Effects of Interventions Based on Patient Expectations on Coronary Surgery Outcomes: A Randomized Clinical Trial
Abstract
Background: Coronary surgery can have various outcomes, such as fear of death, cardiac anxiety, and pain disability. This study aimed to evaluate the effects of interventions based on patient expectations on different outcomes of coronary surgery, including expectations, cardiac anxiety, and pain-induced disability.
Methods: This randomized clinical trial evaluated 60 coronary surgery candidates. Patients meeting the inclusion criteria were randomly assigned to control and intervention groups. The patients were contacted 1 to 2 weeks before coronary surgery to complete the Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ). Based on the analysis of expectations, the intervention group underwent interventions to optimize expectations, whereas the control group received only routine care. The Cardiac Anxiety Questionnaire (CAQ) and the Pain Disability Index (PDI) were completed on the day of hospitalization. Three months later, the participants recompleted all 3 questionnaires. The data were analyzed with descriptive and analytical statistics in SPSS 16.0.
Results: There were no significant differences between the control and intervention groups in baseline variables, pain-induced disability (P=0.353), and cardiac anxiety (P=0.479). After the intervention, no significant differences were observed between the groups concerning expectations (P=0.554) and pain-induced disability (P=0.557) when the confounding variables were adjusted. Nevertheless, cardiac anxiety decreased significantly (P=0.027).
Conclusion: Our interventions improved expectations and mitigated anxiety among coronary surgery patients. Actualization and optimization of patient expectations should be considered in the care of coronary surgery candidates.
2. Sarrafzadegan N, Mohammmadifard N. Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med 2019;22:204-210.
3. Beckmann A, Funkat AK, Lewandowski J, Frie M, Ernst M, Hekmat K, Schiller W, Gummert JF, Welz A. German Heart Surgery Report 2015: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2016;64:462-474.
4. Lee R, Li S, Rankin JS, O'Brien SM, Gammie JS, Peterson ED, McCarthy PM, Edwards FH; Society of Thoracic Surgeons Adult Cardiac Surgical Database. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg 2011;91:677-684.
5. Tully PJ, Baumeister H, Bennetts JS, Rice GD, Baker RA. Depression screening after cardiac surgery: A six month longitudinal follow up for cardiac events, hospital readmissions, quality of life and mental health. Int J Cardiol 2016;206:44-50.
6. Curcio N, Philpot L, Bennett M, Felius J, Powers MB, Edgerton J, Warren AM. Anxiety, depression, and healthcare utilization 1 year after cardiac surgery. Am J Surg 2019;218:335-341.
7. Holmes SD, Fornaresio LM, Miller CE, Shuman DJ, Ad N. Development of the Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ). Qual Life Res 2016;25:2077-2086.
8. Connerney I, Shapiro PA, McLaughlin JS, Bagiella E, Sloan RP. Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet 2001;358(9295):1766-1771.
9. Guimarães-Pereira L, Reis P, Abelha F, Azevedo LF, Castro-Lopes JM. Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity. Pain 2017;158:1869-1885.
10. Bordoni B, Marelli F, Morabito B, Sacconi B, Severino P. Post-sternotomy pain syndrome following cardiac surgery: case report. J Pain Res 2017;10:1163-1169.
11. Tait RC, Pollard CA, Margolis RB, Duckro PN, Krause SJ. The Pain Disability Index: psychometric and validity data. Arch Phys Med Rehabil 1987;68:438-441.
12. Hoyer J, Eifert GH, Einsle F, Zimmermann K, Krauss S, Knaut M, Matschke K, Köllner V. Heart-focused anxiety before and after cardiac surgery. J Psychosom Res 2008;64:291-297.
13. Laferton JA, Kube T, Salzmann S, Auer CJ, Shedden-Mora MC. Patients' Expectations Regarding Medical Treatment: A Critical Review of Concepts and Their Assessment. Front Psychol 2017;8:233.
14. McRae C, Cherin E, Yamazaki TG, Diem G, Vo AH, Russell D, Ellgring JH, Fahn S, Greene P, Dillon S, Winfield H, Bjugstad KB, Freed CR. Effects of perceived treatment on quality of life and medical outcomes in a double-blind placebo surgery trial. Arch Gen Psychiatry 2004;61:412-420.
15. Sullivan M, Tanzer M, Reardon G, Amirault D, Dunbar M, Stanish W. The role of presurgical expectancies in predicting pain and function one year following total knee arthroplasty. Pain 2011;152:2287-2293.
16. Tolver MA, Strandfelt P, Forsberg G, Hjørne FP, Rosenberg J, Bisgaard T. Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair. Surgery 2012;151:556-563.
17. Barefoot JC, Brummett BH, Williams RB, Siegler IC, Helms MJ, Boyle SH, Clapp-Channing NE, Mark DB. Recovery expectations and long-term prognosis of patients with coronary heart disease. Arch Intern Med 2011;171:929-935.
18. Chunta KS. Expectations, anxiety, depression, and physical health status as predictors of recovery in open-heart surgery patients. J Cardiovasc Nurs 2009;24:454-464.
19. Auer CJ, Glombiewski JA, Doering BK, Winkler A, Laferton JA, Broadbent E, Rief W. Patients' Expectations Predict Surgery Outcomes: A Meta-Analysis. Int J Behav Med 2016;23:49-62.
20. Laferton JA, Auer CJ, Shedden-Mora MC, Moosdorf R, Rief W. Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention. Psychol Health Med 2016;21:272-285.
21. Doering BK, Glombiewski JA, Rief W. Expectation-Focused Psychotherapy to Improve Clinical Outcomes. Int Rev Neurobiol 2018;138:257-270.
22. Rief W, Shedden-Mora MC, Laferton JA, Auer C, Petrie KJ, Salzmann S, Schedlowski M, Moosdorf R. Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial. BMC Med 2017;15:4.
23. Girmay A, Marye T, Haftu M, G/Her D, Brhanu T, Gerensea H. Patients expectation strongly associated with patients perception to nursing care: hospital based cross sectional study. BMC Res Notes 2018;11:310.
24. Eifert GH, Thompson RN, Zvolensky MJ, Edwards K, Frazer NL, Haddad JW, Davig J. The cardiac anxiety questionnaire: development and preliminary validity. Behav Res Ther 2000;38:1039-1053.
25. van Beek MH, Voshaar RC, van Deelen FM, van Balkom AJ, Pop G, Speckens AE. The cardiac anxiety questionnaire: cross-validation among cardiac inpatients. Int J Psychiatry Med 2012;43:349-364.
26. Ai AL, McMullen CA, Smyth SS. Preoperative Optimism Related to Low Anxiety in Patients 1 Month After Open Heart Surgery. J Nerv Ment Dis 2020;208:966-973.
27. Lai VKW, Ho KM, Wong WT, Leung P, Gomersall CD, Underwood MJ, Joynt GM, Lee A. Effect of preoperative education and ICU tour on patient and family satisfaction and anxiety in the intensive care unit after elective cardiac surgery: a randomised controlled trial. BMJ Qual Saf 2021;30:228-235.
28. Benson S, Hagen S, Hoffmann O, Pasler A, Bingel U, Schedlowski M, Peters J, Elsenbruch S, Frey UH. Can a brief psychological expectancy intervention improve postoperative pain? A randomized, controlled trial in patients with breast cancer. Pain 2019;160:1562-1571.
| Files | ||
| Issue | Vol 18 No 4 (2023): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v18i4.14826 | |
| Keywords | ||
| expectations cardiac anxiety pain disability coronary artery surgery | ||
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