Effects of Music Listening During Port Catheter Insertion on Anxiety, Fear, and Procedural Pain in Cancer Patients: A Randomized Controlled Study

Effects of Music Listening During Port Catheter Insertion on Anxiety, Fear, and Procedural Pain in Cancer Patients: A Randomized Controlled Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Music Listening During Port Catheter Insertion on Anxiety, Fear, and Procedural Pain in Cancer Patients: A Randomized Controlled Study Ömer Gündoğan, Elif G. İsmailoğlu, Eren İsmailoğlu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7996258/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Port catheter insertion is a common but anxiety-inducing invasive procedure for cancer patients. Listening to music is a simple, non-pharmacological method that may help relieve anxiety, fear, and pain during procedures. Objective To determine the effect of music listening during port catheter insertion on anxiety, fear, and pain levels among cancer patients. Methods A single-centre, single-blind randomized controlled study was conducted in the interventional radiology unit of a tertiary hospital. One hundred patients scheduled for port catheter insertion under local anesthesia were randomly assigned to either a music group (n = 50) or a control group (n = 50). The music group listened to Acemaşiran Maqam through headphones during the procedure, while the control group received standard care. Data were collected using the State Anxiety Inventory, Surgical Fear Questionnaire, and Visual Analogue Scale. Results After the procedure, anxiety and fear scores were significantly lower in the music group than in the control group (p < 0.001). The mean pain score was also lower among patients who listened to music (p = 0.037). In addition, post-procedure systolic and diastolic blood pressure and respiratory rate values were significantly lower in the music group (p < 0.005). Conclusion Listening to music during port catheter insertion effectively reduces anxiety, fear, and pain, while supporting physiological stability. Integrating music listening into port catheter insertion procedures can serve as a simple, cost-effective, and non-pharmacological nursing intervention to reduce patients’ anxiety, fear, and pain while promoting comfort and physiological stability in oncology settings. anxiety fear cancer patient music intervention procedural pain port catheter insertion Figures Figure 1 Introduction It is of great importance to ensure safe and continuous vascular access in patients with long-term intravenous treatment needs, especially oncology patients [ 1 ]. Port catheters are a safe and effective way to provide long-term central venous access in patients undergoing cancer treatment [ 1 , 2 ]. In cancer patients, port catheters are preferred in situations such as reducing invasive interventions, administering high-concentration fluids and drugs and supporting long-term treatments [ 3 ]. With its reservoir placed under the skin and its design that does not require external intervention, port catheters also stand out in terms of patient satisfaction due to low risk of infection, not restricting daily life and cosmetic advantages [ 4 , 5 ]. Capozzi et al found that port catheters have advantage over peripherally placed central catheters in reducing the cost of long-term cancer treatment as well as the rate of problems such as obstruction, infection, malposition, etc. in cancer patients [ 6 ]. Although port catheter insertion is a minor surgical procedure, it is still a procedural intervention that may lead to pain and anxiety [ 7 , 8 ]. According to the Theory of Unpleasant Symptoms (TOUS), such symptoms can result from the interaction of physiological, psychological, and situational factors experienced during medical interventions. In this context, patients’ individual perceptions, prior experiences, and the clinical environment may exacerbate the intensity of unpleasant symptoms such as procedural pain and anxiety [ 9 , 10 ]. The procedural pain associated with administering the needle can cause anxiety in individuals with cancer. Increased anxiety can lead to more pain during administration. In addition, the anxiety and fears experienced by the patient can lead to pain perception by activating pain alert according to the gate control theory [ 11 , 12 ]. These reactions can negatively affect not only the instant experience of the individual, but also physiological parameters, cooperation during the procedure, recovery process and general patient satisfaction. Considering the interrelationship between pain-related fear and anxiety, it is important to comprehensively evaluate these symptoms [ 7 ]. Considering this situation, it is necessary to find a suitable auxiliary method for patients undergoing interventional procedures. In the literature, there are studies using interventions such as virtual reality, aromatherapy, guided imagery, video information as a non-pharmacological intervention to relieve pain, fear and anxiety during port catheter insertion [ 8 , 13 – 17 ]. Music represents another non-pharmacological approach that has been shown to effectively reduce procedural discomfort and emotional distress in clinical settings [ 18 , 19 ]. Music can help patients express their emotions more easily and support the communication of internal feelings [ 20 ]. It also helps regulate the stress response through the limbic system, supports heart rate and breathing balance, and reduces pain perception by acting as a distraction. It has been reported that music interventions, especially those preferred by the patient, have positive effects [ 18 , 21 ]. Today, it is widely used in various clinical areas to reduce pain, anxiety and stress [ 22 – 25 ]. A meta-analysis showed that music interventions before, during, and after surgery revealed a statistically significant reduction in both anxiety and pain in adults.18 In this context, evaluating the effect of music listening during port catheter insertion on the anxiety, fear and pain levels experienced by patients is important in terms of both increasing patient comfort and improving the patient experience in interventional procedures. Materials and Methods Aim The aim of this study was to evaluate the effectiveness of listening to music during port catheter insertion on cancer patients’ levels of perceived anxiety, fear, and pain. Study hypotheses were the following: H1: Cancer patients listening to music during port catheter insertion will have lower anxiety than the control group. H2: Cancer patients listening to music during port catheter insertion will have lower surgical fear than the control group. H3: Cancer patients listening to music during port catheter insertion will report less procedure-related pain than the control group. Design This single-centre, single-blind, randomized, controlled study was conducted in the interventional radiology unit of a tertiary care hospital in İzmir, Türkiye from November 2023 to November 2024. The study received approval from the Clinical Research Ethics Committee of XXX University, and written informed consent was obtained from each participant. Sample Participants were recruited by the researcher from among patients scheduled for port catheter placement at the interventional radiology unit of XXX hospital. The inclusion criteria for all patients were as follows: (1) patients aged ≥ 18 years; (2) diagnosed with cancer; (3) oriented to time and place; (4) underwent port catheterization with only local anesthesia; and (5) agreed to participate in the study. The exclusion criteria were as follows: patients with communication or hearing impairments, those with psychiatric disorders, patients using medications that suppress anxiety or pain, and those who did not enjoy music due to cultural reasons. The withdrawal criteria were: (1) patients who experienced vasovagal syncope, and (2) patients who developed methemoglobinemia related to local anesthesia. Sample size The sample size for this study was determined based on the findings of a previous study examining the effects of port catheter insertion on anxiety and stress [ 19 ]. Using data from that study, a power analysis was conducted with the G*Power 3.1 software, employing a two-sample t-test. The analysis assumed a statistical power of 80% (power = 0.80), a one-tailed