51
|
Expectation-Focused Psychotherapy to Improve Clinical Outcomes. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 138:257-270. [PMID: 29681329 DOI: 10.1016/bs.irn.2018.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Placebo research has shown that patients' expectations are among the strongest predictors of treatment outcome regarding various medical conditions. Therefore, interventions focusing on the change of such expectations might be most effective. This could be of relevance not only for outcome expectations but also for disease-specific, problem-specific, and treatment-specific expectations. A theoretical model is introduced to illustrate the conditions for expectation change and persistence. Strategies for patients regarding how to devalue learning effects in expectation violation situations are exemplified, and ways to optimize expectation-violating effects are highlighted. Data from a large randomized controlled trial serve as a practical example and demonstrate the effect of a presurgery optimization of expectations in patients scheduled for heart surgery (coronary artery bypass grafting). Disability scores that were obtained 6 months postsurgery confirmed that patients who participated in preoperative psychological interventions, which aimed at optimizing expectations, demonstrate the best outcome after heart surgery. Practical aspects of the intervention are presented, and suggestions on implementing these procedures to optimize outcome in medical interventions are discussed. Psychotherapy is conceptualized as an intervention that should target expectation violation of disorder- and treatment-specific expectations.
Collapse
|
52
|
Pedersen SS, Andersen CM, Denollet J, Habibovic M. Depressive symptoms in patients with an implantable cardioverter defibrillator: Does treatment expectations play a role? Gen Hosp Psychiatry 2018; 51:10-14. [PMID: 29268165 DOI: 10.1016/j.genhosppsych.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Patients with an implantable cardioverter defibrillator (ICD) and co-morbid depression are at greater risk of poor quality of life and premature death. We examined if treatment expectations predict depressive symptoms 12months post implant. METHODS First-time implant patients from the WEBCARE study (n=177; 83.1% men) completed the EXPECTations towards ICD therapy questionnaire and the Type D Scale at baseline, and the Patient Health Questionnaire at baseline and 12months. RESULTS Using hierarchical linear regression with 3 models, we identified the following independent predictors of 12-months depressive symptoms: Model 1: Negative treatment expectations (β=0.202; p=0.020) and baseline depression (β=0.376; p<0.0001). Model 2: Baseline depression (β=0.350; p<0.0001) and Type D personality (β=0.162; p=0.042); negative treatment expectations was borderline significant (β=0.169; p=0.051). Model 3: Baseline depression (β=0.353; p<0.0001) and negative treatment expectations (β=0.180; p=0.043); Type D personality was not significant (β=0.150; p=0.067), adjusting for positive treatment expectations, heart failure, sex, and shocks during follow-up. The models accounted for 22.2%, 24.1%, and 23.3% of the variance in 12-months depressive symptoms, respectively. CONCLUSION Further research is warranted to explore the role of treatment expectations at the time of implant and its overlap with personality as a determinant of depression in patients with an ICD.
