Impact of psychosocial intervention on prognosis of cardiac surgery patients

The study examined the impact of two types of psychosocial intervention on prognosis and psychological distress of patients subjected to Coronary Artery Bypass Grafting (CABG), and investigated whether such impact was direct or mediated. A sam ple of 300 participants (243 men and 57 women; mean age: 56.1 years) was recruited into three groups. One group received a unique psycho-educational intervention called Programme for Affective and Cognitive Education (PACE), the second group was given a Relaxation intervention (Guided Imagery), and the third group had only standard medical treatment (Control). The PACE and Relaxation interventions were administered to patients along side standard treatment a day before CABG as well as a day before discharge from hospital. Prognosis was assessed six weeks after discharge. Psychological distress was measured at baseline, week after discharge, and six weeks after discharge. Analyses of vari ance revealed a significant effect of groups on prognosis and a sig nificant group × time interaction for psychological distress. The highest prognosis after CABG and the lowest psychological distress were found in the PACE group. Path analyses indicated that the PACE and Relaxation interventions negatively impacted psy chological distress which in turn predicted higher prognosis. Only the PACE intervention additionally had a positive direct impact on prognosis. Both psychosocial interventions helped enhance the prognosis of patients after CABG primarily by reducing psycho logical distress. PACE emerged as a more effective intervention than Relaxation.
1. Aswathy, S., Unnikrishnan, A. G., Kalra, S., & Leelamoni, K. (2013). Peer support as a strategy for effective management of diabetes in India. Indian Journal of Endocrinology and Metabolism, 17, 5–7. https://doi.org/10.4103/2230-8210.107790
2. Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 69–77. https://doi.org/10.1016/S0022-3999(01)00296-3
3. Broadbent, E., Petrie, K. J., Ellis, C. J., Ying, J., & Gamble, G. (2004). A picture of health—myocardial infarction patients’ drawings of their hearts and subsequent disability: A longitudinal study. Journal of Psychosomatic Research, 57, 583–587. https://doi.org/10.1016/j.jpsychores.2004.03.014
4. Cebeci, F., & Çelik, S. Ş. (2008). Discharge training and counselling increase self-care ability and reduce postdischarge problems in CABG patients. Journal of Clinical Nursing, 17, 412–420. https://doi.org/10.1111/j.1365-2702.2007.01952.x
5. Chaudhury, S., Saini, R., Bakhla, A. K., & Singh, J. (2016). Depression and anxiety following Coronary Artery Bypass Graft: Current Indian scenario. Cardiology Research and Practice, 2016, 2345184. https://doi.org/10.1155/2016/2345184
6. Colom, F. (2011). Keeping therapies simple: Psychoeducation in the prevention of relapse in affective disorders. British Journal of Psychiatry, 198, 338–340. https://doi.org/10.1192/bjp.bp.110.090209
7. Correa-Rodríguez, M., Ejheisheh, M. A., Suleiman-Martos, N., Membrive-Jiménez, M. J., Velando-Soriano, A., Schmidt-RioValle, J., & Gómez-Urquiza, J. L. (2020). Prevalence of depression in Coronary Artery Bypass surgery: A systematic review and meta-analysis. Journal of Clinical Medicine, 9, 909. https://doi.org/10.3390/jcm9040909
8. Daniels, R., & Nicoll, L. H. (2012). Contemporary Medical-Surgical Nursing (2nd ed.). Delmar Cengage Learning.
9. Douki, Z. E., Vaezzadeh, N., Shahmohammadi, S., Shahhosseini, Z., Tabary, S. Z., Mohammadpour, R. A., & Esmaeeli, M. (2011). Anxiety before and after Coronary Artery Bypass Grafting surgery: Relationship to QOL. Middle-East Journal of Scientific Research, 7, 103–108.
10. Drapeau, A., Marchand, A., & Beaulieu-Prévost, D. (2012). Epidemiology of psychological distress. In L. L’Abate (Ed.), Mental Illnesses: Understanding, Prediction and Control (pp. 105–134). https://doi.org/10.5772/30872.
11. Fathi, M., Alavi, S. M., Joudi, M., Joudi, M., Mahdikhani, H., Ferasatkish, R., Bakhshandeh, H., & Nooghabi, M. J. (2014). Preoperative anxiety in candidates for heart surgery. Iranian Journal of Psychiatry and Behavioral Sciences, 8, 90–96.
12. Firoozabadi, M. D., & Ebadi, A. (2014). Effect of relaxation on postoperative pain in patients after Coronary Artery Bypass Grafting (CABG) surgery. NationalPark-Forschung in Der Schweiz (Switzerland Research Park Journal), 103, 185–191.
13. Fisher, W. A., Fisher, J. D., & Harman, J. (2003). The Information–Motivation–Behavioral skills model: A general Social Psychological approach to understanding and promoting health behavior. In J. Suls, & K. A. Wallston (Eds.), Social Psychological Foundations of Health and Illness (pp. 82–106). Blackwell Publishing.
14. Fredrickson, B. L. (2000). Cultivating positive emotions to optimize health and well-being. Prevention & Treatment, 3. http://tinyurl.com/o28me3w.