significance level of 0.05 (α = 0.05). As a result, the required minimum sample size was calculated to be 44 participants per group. However, in the present study, 50 participants were included in both the music intervention group and the control group (total N = 100) to account for potential dropouts or missing data. Randomization Block randomization was used to assign 100 patients equally into the Music and Control groups (50 in each). Each block contained two patients per group, and the order was randomly generated using a computer. Group assignments were made by an independent individual who was not involved in the intervention to prevent bias. Consolidated Standards of Reporting Trials (CONSORT) flow diagram for the study is presented in Fig. 1. Figure 1. Flow diagram of the study. Data collection Pre-procedure As a routine of the clinic where the study was conducted, patients who will have a port catheter be inserted are admitted to the clinic one hour before the procedure. When patients arrived at the clinic, the researchers informed them about the study and obtained their written consent. Immediately before going to the procedure, the researcher collected demographic and baseline data of the patients. After the initial data were collected, an independent individual randomly selected patient. Procedure After the patient is taken to the angiography unit, the procedure is started by local anesthesia with 2% pricain around the jugular vein and at the entrance site. Port catheter insertion of all patients was performed by a single specialist interventional radiologist. Before anesthesia, the researcher began playing music to the patients in the music group. Patients listened to music in Acemaşiran Maqam through headphones. The procedure took about 30–35 minutes. The patient listened to the music during this time. Determining the duration in music listening practices is of great importance in terms of providing therapeutic effect. In the literature, the duration of application usually ranges from two to 45 minutes, and it is reported that this period is adjusted according to the psychological and physiological responses of the individual [ 26 ]. Patients were told to focus on music during the procedure. Routine practice was continued with the patients in the control group, and no music was played. Post-procedure All patients were followed up in the post-procedure care unit for at least 30 minutes. During this time, the researcher measured the vital signs of patients. The researcher also assessed levels of anxiety, fear and pain associated with the procedure. Blinding In this study, the blinding method was used to prevent bias. Group assignments were made by an independent individual who was not involved in the intervention. The researcher assessing outcome variables were also blinded to group allocation. The person performing the statistical analysis did not know from which group the data was obtained. Instruments Patient Identification Form The ‘Patient Identification Form’ developed by the researchers was used to obtain the demographic and health data of the patient. It consists of questions such as the patient's age, gender, educational level, cancer type, and chronic disease. In addition, blood pressure, heart and respiratory values of the patients before and after the procedure were recorded in this form. These data of the patient were measured digitally (Omron HEM71-21, Omron Matsusaka Co Ltd, Kyoto Japan). The device used is regularly calibrated. State Anxiety Inventory The State Anxiety Inventory (SAI) developed by Spielberger et al. was developed to evaluate the state anxiety levels of individuals. The validity and reliability of the inventory in the Turkish population was carried out by Oner and Le Compte [ 27 ]. The inventory consists of 20 items scored over a 4-point Likert-type scale (“almost never,” “sometimes,” “often,” and “almost always”) assessing state anxiety. Higher total scores reflect higher levels of anxiety. Surgical Fear Questionnaire The Surgical Fear Questionnaire (SFQ) was developed by Theunissen et al. to assess fear related to the short- and long-term outcomes of elective surgery. The Turkish validity and reliability study was conducted by Bagdigen and Karaman Ozlu [ 28 ]. SFQ consists of 8 items scored on an 11-point Likert-type scale (0 = “not at all afraid” vs. 10 = “very afraid”). Visual Analogue Scale The Visual Analogue Scale (VAS) is a widely used tool for assessing pain intensity. The scale consists of a 10-centimeter line, horizontal or vertical, fixed at both ends with descriptors; “0” indicates no pain, while “10” indicates the worst pain imaginable. Patients are asked to mark a point on the line that corresponds to the intensity of the pain they are experiencing. Pain scores are recorded by measuring the distance from the "no pain" port to the patient's mark in millimeters [ 29 ]. Data Analysis Descriptive statistics (number, percentage, mean, standard deviation, median, minimum and maximum) are given. Normal distribution assumption was checked by Shapiro Wilk test and variance homogeneity was checked by Levene test. When the normality assumption was met, the Independent Sample T-test was used to compare the two independent groups, the Paired Samples t-Test was used when it was dependent, and the Mann Whitney U and Wilcoxon Sign Rank tests were used when the assumption was not met. The analyses were carried out using IBM SPSS 27 program and p-value of less than 0.05 was considered statistically significant. Ethical Considerations Written permission was obtained from XXX University Clinical Research Ethics Committee (Ethics Committee no: XXX). The patients were given detailed information about the study and their written consents were obtained. Results The demographic and health-related data of the music and control groups are presented in Table 1 . There was no difference between the music and control groups in terms of age, gender, educational level, cancer type, and chronic diseases ( P > 0.05, Table 1 ). 70% of the patients who listened to music were satisfied with the intervention (mean satisfaction score: 7.08 ± 2.41). Table 1 Characteristics of Patients Characteristics Music Group (n = 50) Control Group (n = 50) Test Value P Age M ± SD, y 59.34 ± 9.34 62.06 ± 9.31 -1.459 0.148 Gender Male 28 56.0 25 50.0 0.361 0.548 Female 22 44.0 25 50.0 Educational level Primary school 21 42.0 31 62.0 4.007 0.135 High school 23 46.0 15 30.0 University 6 12.0 4 8.0 Cancer type Stomach 5 10.0 4 8.0 1.720 0.886 Lung 10 20.0 8 16.0 Breast 11 22.0 9 18.0 Colon 8 16.0 8 16.0 Pancreatic 5 10.0 9 18.0 Other 11 22.0 12 24.0 Chronic diseases None 13 26.0 11 22.0 3.945 0.413 Hypertension 13 26.0 18 36.0 Diabetes 14 28.0 12 24.0 COPD 4 8.0 7 14.0 Other 6 12.0 2 4.0 Music satisfaction Yes 35 70.0 Partially 11 22.0 No 4 8.0 Satisfaction score M ± SD 7.08 ± 2.41 (7.5) M = mean; SD = standard deviation; Thirty-two patients were excluded (5 with psychiatric disorders, 3 using anxiolytic medications, and 25 who declined to participate). The remaining 105 patients were randomly assigned to two groups: the music group (n = 52) and the control group (n = 53). During follow-up, two patients from the music group (due to withdrawal) and three patients from the control group (one due to vasovagal syncope and two due to withdrawal) were lost to follow-up. Consequently, 50 patients in each group were included in the final analysis (Fig. 1). State Anxiety Index According to the SAI scores, the pre-procedure average was 49.92 ± 13.9 (median 49), the post-procedure average was 38.2 ± 12.32 (median 35.5) in the music group; while the pre- procedure average was 52.42 ± 10.7 (median 54) and the post- procedure average was 54.58 ± 11.15 (median 53) in the control group. There was no significant difference in anxiety levels between the groups before the procedure. The difference between the groups after the procedure was significant, and the mean state anxiety score was lower in the music group (p < 0.001). In intragroup comparisons, the difference between the pre-procedure and post-procedure state anxiety averages for the music group (p < 0.001) was significant. This difference was not significant for the control group (p = 0.140). (Table 2 ). Table 2 Comparison of State Anxiety Index and Surgical Fear Questionnaire