Collapse
Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | | | - Johan Denollet
- CoRPS - Center of Research on Psychological and Somatic diseases, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Mirela Habibovic
- CoRPS - Center of Research on Psychological and Somatic diseases, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| |
Collapse
|
53
|
Miglioretti M, Meroni C, Baiardo G, Savioli G, Velasco V. The perceptions of the causes of cardiac diseases: a taxonomy. Psychol Health 2017; 33:537-554. [DOI: 10.1080/08870446.2017.1380810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | - Claudia Meroni
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Baiardo
- Psychological Unit, Cardiovascular Institute of Camogli, Ruta di Camogli (GE), Italy
| | - Gaia Savioli
- Psychological Unit, Cardiovascular Institute of Camogli, Ruta di Camogli (GE), Italy
| | - Veronica Velasco
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
54
|
Rassart J, Apers S, Kovacs AH, Moons P, Thomet C, Budts W, Enomoto J, Sluman MA, Wang JK, Jackson JL, Khairy P, Cook SC, Subramanyan R, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Rempel GR, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White KS, Callus E, Kutty S, Luyckx K. Illness perceptions in adult congenital heart disease: A multi-center international study. Int J Cardiol 2017; 244:130-138. [DOI: 10.1016/j.ijcard.2017.06.072] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/01/2017] [Accepted: 06/19/2017] [Indexed: 01/02/2023]
|
55
|
Taylor EC, O'Neill M, Hughes LD, Carroll S, Moss-Morris R. 'It's like a frog leaping about in your chest': Illness and treatment perceptions in persistent atrial fibrillation. Br J Health Psychol 2017; 23:3-21. [PMID: 28875586 DOI: 10.1111/bjhp.12267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/09/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Persistent atrial fibrillation (AF) is an abnormal heart rhythm associated with low quality of life (QoL) and significant health-related costs. The purpose of the study was to examine patients' illness and treatment beliefs and ways of coping with AF symptoms, to provide insight into promoting better QoL and treatment-specific management. DESIGN Beliefs were explored across three procedural treatment groups using a qualitative cross-sectional design. METHODS Thirty semi-structured interviews were carried out with patients undertaking cardioversion (n = 10), catheter ablation (n = 11) and atrioventricular node ablation (n = 9). Interviews were transcribed and analysed using inductive thematic analysis with elements of grounded theory. RESULTS An overarching theme of a vicious cycle was evident, which related to perceived lack of knowledge and understanding of AF, attempts to control symptoms and negative emotional reactions to failed control attempts. This vicious cycle related to three subordinate themes: (1) unpredictability and uncertainty of AF and symptoms; (2) coping with symptoms through (a) avoidance (b) all-or-nothing- (c) slowing down behaviours; and (3) concerns and expectations about treatment. CONCLUSIONS Patients outlined a need to gain control of unpredictable symptoms by monitoring and varying activity levels. These behaviours were often appraised as ineffective at controlling symptoms, leading to heightened uncertainty and increased activity avoidance. Treatment concerns escalated with increasing number and invasiveness of procedures. Improving AF patients' perceived understanding of their illness and treatment and promoting more effective symptom-management strategies may alleviate psychological distress and improve QoL. Themes elaborated on the common-sense model whereby patients' beliefs about illness and treatment interact with coping behaviours. Statement of contribution What is already known about this subject? Quality of life (QoL) is disproportionately low in people with persistent atrial fibrillation (psAF). The common-sense model suggests illness perceptions and coping predict QoL in chronic illnesses. No previous studies have examined the idiosyncratic beliefs and coping behaviours of psAF patients. What does this study add? A vicious cycle of perceived lack of understanding of AF, attempts to control AF and distress at failed attempts at control, was a key theme. PsAF patients reported continued avoidance/all-or-nothing behaviours despite symptomatic relief post-procedure, and disengagement from enjoyable activities. PsAF patients reported procedure-specific concerns/expectations, which could be targeted in future interventions aimed at reducing distress.