15. Fredrickson, B. L. (2001). The role of positive emotions in Positive Psychology: The Broaden-and-Build theory of positive emotions. American Psychologist, 56, 218–226. https://doi.org/10.1037/0003-066X.56.3.218
16. Gaziano, T. A., Bitton, A., Anand, S., Abrahams-Gessel, S., & Murphy, A. (2010). Growing epidemic of Coronary Heart Disease in low- and middle-income countries. Current Problems in Cardiology, 35, 72–115. https://doi.org/10.1016/j.cpcardiol.2009.10.002
17. Hariharan, M., Thomas, M., & Rana, S. (2017). Development and preliminary testing of the Biopsychosocial Prognosis Scale for CABG. Indian Journal of Psychological Medicine, 39, 619–626.
18. Hilden, J., & Habbema, J. D. F. (1987). Prognosis in medicine: An analysis of its meaning and rôles. Theoretical Medicine, 8, 349–365. https://doi.org/10.1007/BF00489469
19. Mallik, S., Krumholz, H. M., Lin, Z. Q., Kasl, S. V., Mattera, J. A., Roumains, S. A., & Vaccarino, V. (2005). Patients with depressive symptoms have lower health status benefits after Coronary Artery Bypass surgery. Circulation, 111, 271–277. https://doi.org/10.1161/01.CIR.0000152102.29293.D7
20. Mangiafico, S. S. (2016). Summary and Analysis of Extension Program Evaluation in R (version1.18.1). Retrieved from https://rcompanion.org/handbook/
21. Martinsen, R., & Moen, A. (2010). Unmet information needs and communication needs in the intermediate recovery from Coronary Artery Bypass surgery. Nordic Journal of Nursing Research, 30, 15–19.
22. Miller, D. W. Jr. (1977). Benefits of Coronary Artery Bypass surgery. Archives of Internal Medicine, 137, 1439–1446. https://doi.org/10.1001/archinte.1977.03630220073017
23. Moder, K. (2010). Alternatives to F-test in one way ANOVA in case of heterogeneity of variance (a simulation study). Psychological Test and Assessment Modeling, 52, 343-353.
24. Parker, R. D., & Adams, J. (2008). Activity restrictions and recovery after open chest surgery: Understanding the patient’s perspective. Baylor University Medical Center Proceedings, 21, 421–425. https://doi.org/10.1080/08998280.2008.11928442
25. Pedersen, S. S., Versteeg, H., Denollet, J., Cheng, J. M., Serruys, P. W., & van Domburg, R. T. (2011). Patient-rated health status predicts prognosis following Percutaneous Coronary Intervention with drug-eluting stenting. Quality of Life Research, 20, 559–567. https://doi.org/10.1007/s11136-010-9775-5
26. Protogerou, C., Fleeman, N., Dwan, K., Richardson, M., Dundar, Y., & Hagger, M. S. (2015). Moderators of the effect of psychological interventions on depression and anxiety in cardiac surgery patients: A systematic review and meta-analysis. Behaviour Research and Therapy, 73, 151–164. https://doi.org/10.1016/j.brat.2015.08.004
27. Redelmeier, D. A., Rozin, P., & Kahneman, D. (1993). Understanding patients’ decisions: Cognitive and emotional perspectives. Journal of the American Medical Association, 270, 72–76. https://doi.org10.1001/jama.1993.03510010078034
28. Smith, G. (2012). An introduction to psychological interventions. In G. Smith (Ed.), Psychological Interventions in Mental Health Nursing (pp. 1–23). Open University Press.
29. Thomas, M., Hariharan, M., & Rana, S. (2016). Psychological distress as predictor of adherence and prognosis among patients undergoing Coronary Artery Bypass Grafting. Journal of the Indian Academy of Applied Psychology, 42, 161–171.
30. Tomarken, A. J., & Serlin, R. C. (1986). Comparison of ANOVA alternatives under variance heterogeneity and specific noncentrality structures. Psychological Bulletin, 99, 90–99.
31. Upton, D., & Solowiej, K. (2010). Pain and stress as contributors to delayed wound healing. Wound Practice and Research, 18, 114–122.
32. van Dixhoorn, J., & White, A. (2005). Relaxation therapy for rehabilitation and prevention in Ischemic Heart Disease: A systemic review and meta-analysis. European Journal of Preventive Cardiology, 12, 193–202.
33. Waight, C. A., Strodl, E., Sheridan, J., & Tesar, P. (2015). Posttraumatic growth in post-surgical Coronary Artery Bypass Graft patients. Health Psychology Open, 2, 1–9. https://doi.org/10.1177/2055102915571370
34. World Health Organization. (2015). Noncommunicable diseases – Fact sheet. http://tinyurl.com/pdb8w2t. Accessed 20 April 2016.
35. Wulsin, L. (2012). Psychological challenges of coping with Coronary Artery Disease. In E. A. Dornelas (Ed.), Stress Proof the Heart: Behavioral Interventions for Cardiac Patients (pp. 9–24). Springer.
36. Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x