Scores Between Music and Control Groups Music Group (n = 50) Control Group (n = 50) Between Groups M ± SD (Median) M ± SD (Mediyan) Test Value a P Effect Size SAI Pre-procedure 49.92 ± 13.9(49) 38.2 ± 12.32(35.5) 52.42 ± 10.7 (54) -1.121 .262 - Post-procedure 54.58 ± 11.15 (53) -5.804 < .001 1.394 Test Statistic b -3.709 -1.476 P < .001 .140 Effect Size 0.668 - SFQ Pre-procedure 40.04 ± 19.86(39.5) 34.34 ± 23.37(30) -1.407 0.159 - Post-procedure 12.26 ± 12.91(7.5) 34.34 ± 25.4(29) -4.306 < .001 1.096 Test Statistic b -5.747 -0.168 P < .001 .867 Effect Size 1.347 - Abbreviations: SAI, state anxiety index; SFQ, surgical fear questionnaire; M, mean; SD, standard deviation a Mann–Whitney U Test b Wilcoxon Signed-Rank Test Surgical Fear levels The pre-procedure fear score was 40.04 ± 19.86 (median 39.5) and the post-procedure score was 12.26 ± 12.91 (median 7.5) in the music group; the pre-procedure score was 34.34 ± 23.37 (median 30) and the post-procedure score was 34.34 ± 25.4 (median 29) in the control group. There was no significant difference in fear levels between the groups before the procedure. The difference between the groups after the procedure was significant, and the mean fear was lower in the music group (p < 0.001). In intragroup comparisons, the difference between pre and post procedure fear averages for the music group (p < 0.001) was significant. This difference was not significant for the control group (p = 0.167). (Table 2 ). Pain levels The mean procedure-related pain score was 2.24 ± 1.44 in the music group and 2.94 ± 1.92 in the control group. The difference in pain levels between groups was significant, and the pain level was higher in the control group (p = 0.037). (Table 3 ). Table 3 Comparison of Pain Scores and Vital Signs Between Music and Control Groups Music Group (n = 50) Control Group (n = 50) Between Groups M ± SD (Median) M ± SD (Mediyan) Test Value P Effect Size Heart rate/min Pre-procedure 81.78 ± 11.7(80) 76.18 ± 10.82(75.5) 2.486 a 0.015 0.497 Post-procedure 75.22 ± 9.77(74) 79.36 ± 11.95(78) -1.896 a 0.061 - Test Statistic 6.932 c -3.001 c P < 0.001 0.003 Effect Size 0.980 0.429 Respiratory rate/min Pre-procedure 18.88 ± 3(19) 16.76 ± 2.24(16) -3.371 b < 0.001 0.801 Post-procedure 16.58 ± 2.51(16) 18.2 ± 2.77(18) -3.066 a 0.003* 0.613 Test Statistic 7.081 c -3.839 d P < 0.001 < 0.001 Effect Size 1.001 0.611 Systolic Blood Pressure (mmHg) Pre-procedure 128.12 ± 17.36(131) 125.84 ± 16.03(121.5) -1.087 b 0.277 - Post-procedure 116.9 ± 15.23(115.5) 129.38 ± 17.36(132.5) -2.471 b 0.013 0.764 Test Statistic 7.729 c -2.225 d P < 0.001 0.026 Effect Size 1.093 0.280 Dystolic Blood Pressure (mmHg) Pre-procedure 72.76 ± 10.86(72) 68.36 ± 11.43(66) -2.196 b 0.028 0.395 Post-procedure 67.12 ± 7.59(66) 73.1 ± 12.36(70.5) -2.915 a 0.005* 0.583 Test Statistic 4.309 c -2.794 d P < 0.001 0.005 Effect Size 0.609 0.450 Procedure-related pain 2.24 ± 1.44 (2) 2.94 ± 1.92 (3) -2.086 b 0.037* 0.413 M, mean; SD, standard deviation a Independent Samples t-Test b Mann–Whitney U Test cPaired Samples t-Test d Wilcoxon Signed-Rank Test Vital signs The post-procedure respiratory rate, SBP, and DBP were significantly higher in the control group compared to the music group (p < 0.005), while the difference in mean heart rate between the groups was not statistically significant (p = 0.061). In intra-group comparisons, the difference between all these parameters before and after the procedure is significant (p < 0.005). (Table 3 ). Discussion Listening to music creates a calming and relaxing response by balancing heart rate and breathing through the autonomic nervous system; thus, relieving the stress caused by the procedure [ 30 ]. In this study, it was determined that post-procedure fear and anxiety levels were lower in patients who listened to music compared to the control group. This finding shows that music can be effective not only as a physiological but also as a psychological intervention tool. The decrease in fear and anxiety levels after the procedure, especially in the group listening to music, can be explained by the relaxing, distracting and emotional regulatory effect of music. This result is similar to previous studies showing that music intervention has a positive effect on these dependent variables in port catheter placement [ 23 , 31 , 32 ] and other surgical settings [ 22 , 24 ]. However, in contrast to our findings, the first randomized pilot trial involving awake intensive care patients undergoing central venous catheterization reported no significant reduction in anxiety levels with music intervention compared to standard care [ 33 ]. In line with this, Schaal et al who conducted their research among patients undergoing port catheter placement, also found that music did not significantly affect subjective anxiety levels. Schaal reported that this ineffectiveness was due to the blinding of the medical staff [ 19 ]. However, in our study, the emergence of a similar result as a result of the blindness of the evaluator shows that the blindness of the evaluator to the groups alone will not overshadow the effect of the music application and that the application may have a significant relaxing effect on anxiety levels. Due to its multidimensional nature, pain perception can be influenced by external regulatory interventions. Among these, music listening is considered an effective, low-cost, and low-risk complementary therapy for alleviating procedural and postoperative pain during or after surgical interventions, whether under sedation or general anesthesia [ 18 , 34 ]. In our study, music was played to the patients for about 30–35 minutes during the procedure, and the patients included were conscious cancer patients. Our results also support the effect of music on pain relief due to the difference in pain levels between the group that was listening to music during the procedure and the group that was not. In the literature, it has been reported that both port catheter insertion [ 32 ] and music intervention in other surgical procedures [ 22 , 24 ] reduce pain. Since preoperative anxiety is associated with postoperative pain, the pain reduction recorded after preoperative music interventions may be the result of decreased anxiety. The findings showed that there were significant differences between the pre- and post-procedure heart rate, respiratory rate and blood pressure averages in both the music group and the control group. However, the direction of these changes differs between the groups: physiological parameters decreased significantly after the procedure in the music group, while a significant increase was observed in these parameters in the control group. These results are also consistent with previous studies emphasizing the soothing effects of music interventions on vital signs in different clinical settings [ 8 , 24 , 35 ]. In line with these findings, several studies [ 19 , 32 ] have specifically examined the impact of music during port catheter insertion procedures, demonstrating that music can promote physiological relaxation and reduce autonomic responses to procedural stress. Limitations Given the limited scope of this study in a single clinic, caution should be exercised regarding its applicability to all patients with port catheter insertion. It is crucial to recognize that participants' cultural background may have potentially influenced their responses to the selected music. It is also important to note that the subjective measures used in the study, such as anxiety and pain, are subject to individual interpretation. Future studies should be designed to evaluate the effectiveness of musical intervention in different age groups, individuals with a history of chronic disease, or patients with different cultural characteristics. In addition, the selection of a single music genre by the researchers in the study is a limitation. New research should be conducted that comparatively examines the effect of music according to different patient groups, music genres and application styles. In addition, in this study, musical intervention was carried out only during the procedure; in future studies, it may be recommended to evaluate the effect of listening to music more comprehensively by continuing before and after the procedure. Conclusion In conclusion of the study, anxiety and fear levels, and procedural-related pain of cancer patients who listened to music during port catheter insertion decreased. Accordingly, music application can be integrated into nursing care protocols in order to increase the comfort of patients and support their physiological stability, especially before and during the invasive procedure. Such research will contribute to the more effective use of non-pharmacological approaches such as music as an evidence-based care method in nursing and to the strengthening of patient-centered health services. Declarations Competing Interests: The authors have no relevant financial or non-financial interests to disclose Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Bakircay University (15.11.2023/1308). Consent to participate: Informed consent was obtained from all individual participants included in the study. Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution All authors contributed to the study conception and design. Ö.G., E.G.İ. and E.İ colllected the data. Ö.G. and E.G.İ. wrote the main manuscript text. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.” Acknowledgment: We would like to thank the expert statistician who performed the data analysis and the patients who voluntarily participated in the study. References Madabhavi I, Apurva P, Parikh S, et al. A study of use of “PORT” catheter in patients with cancer: a single-center experience. Clin Med Insights Oncol . 2017;11:1–6. Taxbro K, Hammarskjöld F, Thelin B, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth . 2019;122(6):734–41. Kalender N, Tosun N. Nursing studies about central venous catheter care: A literature review and recommendations for clinical practice. 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A prospective randomized controlled trial assessing the effect of music on patients’ anxiety in venous catheter placement procedures. Sci Reports. 2022;12(1):6922. Jacquier S, Nay MA, Muller G, Muller L, Mathonnet A, Lefèvre-Benzekri D, Bretagnol A, Barbier F, Kamel T, Runge I, Skarzynski M. Effect of a musical intervention during the implantation of a central venous catheter or a dialysis catheter in the intensive care unit: a prospective randomized pilot study. Anesth Analg. 2022;134(4):781–90. Frickmann FC, Urman RD, Siercks K, Burgermeister G, Luedi MM, Lersch FE. The effect of perioperative auditory stimulation with music on procedural pain: a narrative review. Curr Pain Headache R. 2023;27(8):217–26. Sabzevari A, Kianifar H, Jafari SA, Saeidi M, Ahanchian H, Kiani MA, Jarahi L. The effect of music on pain and vital signs of children before and after endoscopy. Electron Physician. 2017;9(7):4801. Additional Declarations No competing interests reported. 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İsmailoğlu","email":"data:image/png;base64,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","orcid":"","institution":"Bakırçay Üniversitesi","correspondingAuthor":true,"prefix":"","firstName":"Elif","middleName":"G.","lastName":"İsmailoğlu","suffix":""},{"id":555411944,"identity":"8d361870-ff61-414c-bdbc-892a76e5ccd8","order_by":2,"name":"Eren İsmailoğlu","email":"","orcid":"","institution":"Bakırçay 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1","display":"","copyAsset":false,"role":"figure","size":79821,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of the study.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7996258/v1/d53960e4f309b90f55b3df07.jpg"},{"id":108804794,"identity":"015dffe7-9a22-4ecb-a312-a24f086087e3","added_by":"auto","created_at":"2026-05-08 15:23:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":540923,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7996258/v1/97f0eb53-8560-4317-8c11-9da5950ead5f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Music Listening During Port Catheter Insertion on Anxiety, Fear, and Procedural Pain in Cancer Patients: A Randomized Controlled Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIt is of great importance to ensure safe and continuous vascular access in patients with long-term intravenous treatment needs, especially oncology patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Port catheters are a safe and effective way to provide long-term central venous access in patients undergoing cancer treatment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In cancer patients, port catheters are preferred in situations such as reducing invasive interventions, administering high-concentration fluids and drugs and supporting long-term treatments [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. With its reservoir placed under the skin and its design that does not require external intervention, port catheters also stand out in terms of patient satisfaction due to low risk of infection, not restricting daily life and cosmetic advantages [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Capozzi et al found that port catheters have advantage over peripherally placed central catheters in reducing the cost of long-term cancer treatment as well as the rate of problems such as obstruction, infection, malposition, etc. in cancer patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough port catheter insertion is a minor surgical procedure, it is still a procedural intervention that may lead to pain and anxiety [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. According to the Theory of Unpleasant Symptoms (TOUS), such symptoms can result from the interaction of physiological, psychological, and situational factors experienced during medical interventions. In this context, patients\u0026rsquo; individual perceptions, prior experiences, and the clinical environment may exacerbate the intensity of unpleasant symptoms such as procedural pain and anxiety [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The procedural pain associated with administering the needle can cause anxiety in individuals with cancer. Increased anxiety can lead to more pain during administration. In addition, the anxiety and fears experienced by the patient can lead to pain perception by activating pain alert according to the gate control theory [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These reactions can negatively affect not only the instant experience of the individual, but also physiological parameters, cooperation during the procedure, recovery process and general patient satisfaction. Considering the interrelationship between pain-related fear and anxiety, it is important to comprehensively evaluate these symptoms [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Considering this situation, it is necessary to find a suitable auxiliary method for patients undergoing interventional procedures.\u003c/p\u003e\u003cp\u003eIn the literature, there are studies using interventions such as virtual reality, aromatherapy, guided imagery, video information as a non-pharmacological intervention to relieve pain, fear and anxiety during port catheter insertion [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Music represents another non-pharmacological approach that has been shown to effectively reduce procedural discomfort and emotional distress in clinical settings [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Music can help patients express their emotions more easily and support the communication of internal feelings [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It also helps regulate the stress response through the limbic system, supports heart rate and breathing balance, and reduces pain perception by acting as a distraction. It has been reported that music interventions, especially those preferred by the patient, have positive effects [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Today, it is widely used in various clinical areas to reduce pain, anxiety and stress [\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. A meta-analysis showed that music interventions before, during, and after surgery revealed a statistically significant reduction in both anxiety and pain in adults.18 In this context, evaluating the effect of music listening during port catheter insertion on the anxiety, fear and pain levels experienced by patients is important in terms of both increasing patient comfort and improving the patient experience in interventional procedures.