Collapse
Affiliation(s)
- Elaina C Taylor
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Mark O'Neill
- Divisions of Imaging Sciences & Biomedical Engineering & Cardiovascular Medicine, King's College London, UK
| | - Lyndsay D Hughes
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Carroll
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
56
|
Effects of Preoperative Psychological Interventions on Catecholamine and Cortisol Levels After Surgery in Coronary Artery Bypass Graft Patients: The Randomized Controlled PSY-HEART Trial. Psychosom Med 2017; 79:806-814. [PMID: 28846584 DOI: 10.1097/psy.0000000000000483] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of the study was to examine whether preoperative psychological interventions targeting patients' expectations are capable of influencing the biological stress response after coronary artery bypass graft (CABG) surgery and could thus improve recovery after heart surgery. METHODS Randomized controlled trial with assessments 10 days before surgery, after psychological intervention (day of hospital admission, but before surgery), postoperative (6-8 days later), and at follow-up (6 months after surgery). Eligible patients (N = 124) scheduled for elective on-pump CABG or CABG with valve replacement surgery were approached before hospital admission. Standard medical care (SMC) was compared with two additional preoperative psychological interventions: (a) an expectation manipulation intervention to optimize patients' expectations about course and outcomes or (b) supportive therapy, containing the same amount of therapeutic attention, but without specifically focusing on expectations. Postoperative plasma adrenaline, noradrenaline, and cortisol levels were a secondary outcome of our study (primary outcome patients' disability 6 months after surgery and other secondary patient-reported or clinical outcomes were reported elsewhere). RESULTS Expectation manipulation intervention (3.68 ln pg/mL, 95% confidence interval = 3.38-3.98, p = .015) and supportive therapy (3.70 ln pg/mL, 95% confidence interval = 3.38-4.01, p = .026) led to significantly lower postoperative adrenaline levels compared with SMC (4.26 ln pg/mL, 95% confidence interval = 3.99-4.53) only. There were no treatment effects of the preoperative intervention for noradrenaline (p = .90) or cortisol (p = .30). Higher postoperative adrenaline levels predicted disability 6 months after surgery (r = .258, p = .018). CONCLUSIONS In addition to SMC, preoperative psychological interventions seem to buffer psychobiological stress responses and could thus facilitate recovery from CABG surgery. Patients' postoperative stress responses could be an important factor for explaining trajectories of long-term outcomes. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov(NCT01407055).
Collapse
|
57
|
Norkienė I, Urbanaviciute I, Kezyte G, Vicka V, Jovaisa T. Impact of pre-operative health-related quality of life on outcomes after heart surgery. ANZ J Surg 2017; 88:332-336. [PMID: 28702944 DOI: 10.1111/ans.14061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/02/2017] [Accepted: 04/05/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Long-term improvement in health-related quality of life (HRQOL) is one of the most important outcomes of cardiac surgery. The aim of this study is to define the impact of perioperative patient and procedural variables on HRQOL dynamics, a year after cardiac surgery. METHODS Consecutive patients undergoing elective on-pump cardiac surgery were enrolled in this prospective observational cohort study. Patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire a day before surgery and once again a year after surgery. The effect size method was used to determine whether treatment resulted in the improvement of HRQOL. RESULTS A total of 67.3% of patients achieved long-term improvement in HRQOL. Significant negative association was identified between Physical and Mental Component Summary scores (PCS/MCS) and long-term outcomes. Pre-operative PCS were 40.7 ± 13.7 for improvers and 56.6 ± 14.4 for non-improvers; MCS were 45.8 ± 12.1 and 65.2 ± 13.7, respectively (P < 0.001 for all). There were no statistically significant differences in pre-operative risk factors, demographics, operative factors or post-operative variables between the two groups. CONCLUSION Among those completing this study, one in three patients did not experience long-term HRQOL improvements following cardiac surgery. Multivariate analysis confirmed that higher pre-operative PCS and MCS are independent predictors of worse HRQOL a year after surgery. Further research should focus on establishing the prevalence of this phenomenon worldwide and develop targeted interventions to improve long-term self-perceived quality of life for patients with relatively good pre-operative health.
