The effect of mandala coloring on perioperative psychological well-being, emotional self-efficacy and anxiety in gynecologic cancer patients: a randomized controlled study

Women diagnosed with gynecologic cancer frequently experience heightened anxiety and psychological distress during the perioperative period. Mandala coloring, defined as the structured coloring of pre-drawn symmetrical circular patterns to promote focused attention and relaxation, is a brief art-based intervention increasingly used in oncology settings. This randomized controlled study aimed to evaluate the effect of perioperative mandala coloring on psychological well-being, emotional self-efficacy, and state anxiety in women undergoing surgery for gynecologic cancer. The study was conducted between May and August 2025 in the inpatient Obstetrics and Gynecology ward of a state hospital in Türkiye. Eighty-four patients were randomly assigned to an intervention group ( n = 42) or a control group ( n = 42). The intervention group received two structured mandala coloring sessions on two consecutive preoperative days (35–50 min each). Outcome measures including the Psychological Well-Being Scale (PWBS), Emotional Self-Efficacy Scale (ESES), and State Anxiety Scale (SAS) were administered at baseline (T1), 1–3 h after the first session (T2), and 24 h after the second session (T3). For the control group, outcome assessments were conducted at baseline (T1), 1–3 h after baseline (T2), and 24 h after baseline (T3). Data were analyzed using two-way repeated-measures ANOVA to examine group (intervention vs. control), time (T1–T3), and group × time interaction effects. No significant between-group differences were observed at baseline ( p > .05). Significant group × time interactions were observed for psychological well-being, emotional self-efficacy, and state anxiety ( p < .001). Compared with controls, the intervention group demonstrated significantly greater increases in psychological well-being and emotional self-efficacy and greater reductions in anxiety at T2 and T3. Significant group × time interaction effects were observed for psychological well-being, emotional self-efficacy, and state anxiety (all p < .001). Compared with controls, the intervention group demonstrated greater increases in psychological well-being and emotional self-efficacy, along with greater reductions in anxiety across the perioperative period. Effect sizes were large (partial η² range: 0.80–0.85). Brief perioperative mandala coloring significantly improved psychological well-being and emotional self-efficacy while reducing state anxiety in women with gynecologic cancer. Mandala coloring may serve as a feasible, low-cost supportive nursing intervention during the perioperative period. ClinicalTrials.gov NCT07160062; registered September 6, 2025.