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eThe aim of this study was to evaluate the effectiveness of listening to music during port catheter insertion on cancer patients\u0026rsquo; levels of perceived anxiety, fear, and pain.\u003c/p\u003e\u003cp\u003eStudy hypotheses were the following:\u003c/p\u003e\u003cp\u003eH1: Cancer patients listening to music during port catheter insertion will have lower anxiety than the control group.\u003c/p\u003e\u003cp\u003eH2: Cancer patients listening to music during port catheter insertion will have lower surgical fear than the control group.\u003c/p\u003e\u003cp\u003eH3: Cancer patients listening to music during port catheter insertion will report less procedure-related pain than the control group.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDesign\u003c/h3\u003e\n\u003cp\u003e This single-centre, single-blind, randomized, controlled study was conducted in the interventional radiology unit of a tertiary care hospital in İzmir, T\u0026uuml;rkiye from November 2023 to November 2024. The study received approval from the Clinical Research Ethics Committee of XXX University, and written informed consent was obtained from each participant.\u003c/p\u003e\n\u003ch3\u003eSample\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited by the researcher from among patients scheduled for port catheter placement at the interventional radiology unit of XXX hospital. The inclusion criteria for all patients were as follows: (1) patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (2) diagnosed with cancer; (3) oriented to time and place; (4) underwent port catheterization with only local anesthesia; and (5) agreed to participate in the study. The exclusion criteria were as follows: patients with communication or hearing impairments, those with psychiatric disorders, patients using medications that suppress anxiety or pain, and those who did not enjoy music due to cultural reasons. The withdrawal criteria were: (1) patients who experienced vasovagal syncope, and (2) patients who developed methemoglobinemia related to local anesthesia.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eThe sample size for this study was determined based on the findings of a previous study examining the effects of port catheter insertion on anxiety and stress [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Using data from that study, a power analysis was conducted with the G*Power 3.1 software, employing a two-sample t-test. The analysis assumed a statistical power of 80% (power\u0026thinsp;=\u0026thinsp;0.80), a one-tailed significance level of 0.05 (α\u0026thinsp;=\u0026thinsp;0.05). As a result, the required minimum sample size was calculated to be 44 participants per group. However, in the present study, 50 participants were included in both the music intervention group and the control group (total N\u0026thinsp;=\u0026thinsp;100) to account for potential dropouts or missing data.\u003c/p\u003e\n\u003ch3\u003eRandomization\u003c/h3\u003e\n\u003cp\u003eBlock randomization was used to assign 100 patients equally into the Music and Control groups (50 in each). Each block contained two patients per group, and the order was randomly generated using a computer. Group assignments were made by an independent individual who was not involved in the intervention to prevent bias. Consolidated Standards of Reporting Trials (CONSORT) flow diagram for the study is presented in Fig.\u0026nbsp;1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.\u003c/b\u003e Flow diagram of the study.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003ePre-procedure\u003c/h2\u003e\u003cp\u003eAs a routine of the clinic where the study was conducted, patients who will have a port catheter be inserted are admitted to the clinic one hour before the procedure. When patients arrived at the clinic, the researchers informed them about the study and obtained their written consent. Immediately before going to the procedure, the researcher collected demographic and baseline data of the patients. After the initial data were collected, an independent individual randomly selected patient.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eAfter the patient is taken to the angiography unit, the procedure is started by local anesthesia with 2% pricain around the jugular vein and at the entrance site. Port catheter insertion of all patients was performed by a single specialist interventional radiologist. Before anesthesia, the researcher began playing music to the patients in the music group. Patients listened to music in Acemaşiran Maqam through headphones. The procedure took about 30\u0026ndash;35 minutes. The patient listened to the music during this time. Determining the duration in music listening practices is of great importance in terms of providing therapeutic effect. In the literature, the duration of application usually ranges from two to 45 minutes, and it is reported that this period is adjusted according to the psychological and physiological responses of the individual [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Patients were told to focus on music during the procedure.\u003c/p\u003e\u003cp\u003eRoutine practice was continued with the patients in the control group, and no music was played.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePost-procedure\u003c/h2\u003e\u003cp\u003eAll patients were followed up in the post-procedure care unit for at least 30 minutes. During this time, the researcher measured the vital signs of patients. The researcher also assessed levels of anxiety, fear and pain associated with the procedure.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eBlinding\u003c/h2\u003e\u003cp\u003eIn this study, the blinding method was used to prevent bias. Group assignments were made by an independent individual who was not involved in the intervention. The researcher assessing outcome variables were also blinded to group allocation. The person performing the statistical analysis did not know from which group the data was obtained.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eInstruments\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003ePatient Identification Form\u003c/h2\u003e\u003cp\u003eThe \u0026lsquo;Patient Identification Form\u0026rsquo; developed by the researchers was used to obtain the demographic and health data of the patient. It consists of questions such as the patient's age, gender, educational level, cancer type, and chronic disease. In addition, blood pressure, heart and respiratory values of the patients before and after the procedure were recorded in this form. These data of the patient were measured digitally (Omron HEM71-21, Omron Matsusaka Co Ltd, Kyoto Japan). The device used is regularly calibrated.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eState Anxiety Inventory\u003c/h2\u003e\u003cp\u003eThe State Anxiety Inventory (SAI) developed by Spielberger et al. was developed to evaluate the state anxiety levels of individuals. The validity and reliability of the inventory in the Turkish population was carried out by Oner and Le Compte [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The inventory consists of 20 items scored over a 4-point Likert-type scale (\u0026ldquo;almost never,\u0026rdquo; \u0026ldquo;sometimes,\u0026rdquo; \u0026ldquo;often,\u0026rdquo; and \u0026ldquo;almost always\u0026rdquo;) assessing state anxiety. Higher total scores reflect higher levels of anxiety.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSurgical Fear Questionnaire\u003c/h2\u003e\u003cp\u003eThe Surgical Fear Questionnaire (SFQ) was developed by Theunissen et al. to assess fear related to the short- and long-term outcomes of elective surgery. The Turkish validity and reliability study was conducted by Bagdigen and Karaman Ozlu [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. SFQ consists of 8 items scored on an 11-point Likert-type scale (0 = \u0026ldquo;not at all afraid\u0026rdquo; vs. 10 = \u0026ldquo;very afraid\u0026rdquo;).