Collapse
Affiliation(s)
- Ieva Norkienė
- Faculty of Medicine, Clinic of Anaesthesiology and Reanimatology, Vilnius University, Vilnius, Lithuania
| | - Indre Urbanaviciute
- Faculty of Medicine, Clinic of Anaesthesiology and Reanimatology, Vilnius University, Vilnius, Lithuania
| | - Greta Kezyte
- Faculty of Medicine, Clinic of Anaesthesiology and Reanimatology, Vilnius University, Vilnius, Lithuania
| | - Vaidas Vicka
- Faculty of Medicine, Clinic of Anaesthesiology and Reanimatology, Vilnius University, Vilnius, Lithuania
| | - Tomas Jovaisa
- Clinic of Anaesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
58
|
Timmermans I, Meine M, Zitron E, Widdershoven J, Kimman G, Prevot S, Rauwolf T, Anselme F, Szendey I, Romero Roldán J, Mabo P, Schaer B, Denollet J, Versteeg H. The patient perspective on remote monitoring of patients with an implantable cardioverter defibrillator: Narrative review and future directions. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:826-833. [DOI: 10.1111/pace.13123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/14/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Ivy Timmermans
- Department of Cardiology; University Medical Center Utrecht; 3508 GA Utrecht the Netherlands
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology; Tilburg University; 5000 LE Tilburg the Netherlands
| | - Matias Meine
- Department of Cardiology; University Medical Center Utrecht; 3508 GA Utrecht the Netherlands
| | - Edgar Zitron
- Department of Cardiology; Universitätsklinikum Heidelberg; Heidelberg Germany
| | - Jos Widdershoven
- Department of Cardiology; Elisabeth Tweesteden Hospital; AD Tilburg the Netherlands
| | - Geert Kimman
- Department of Cardiology; Medisch Centrum Alkmaar; JD Alkmaar the Netherlands
| | - Sébastien Prevot
- Department of Cardiology; Hôpital Privé Clairval; Marseille France
| | - Thomas Rauwolf
- Department of Cardiology; Universitätsklinikum Magdeburg; Magdeburg Germany
| | | | - Istvan Szendey
- Department of Cardiology; Kliniken Maria Hilf GmbH; Mönchengladbach Germany
| | | | - Philippe Mabo
- Department of Cardiology; Centre Hospitalier Universitaire; Rennes France
| | - Beat Schaer
- Department of Cardiology; University Hospital Basel; Basel Switzerland
| | - Johan Denollet
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology; Tilburg University; 5000 LE Tilburg the Netherlands
| | - Henneke Versteeg
- Department of Cardiology; University Medical Center Utrecht; 3508 GA Utrecht the Netherlands
| |
Collapse
|
59
|
Auer CJ, Laferton JAC, Shedden-Mora MC, Salzmann S, Moosdorf R, Rief W. Optimizing preoperative expectations leads to a shorter length of hospital stay in CABG patients: Further results of the randomized controlled PSY-HEART trial. J Psychosom Res 2017; 97:82-89. [PMID: 28606503 DOI: 10.1016/j.jpsychores.2017.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the effect of a preoperative expectation-optimizing psychological intervention on length of stay in the hospital and time spent in the Intensive Care Unit (ICU) in patients undergoing elective cardiac surgery. METHODS In a randomized controlled trial, 124 patients prior to undergoing coronary artery bypass grafting (CABG) or CABG combined with heart valve surgery were randomized to either a) standard medical care alone (SMC) or an additional preoperative intervention, b) an additional expectation manipulation intervention (EXPECT) to optimize patients' expectations, or c) an additional supportive therapy (SUPPORT), containing the same amount of therapeutic attention but without a specific focus. Participants were followed-up post-operatively to assess their length of hospital stay and the time spent in the ICU. RESULTS Patients in both psychological intervention groups spent significantly less days in the hospital then patients in the SMC group (M(EXPECT)=12.62, M(SUPPORT)=14.13, M(SMC)=17.27, p=0.028). There was a significant linear trend (F(1112)=7.68, p=0.009) showing that the more specific the intervention patients received the shorter they stayed in the hospital. The effect of the intervention on time spent in the ICU was only marginally significant (M(EXPECT)=103.76, M(SUPPORT)=103.10, M(SMC)=158.45, p=0.066). CONCLUSION Changing patients' preoperative expectations via a psychological intervention leads to less days spent in the hospital. The psychological interventions are associated with positive cost-benefit ratios. Specific psychological mechanisms underlying the effect of our intervention remain unclear and need to be investigated further. TRIAL REGISTRATION www.clinicaltrials.gov (NCT01407055).
