Video information combined with individualized information sessions: Effects upon emotional well-being following coronary artery bypass surgery—A randomized trial

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Abstract

Objective

To test the efficacy of an information intervention upon emotional recovery following coronary artery bypass surgery.

Methods

Randomized trial. Video information was combined with individualized information sessions carried out by nurses at admission and at discharge from the hospital. The video was shown pre-operatively and again during the session at admission. Patients were helped to express their questions and worries and congruent information and support was provided. Control group patients received standardized information and no video. Recordings were made at baseline, discharge from hospital and during a 2 years follow-up period.

Results

One hundred and nine patients were randomized to the intervention or the control groups. A MANOVA was used to test of the variance of the outcome variables at each time point. At discharge intervention patients reported less anxiety (p = 0.046) and better subjective health (p = 0.005). They reported better subjective health during the whole follow-up period (0.040  p  0.000), less anxiety up to 1 year (0.042  p  0.004), and less depression from 6 months to 2 years following discharge (0.023  p  0.004).

Conclusion

The effects of the intervention probably relate to the combined use of the video and patient centered information sessions.

Practice implications

The intervention can easily be implemented in clinical practice and nurses strongly identified with its principles.

Introduction

Despite its beneficial effects upon pain and reduced function, recovery following CABG may be associated with reduced psychological and physical functioning as long as 1 year following surgery [1]. The first few weeks of recovery are particularly stressful. Patients report considerable anxiety, depression and anger [2], [3], [4]. Also, higher levels of pre-operative state anxiety and depression have been associated with poorer post-operative outcome [1], [4], [5], [6], [7].

Considerable evidence indicates that significant benefits can be obtained by pre-operative interventions that provide information and teach coping skills to the patient [8], [9], [10], [11]. Videotape information has had positive impact on patients’ decision making [12] and their diet and exercise after CABG [13]. In general, treatment outcomes are more favorable when patients feel they are active participants in their care and that their problem has been discussed fully, when they feel encouraged to ask questions, feel emotionally supported and when they share in the treatment planning process [14], [15]. In a previous study of various surgical patients we found a strong relationship between the experienced quality of the contact with the nursing staff and the degree to which the patients felt well informed [16]. Evidence indicate that psychological interventions may to be most effective when they are congruent with the individual's coping style [17], [18], [19], [20] and a current trend in intervention research is to design strategies and techniques that match the characteristics of individual patients [21]. The concept of self-regulation has been used to conceptualize the importance of the individualized approach. It includes both intra- and inter-personal components involving both cognitive and behavioral activities as well as interpersonal interactions seeking such as experiential confirmation, emotional support and information [22], [23], [24].

This knowledge made us reconsider the utility of the standard care nurse information sessions at the study department which gave all patients the same information on a checklist without emphasizing dialogue with the patients and individualization of the approach. We designed an information procedure that we expected would assist the patients more effectively than the previous one. It consisted of two components: (a) a pre-admission video containing general information about the major aspects of the hospital situation, the treatment and the aftercare and (b) a patient-centered information session at admission and at discharge from the hospital. The effects of this intervention as compared with the standard information sessions were tested at discharge from the hospital and during a 2-year follow-up period. The psychological measures of effectiveness of the intervention were anxiety, depression and subjective health.

Section snippets

Eligibility criteria

Patients were eligible if: (a) were less than 68 years, (b) had no severe cognitive impairment (to secure an adequate understanding of the questionnaires and to minimize variation in other health related problems), (c) had stable angina with a planned first time CABG (some 8 weeks following angiography and other necessary pre-operative diagnostics), (d) had no severe co-morbidity and (e) were not transferred from other kinds of medical treatment or care.

Patient recruitment and enrollment

All patients were treated at the

Participants’ flow into the study

Of those 238 who were eligible, 136 agreed to participate (57.1%). Twenty-seven were excluded due to: major procedural errors (four), were treated at other hospitals (two), received a different kind of heart surgery (three), responded very incompletely to the questionnaires (seven), refused further participation (three), were too somatically ill (two), post-operative psychosis (one), moved to other places (three), was not operated (one) or died (one). The remaining 109 (80.1% of those who

Discussion

Our findings indicate that the patients in the intervention group were feeling better emotionally at discharge from the hospital as compared with the patients in the control group. Specifically, they reported less anxiety and subjective health than their counterparts in the control group (Table 2).

At follow-up, the overall effect of the intervention upon the emotional well-being of the participants appeared significant at all time points except for at 1 year. The difference was at its peak at 6

Acknowledgements

We thank patients and staff at the Department of Cardiothoracic and Vascular Surgery at the University Hospital of North Norway for their participation and the North Norwegian Psychiatric Research Center for their economical support.

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