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eVisual Analogue Scale\u003c/h2\u003e\u003cp\u003eThe Visual Analogue Scale (VAS) is a widely used tool for assessing pain intensity. The scale consists of a 10-centimeter line, horizontal or vertical, fixed at both ends with descriptors; \u0026ldquo;0\u0026rdquo; indicates no pain, while \u0026ldquo;10\u0026rdquo; indicates the worst pain imaginable. Patients are asked to mark a point on the line that corresponds to the intensity of the pain they are experiencing. Pain scores are recorded by measuring the distance from the \"no pain\" port to the patient's mark in millimeters [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics (number, percentage, mean, standard deviation, median, minimum and maximum) are given. Normal distribution assumption was checked by Shapiro Wilk test and variance homogeneity was checked by Levene test. When the normality assumption was met, the Independent Sample T-test was used to compare the two independent groups, the Paired Samples t-Test was used when it was dependent, and the Mann Whitney U and Wilcoxon Sign Rank tests were used when the assumption was not met. The analyses were carried out using IBM SPSS 27 program and p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003eWritten permission was obtained from XXX University Clinical Research Ethics Committee (Ethics Committee no: XXX). The patients were given detailed information about the study and their written consents were obtained.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographic and health-related data of the music and control groups are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There was no difference between the music and control groups in terms of age, gender, educational level, cancer type, and chronic diseases (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). 70% of the patients who listened to music were satisfied with the intervention (mean satisfaction score: 7.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of Patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eMusic Group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTest Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, y\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e59.34\u0026thinsp;\u0026plusmn;\u0026thinsp;9.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e62.06\u0026thinsp;\u0026plusmn;\u0026thinsp;9.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.459\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.148\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.361\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.548\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e62.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCancer type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStomach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.720\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.886\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLung\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBreast\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eColon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePancreatic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChronic diseases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.945\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.413\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e36.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMusic satisfaction\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePartially\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSatisfaction score M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u003cp\u003e7.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41 (7.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eM\u0026thinsp;=\u0026thinsp;mean; SD\u0026thinsp;=\u0026thinsp;standard deviation;\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThirty-two patients were excluded (5 with psychiatric disorders, 3 using anxiolytic medications, and 25 who declined to participate). The remaining 105 patients were randomly assigned to two groups: the music group (n\u0026thinsp;=\u0026thinsp;52) and the control group (n\u0026thinsp;=\u0026thinsp;53). During follow-up, two patients from the music group (due to withdrawal) and three patients from the control group (one due to vasovagal syncope and two due to withdrawal) were lost to follow-up. Consequently, 50 patients in each group were included in the final analysis (Fig.\u0026nbsp;1).\u003c/p\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eState Anxiety Index\u003c/h2\u003e\u003cp\u003eAccording to the SAI scores, the pre-procedure average was 49.92\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9 (median 49), the post-procedure average was 38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.32 (median 35.5) in the music group; while the pre- procedure average was 52.42\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7 (median 54) and the post- procedure average was 54.58\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15 (median 53) in the control group. There was no significant difference in anxiety levels between the groups before the procedure. The difference between the groups after the procedure was significant, and the mean state anxiety score was lower in the music group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In intragroup comparisons, the difference between the pre-procedure and post-procedure state anxiety averages for the music group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was significant. This difference was not significant for the control group (p\u0026thinsp;=\u0026thinsp;0.140). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of State Anxiety Index and Surgical Fear Questionnaire Scores Between Music and Control Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMusic Group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eBetween Groups\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Median)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Mediyan)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTest Value \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEffect Size\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eSAI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e49.92\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9(49)\u003c/p\u003e\u003cp\u003e38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.32(35.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e52.42\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7 (54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e54.58\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-5.804\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.394\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTest Statistic\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-3.709\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e-1.476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEffect Size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.668\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eSFQ\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e40.04\u0026thinsp;\u0026plusmn;\u0026thinsp;19.86(39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34.34\u0026thinsp;\u0026plusmn;\u0026thinsp;23.37(30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.407\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e12.26\u0026thinsp;\u0026plusmn;\u0026thinsp;12.91(7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34.34\u0026thinsp;\u0026plusmn;\u0026thinsp;25.4(29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-4.306\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.096\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTest Statistic\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-5.747\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e-0.168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.867\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEffect Size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.347\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eAbbreviations: SAI, state anxiety index; SFQ, surgical fear questionnaire; M, mean; SD, standard deviation\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003eMann\u0026ndash;Whitney U Test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003eb\u003c/sup\u003eWilcoxon Signed-Rank Test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eSurgical Fear levels\u003c/h2\u003e\u003cp\u003eThe pre-procedure fear score was 40.04\u0026thinsp;\u0026plusmn;\u0026thinsp;19.86 (median 39.5) and the post-procedure score was 12.26\u0026thinsp;\u0026plusmn;\u0026thinsp;12.91 (median 7.5) in the music group; the pre-procedure score was 34.34\u0026thinsp;\u0026plusmn;\u0026thinsp;23.37 (median 30) and the post-procedure score was 34.34\u0026thinsp;\u0026plusmn;\u0026thinsp;25.4 (median 29) in the control group. There was no significant difference in fear levels between the groups before the procedure. The difference between the groups after the procedure was significant, and the mean fear was lower in the music group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In intragroup comparisons, the difference between pre and post procedure fear averages for the music group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was significant. This difference was not significant for the control group (p\u0026thinsp;=\u0026thinsp;0.167). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003ePain levels\u003c/h2\u003e\u003cp\u003eThe mean procedure-related pain score was 2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44 in the music group and 2.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92 in the control group. The difference in pain levels between groups was significant, and the pain level was higher in the control group (p\u0026thinsp;=\u0026thinsp;0.037). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Pain Scores and Vital Signs Between Music and Control Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMusic Group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eBetween Groups\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Median)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Mediyan)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTest Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eEffect Size\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eHeart rate/min\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.78\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7(80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76.18\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82(75.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.486\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.497\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75.22\u0026thinsp;\u0026plusmn;\u0026thinsp;9.77(74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.36\u0026thinsp;\u0026plusmn;\u0026thinsp;11.95(78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.896\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTest Statistic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.932\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.001\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEffect Size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.980\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.429\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eRespiratory rate/min\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3(19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24(16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.371\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51(16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77(18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.066\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.613\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTest Statistic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.081\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.839\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEffect Size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.611\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eSystolic Blood Pressure (mmHg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128.12\u0026thinsp;\u0026plusmn;\u0026thinsp;17.36(131)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e125.84\u0026thinsp;\u0026plusmn;\u0026thinsp;16.03(121.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.087\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e116.9\u0026thinsp;\u0026plusmn;\u0026thinsp;15.23(115.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e129.38\u0026thinsp;\u0026plusmn;\u0026thinsp;17.36(132.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.471\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.764\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTest Statistic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.729\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.225\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEffect Size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.093\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eDystolic Blood Pressure (mmHg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.76\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86(72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.36\u0026thinsp;\u0026plusmn;\u0026thinsp;11.43(66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.196\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.395\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost-procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67.12\u0026thinsp;\u0026plusmn;\u0026thinsp;7.59(66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.36(70.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.915\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.005*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.583\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTest Statistic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.309\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.794\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEffect Size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.609\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProcedure-related pain\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.086\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.037*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.413\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eM, mean; SD, standard deviation\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003eIndependent Samples t-Test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003eMann\u0026ndash;Whitney U Test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003ecPaired Samples t-Test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ed\u003c/sup\u003eWilcoxon Signed-Rank Test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eVital signs\u003c/h2\u003e\u003cp\u003eThe post-procedure respiratory rate, SBP, and DBP were significantly higher in the control group compared to the music group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005), while the difference in mean heart rate between the groups was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.061). In intra-group comparisons, the difference between all these parameters before and after the procedure is significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eListening to music creates a calming and relaxing response by balancing heart rate and breathing through the autonomic nervous system; thus, relieving the stress caused by the procedure [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In this study, it was determined that post-procedure fear and anxiety levels were lower in patients who listened to music compared to the control group. This finding shows that music can be effective not only as a physiological but also as a psychological intervention tool. The decrease in fear and anxiety levels after the procedure, especially in the group listening to music, can be explained by the relaxing, distracting and emotional regulatory effect of music. This result is similar to previous studies showing that music intervention has a positive effect on these dependent variables in port catheter placement [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and other surgical settings [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, in contrast to our findings, the first randomized pilot trial involving awake intensive care patients undergoing central venous catheterization reported no significant reduction in anxiety levels with music intervention compared to standard care [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In line with this, Schaal et al who conducted their research among patients undergoing port catheter placement, also found that music did not significantly affect subjective anxiety levels. Schaal reported that this ineffectiveness was due to the blinding of the medical staff [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, in our study, the emergence of a similar result as a result of the blindness of the evaluator shows that the blindness of the evaluator to the groups alone will not overshadow the effect of the music application and that the application may have a significant relaxing effect on anxiety levels.