Collapse
Affiliation(s)
- Charlotte J Auer
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
| | - Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany; Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany.
| | - Meike C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stefan Salzmann
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
| | - Rainer Moosdorf
- Clinic for Cardiac and Thoracic Vessel Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany.
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
| |
Collapse
|
60
|
|
61
|
Laferton JAC, 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. [PMID: 28270786 PMCID: PMC5318458 DOI: 10.3389/fpsyg.2017.00233] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/06/2017] [Indexed: 01/29/2023] Open
Abstract
Patients’ expectations in the context of medical treatment represent a growing area of research, with accumulating evidence suggesting their influence on health outcomes across a variety of medical conditions. However, the aggregation of evidence is complicated due to an inconsistent and disintegrated application of expectation constructs and the heterogeneity of assessment strategies. Therefore, based on current expectation concepts, this critical review provides an integrated model of patients’ expectations in medical treatment. Moreover, we review existing assessment tools in the context of the integrative model of expectations and provide recommendations for improving future assessment. The integrative model includes expectations regarding treatment and patients’ treatment-related behavior. Treatment and behavior outcome expectations can relate to aspects regarding benefits and side effects and can refer to internal (e.g., symptoms) and external outcomes (e.g., reactions of others). Furthermore, timeline, structural and process expectations are important aspects with respect to medical treatment. Additionally, generalized expectations such as generalized self-efficacy or optimism have to be considered. Several instruments assessing different aspects of expectations in medical treatment can be found in the literature. However, many were developed without conceptual standardization and psychometric evaluation. Moreover, they merely assess single aspects of expectations, thus impeding the integration of evidence regarding the differential aspects of expectations. As many instruments assess treatment-specific expectations, they are not comparable between different conditions. To generate a more comprehensive understanding of expectation effects in medical treatments, we recommend that future research should apply standardized, psychometrically evaluated measures, assessing multidimensional aspects of patients’ expectations that are applicable across various medical treatments. In the future, more research is needed on the interrelation of different expectation concepts as well as on factors influencing patients’ expectations of illness and treatment. Considering the importance of patients’ expectations for health outcomes across many medical conditions, an integrated understanding and assessment of such expectations might facilitate interventions aiming to optimize patients’ expectations in order to improve health outcomes.
Collapse
Affiliation(s)
- Johannes A C Laferton
- Department of Psychology, Clinical Psychology and Psychotherapy, Psychologische Hochschule BerlinBerlin, Germany; Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of MarburgMarburg, Germany
| | - Tobias Kube
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg Marburg, Germany
| | - Stefan Salzmann
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg Marburg, Germany
| | - Charlotte J Auer
- Division of Psychotherapy and Psychiatry, University Hospital Lübeck Lübeck, Germany
| | - Meike C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| |
Collapse
|
62
|
