Enhancing the efficacy of heart surgery by optimizing patients' preoperative expectations: Study protocol of a randomized controlled trial

• Published in: The American heart journal 2013, Vol.165 (1), p.1-7
• Main Authors: Laferton, Johannes A.C., MSc, Shedden Mora, Meike, PhD, Auer, Charlotte J., MSc, Moosdorf, Rainer, MD, Rief, Winfried, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anxiety; Cardiac Surgical Procedures - psychology; Cardiovascular; Cardiovascular disease; Clinical trials; Comorbidity; Coronary Artery Bypass - psychology; Coronary Disease - surgery; Disability; Female; Heart; Heart attacks; Heart surgery; Hospitals; Humans; Illnesses; Informed consent; Intervention; Male; Middle Aged; Multivariate analysis; Older people; Postoperative Complications - psychology; Preoperative Care; Quality of Life; Return to Work; Self-Help Groups; Studies; Treatment Outcome; Young Adult
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2012.10.007

In coronary heart disease (CHD) and heart surgery, there is sound evidence for the relationship between patients' expectations and treatment outcome, especially for outcome variables such as disability and quality of life. In addition, patients' expectations have been shown to be modifiable through psychological interventions. Therefore, targeting patients' expectations might offer a promising opportunity to enhance heart surgery outcome. However, few studies have tried to actively change patients' expectations before surgery. The purpose of this clinical trial is to optimize patients' outcome expectations before undergoing coronary artery bypass graft surgery (CABG) through a brief psychoeducational program. The present article describes the study protocol and reports preliminary data on feasibility. Using a randomized controlled design, 180 patients who are scheduled to undergo elective CABG are randomly assigned to either (1) standard medical care (SMC) alone, (2) to an additional expectation manipulation intervention during the 2 weeks before surgery, and (3) to an additional attention-control group (“supportive therapy”). The main goal is to test ( a ) whether expectation manipulation intervention can optimize patients' expectations and ( b ) whether optimized expectations lead to enhanced surgery efficacy. The primary outcome variable is illness-related disability 6 months after surgery, whereas secondary outcome variables will be quality of life, return to work, physical activity, and medical outcome variables. First, feasibility data of 36 patients show that the patients appreciated the additional psychological intervention before CABG. Satisfaction of those who received psychological interventions was very high.