\u003c/p\u003e\u003cp\u003eDue to its multidimensional nature, pain perception can be influenced by external regulatory interventions. Among these, music listening is considered an effective, low-cost, and low-risk complementary therapy for alleviating procedural and postoperative pain during or after surgical interventions, whether under sedation or general anesthesia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In our study, music was played to the patients for about 30\u0026ndash;35 minutes during the procedure, and the patients included were conscious cancer patients. Our results also support the effect of music on pain relief due to the difference in pain levels between the group that was listening to music during the procedure and the group that was not. In the literature, it has been reported that both port catheter insertion [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and music intervention in other surgical procedures [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] reduce pain. Since preoperative anxiety is associated with postoperative pain, the pain reduction recorded after preoperative music interventions may be the result of decreased anxiety.\u003c/p\u003e\u003cp\u003eThe findings showed that there were significant differences between the pre- and post-procedure heart rate, respiratory rate and blood pressure averages in both the music group and the control group. However, the direction of these changes differs between the groups: physiological parameters decreased significantly after the procedure in the music group, while a significant increase was observed in these parameters in the control group. These results are also consistent with previous studies emphasizing the soothing effects of music interventions on vital signs in different clinical settings [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In line with these findings, several studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] have specifically examined the impact of music during port catheter insertion procedures, demonstrating that music can promote physiological relaxation and reduce autonomic responses to procedural stress.\u003c/p\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eGiven the limited scope of this study in a single clinic, caution should be exercised regarding its applicability to all patients with port catheter insertion. It is crucial to recognize that participants' cultural background may have potentially influenced their responses to the selected music. It is also important to note that the subjective measures used in the study, such as anxiety and pain, are subject to individual interpretation. Future studies should be designed to evaluate the effectiveness of musical intervention in different age groups, individuals with a history of chronic disease, or patients with different cultural characteristics. In addition, the selection of a single music genre by the researchers in the study is a limitation. New research should be conducted that comparatively examines the effect of music according to different patient groups, music genres and application styles. In addition, in this study, musical intervention was carried out only during the procedure; in future studies, it may be recommended to evaluate the effect of listening to music more comprehensively by continuing before and after the procedure.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion of the study, anxiety and fear levels, and procedural-related pain of cancer patients who listened to music during port catheter insertion decreased. Accordingly, music application can be integrated into nursing care protocols in order to increase the comfort of patients and support their physiological stability, especially before and during the invasive procedure. Such research will contribute to the more effective use of non-pharmacological approaches such as music as an evidence-based care method in nursing and to the strengthening of patient-centered health services.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCompeting Interests:\u003c/h2\u003e\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eEthics approval:\u003c/h2\u003e\u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Bakircay University (15.11.2023/1308).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e\u003cp\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. \u0026Ouml;.G., E.G.İ. and E.İ colllected the data. \u0026Ouml;.G. and E.G.İ. wrote the main manuscript text. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u0026rdquo;\u003c/p\u003e\u003ch2\u003eAcknowledgment:\u003c/h2\u003e\u003cp\u003eWe would like to thank the expert statistician who performed the data analysis and the patients who voluntarily participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMadabhavi I, Apurva P, Parikh S, et al. A study of use of \u0026ldquo;PORT\u0026rdquo; catheter in patients with cancer: a single-center experience. \u003cem\u003eClin Med Insights Oncol\u003c/em\u003e. 2017;11:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTaxbro K, Hammarskj\u0026ouml;ld F, Thelin B, et al. 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Listening to music is a simple, non-pharmacological method that may help relieve anxiety, fear, and pain during procedures.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo determine the effect of music listening during port catheter insertion on anxiety, fear, and pain levels among cancer patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA single-centre, single-blind randomized controlled study was conducted in the interventional radiology unit of a tertiary hospital. One hundred patients scheduled for port catheter insertion under local anesthesia were randomly assigned to either a music group (n\u0026thinsp;=\u0026thinsp;50) or a control group (n\u0026thinsp;=\u0026thinsp;50). The music group listened to \u003cem\u003eAcemaşiran Maqam\u003c/em\u003e through headphones during the procedure, while the control group received standard care. Data were collected using the State Anxiety Inventory, Surgical Fear Questionnaire, and Visual Analogue Scale.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAfter the procedure, anxiety and fear scores were significantly lower in the music group than in the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean pain score was also lower among patients who listened to music (p\u0026thinsp;=\u0026thinsp;0.037). In addition, post-procedure systolic and diastolic blood pressure and respiratory rate values were significantly lower in the music group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eListening to music during port catheter insertion effectively reduces anxiety, fear, and pain, while supporting physiological stability. Integrating music listening into port catheter insertion procedures can serve as a simple, cost-effective, and non-pharmacological nursing intervention to reduce patients\u0026rsquo; anxiety, fear, and pain while promoting comfort and physiological stability in oncology settings.\u003c/p\u003e","manuscriptTitle":"Effects of Music Listening During Port Catheter Insertion on Anxiety, Fear, and Procedural Pain in Cancer Patients: A Randomized Controlled Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 12:21:52","doi":"10.21203/rs.3.rs-7996258/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"499c1a12-8453-4c55-9fcf-f59aea814382","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-06T02:11:40+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T02:25:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 12:21:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7996258","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7996258","identity":"rs-7996258","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}