Rief W, Shedden-Mora MC, Laferton JAC, 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. [PMID: 28069021 PMCID: PMC5223324 DOI: 10.1186/s12916-016-0767-3] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/17/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Placebo effects contribute substantially to outcome in most fields of medicine. While clinical trials typically try to control or minimize these effects, the potential of placebo mechanisms to improve outcome is rarely used. Patient expectations about treatment efficacy and outcome are major mechanisms that contribute to these placebo effects. We aimed to optimize these expectations to improve outcome in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS In a prospective three-arm randomized clinical trial with a 6 month follow-up, 124 patients scheduled for CABG surgery were randomized to either a brief psychological pre-surgery intervention to optimize outcome expectations (EXPECT); or a psychological control intervention focusing on emotional support and general advice, but not on expectations (SUPPORT); or to standard medical care (SMC). Interventions were kept brief to be feasible with a heart surgery environment; "dose" of therapy was identical for both pre-surgery interventions. Primary outcome was disability 6 months after surgery. Secondary outcomes comprised further clinical and immunological variables. RESULTS Patients in the EXPECT group showed significantly larger improvements in disability (-12.6; -17.6 to -7.5) than the SMC group (-1.9; -6.6 to +2.7); patients in the SUPPORT group (-6.7; -11.8 to 1.7) did not differ from the SMC group. Comparing follow-up scores and controlling for baseline scores of EXPECT versus SUPPORT on the variable disability only revealed a trend in favor of the EXPECT group (P = 0.09). Specific advantages for EXPECT compared to SUPPORT were found for mental quality of life and fitness for work (hours per week). Both psychological pre-surgery interventions induced less pronounced increases in pro-inflammatory cytokine concentrations reflected by decreased interleukin-8 levels post-surgery compared to changes in SMC patients and lower interleukin-6 levels in patients of the EXPECT group at follow-up. Both pre-surgery interventions were characterized by great patient acceptability and no adverse effects were attributed to them. Considering the innovative nature of this approach, replication in larger, multicenter trials is needed. CONCLUSIONS Optimizing patients' expectations pre-surgery helps to improve outcome 6 months after treatment. This implies that making use of placebo mechanisms has the potential to improve long-term outcome of highly invasive medical interventions. Further studies are warranted to generalize this approach to other fields of medicine. TRIAL REGISTRATION Ethical approval for the study was obtained from the IRB of the Medical School, University of Marburg, and the trial was registered at ( NCT01407055 ) on July 25, 2011.
Collapse
Affiliation(s)
- Winfried Rief
- Division of Clinical Psychology, University of Marburg, Gutenbergstrasse 18, Marburg, 35032, Germany.
| | - Meike C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Johannes A C Laferton
- Division of Clinical Psychology, University of Marburg, Gutenbergstrasse 18, Marburg, 35032, Germany
| | - Charlotte Auer
- Division of Clinical Psychology, University of Marburg, Gutenbergstrasse 18, Marburg, 35032, Germany
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Stefan Salzmann
- Division of Clinical Psychology, University of Marburg, Gutenbergstrasse 18, Marburg, 35032, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany
| | - Rainer Moosdorf
- Department of Cardiac and Thoracic Vessel Surgery, Heart Centre, University of Marburg, Marburg, Germany
| |
Collapse
|
63
|
Singh A, Agrawal S, Gargya S, Saluja S, Kumar A, Kumar A, Kalra K, Thind M, Saluja S, Stone LE, Ali F, Duarte-Chavez R, Marchionni C, Sholevar F, Shirani J, Nanda S. Posttraumatic stress disorder after myocardial infarction and coronary artery bypass grafting. Int J Crit Illn Inj Sci 2017; 7:84-90. [PMID: 28660161 PMCID: PMC5479081 DOI: 10.4103/ijciis.ijciis_27_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Post traumatic stress disorder is a psychiatric disease that is usually precipitated by life threatening stressors. Myocardial infarction, especially in the young can count as one such event. The development of post traumatic stress after a coronary event not only adversely effects psychiatric health, but leads to increased cardiovascular morbidity and mortality. There is increasing evidence that like major depression, post traumatic stress disorder is also a strong coronary risk factor. Early diagnosis and treatment of this disease in patients with acute manifestations of coronary artery disease can improve patient outcomes.
