independent factors associated with discharge readiness. After controlling for demographic variables such as age, gender, education, and income, the final model retained the total HADS score and the total SSRS score as significant predictors. The total HADS score had a negative coefficient (B = -1.077, 95% CI: -1.424 to -0.731), confirming that higher psychological distress is independently associated with lower discharge readiness. The total SSRS score had a positive coefficient (B = 0.472, 95% CI: 0.155 to 0.789), indicating that greater social support is independently associated with higher discharge readiness. The final regression model explained 62.6% of the variance in RHDS scores, demonstrating that psychosocial factors play a substantial role in determining how prepared patients feel to leave the hospital.

The study also noted a statistically significant difference in RHDS scores between male and female patients, with males scoring higher. However, gender was not retained in the final multivariable regression model, suggesting that the observed difference may be confounded by other factors or should be interpreted with caution. Other demographic variables, such as education level, marital status, and length of hospital stay, did not show significant independent associations with discharge readiness in the final model. The authors suggest that the lower scores in the personal status dimension of the RHDS may be related to the shortened hospital stays under the ERAS protocol, which may limit the time available for patients to fully master post-discharge care skills such as neck functional exercises and medication management.

The authors emphasize that these findings have important clinical implications for perioperative care. They suggest that discharge preparation should not be limited to the day of discharge but should be initiated throughout the perioperative period. Healthcare professionals are encouraged to incorporate routine psychological assessments and social support evaluations into their standard care pathways. By identifying patients with high levels of anxiety or low levels of social support early in the hospitalization process, clinicians can provide targeted interventions, such as individualized discharge planning, intensified self-management education, and referrals for psychological support. Involving family caregivers in the discharge planning process may also help facilitate a smoother transition and reduce the risk of unplanned readmissions.

Despite the significant findings, the study has several limitations that must be considered. First, the cross-sectional design precludes the determination of causal relationships or temporal sequences between psychological distress, social support, and discharge readiness. It is possible that low discharge readiness contributes to psychological distress rather than the other way around. Second, the study was conducted at a single center using convenience sampling, which may limit the generalizability of the findings to other healthcare settings or patient populations. Third, all variables were assessed using self-reported questionnaires, which may introduce reporting bias and common-method bias. Finally, the study did not include a non-ERAS comparison group, so it cannot evaluate the specific impact of the ERAS protocol on discharge readiness. Future prospective, multi-center studies with appropriate comparison groups are needed to further investigate these associations and develop evidence-based interventions for improving discharge readiness in thyroid cancer patients.

Subject of Research: Psychosocial factors influencing discharge readiness in thyroid cancer patients undergoing ERAS-based perioperative management

Article Title: Discharge readiness and associated factors among thyroid cancer patients under ERAS-based perioperative management: a cross-sectional study

Article References: Wang, Y., Li, S., Guo, L., Gao, J., Zhang, X., Song, D., Yang, B., Yin, X., & Liu, W. (2026). Discharge readiness and associated factors among thyroid cancer patients under ERAS-based perioperative management: a cross-sectional study. Frontiers in Psychology, 17, Article 1954989. https://doi.org/10.3389/fpsyg.2026.1954989

Image Credits: AI Generated

DOI: 10.3389/fpsyg.2026.1954989

Keywords: thyroid cancer, discharge readiness, ERAS, psychological distress, social support, perioperative care, cross-sectional study, hospital anxiety, postoperative recovery, healthcare transition, Discharge, readiness