Mental Enhanced Education Strategy

Patients allocated to the enhanced mental health education intervention cohort will receive supplemental medical humanities modules alongside the standard Practical Education Strategy during hospitalization. This content is derived from a comic publication compiled by the breast surgery team of Fudan University Shanghai Cancer Center, which narrates the 4600-year human battle against breast cancer in a grand story. The content combines humorous cartoons with novel-like text, covering the evolution of human understanding of breast cancer, and the emergence and development of various therapies, drugs, and technologies. For patients unable to read, audio books and dynamic cartoon videos are available on mobile devices. The general content framework is as follows:

• Understanding of breast cancer in ancient Egypt and Persia;
• Hippocratic-Galenic Theories: early management of breast disorders in Greco-Roman antiquity;
• Traditional Chinese medical interpret

Practical Education Strategy

Admission Day

• Comprehensive admission nursing assessment and introduction to care protocols: Admission assessment form, nutritional assessment, fall risk assessment, deep vein thrombosis risk assessment, pain assessment, etc.
• Orientation to ward environment and policies: introduction to the medical team, online doctor-patient communication platform, ward facilities, daily routines, dietary guidelines, and other essential services, etc.
• Review of medical history and guidance on preoperative examinations and precautions: Hematological tests, electrocardiogram, ultrasound, mammography, CT, MRI, core needle biopsy, fine needle aspiration, etc.

Days Before Surgery

• Personal preparation instructions: Bathing, hair washing, fasting, and fluid restriction guidelines, etc.
• Interpretation of preoperative examination results.
• Overview of common surgical approaches for breast cancer, introduction of surgery options based on the condition, especially emphasis on

Medical Humanities-based Patient Education with Comic-based Medical Education Materials for Breast Cancer Patients during Perioperative Hospitalization Stage

anxiety status at hospital discharge evaluated using the GAD-7 questionnaire Generalized Anxiety Disorder scale, GAD-7 (0-21 points): Cut-off values of 5, 10, and 15 delineated mild, moderate, and severe anxiety

depression severity at hospital discharge assessed with the PHQ-9 instrument Patient Health Questionnaire, PHQ-9 (0-27 points): Thresholds at 5, 10, 15, and 20 classified mild, moderate, moderately severe, and severe depression.

sleep quality at hospital discharge measured via the ISI scale Insomnia Severity Index, ISI (0-28 points): Scores ≥8, ≥15, and ≥22 indicated subthreshold, moderate, and severe insomnia.

including breast-conserving surgery, oncoplastic breast-conserving surgery, implant-based or autologous breast reconstruction