Collapse
Affiliation(s)
- Amitoj Singh
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sahil Agrawal
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sanchita Gargya
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Sabir Saluja
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Akshat Kumar
- Department of Internal Medicine, St Peters University Hospital, New Brunswick, NJ, USA
| | - Abhishek Kumar
- Department of Internal Medicine, St Peters University Hospital, New Brunswick, NJ, USA
| | - Kartik Kalra
- Department of Internal Medicine, St Peters University Hospital, New Brunswick, NJ, USA
| | - Munveer Thind
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Sajeev Saluja
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Lauren E Stone
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Farhan Ali
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Rodrigo Duarte-Chavez
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Christine Marchionni
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Farhad Sholevar
- Department of Psychiatry, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sudip Nanda
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| |
Collapse
|
64
|
Return to work after coronary revascularization procedures and a patient's job satisfaction: A prospective study. Int J Occup Med Environ Health 2016; 28:52-61. [PMID: 26159947 DOI: 10.2478/s13382-014-0313-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Research into work reintegration following invasive cardiac procedures is limited. The aim of this prospective study was to explore predictors of job satisfaction among cardiac patients who have returned to work after cardiac rehabilitation (CR). MATERIAL AND METHODS The study population consisted of 90 cardiac patients who have recently been treated with coronary angioplasty or heart surgery. They were evaluated during their CR and 12 months after the discharge using validated self-report questionnaires measuring job satisfaction, work stress-related factors, emotional distress and illness perception. Information on socio-demographic, medical and occupational factors has also been collected. RESULTS After adjusting for demographic, occupational and medical variables, baseline job satisfaction (p < 0.001), depression (p < 0.01) and ambition (p < 0.05) turned out to be independent, significant predictors of job satisfaction following return to work (RTW). Patients who had a partial RTW were more satisfied with their job than those who had a full RTW, controlling for baseline job satisfaction. CONCLUSIONS These findings recommend an early assessment of patients' psychosocial work environment and emotional distress, with particular emphasis on job satisfaction and depressive symptoms, in order to promote satisfying and healthy RTW after cardiac interventions.
Collapse
|
65
|
Wilhelm M, Winkler A, Rief W, Doering BK. Effect of placebo groups on blood pressure in hypertension: a meta-analysis of beta-blocker trials. ACTA ACUST UNITED AC 2016; 10:917-929. [DOI: 10.1016/j.jash.2016.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/18/2016] [Accepted: 10/27/2016] [Indexed: 01/02/2023]
|
66
|
Using Animation to Improve Recovery from Acute Coronary Syndrome: A Randomized Trial. Ann Behav Med 2016; 50:108-18. [PMID: 26497696 DOI: 10.1007/s12160-015-9736-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
UNLABELLED Background: Recovery from myocardial infarction has been associated with patients' perceptions of damage to their heart. New technologies offer a way to show patients animations that may foster more accurate perceptions and encourage medication adherence, increased exercise and faster return to activities. PURPOSE The purpose of this study was to investigate the effects of a brief animated intervention delivered at the patients' bedside on perceptions and recovery in acute coronary syndrome patients. METHODS Seventy acute coronary syndrome patients were randomly assigned to the intervention or standard care alone. Illness perceptions, medication beliefs and recovery outcomes were measured. RESULTS Post-intervention, the intervention group had significantly increased treatment control perceptions and decreased medication harm beliefs and concerns. Seven weeks later, intervention participants had significantly increased treatment control and timeline beliefs, decreased symptoms, lower cardiac avoidance, greater exercise and faster return to normal activities compared to control patients. CONCLUSIONS A brief animated intervention may be clinically effective for acute coronary syndrome patients (Trial-ID: ACTRN12614000440628).
Collapse
|
67
|
Rovai D, Giannessi D, Andreassi MG, Gentili C, Pingitore A, Glauber M, Gemignani A. Mind injuries after cardiac surgery. J Cardiovasc Med (Hagerstown) 2016; 16:844-51. [PMID: 24933202 DOI: 10.2459/jcm.0000000000000133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
After cardiac surgery, delirium, cognitive dysfunction, depression, or anxiety disorders frequently occur, and profoundly affect patients' prognosis and quality of life. This narrative review focuses on the main clinical presentations of cognitive and psychological problems ('mind injuries') that occur postoperatively in absence of ascertainable focal neurologic deficits, exploring their pathophysiological mechanisms and possible strategies for prevention and treatment. Postoperative cognitive dysfunction is a potentially devastating complication that can involve several mechanisms and several predisposing, intraoperative, and postoperative risk factors, which can result in or be associated to cerebral microvascular damage. Postoperative depression is influenced by genetic or psychosocial predisposing factors, by neuroendocrine activation, and by the release of several pro-inflammatory factors. The net effect of these changes is neuroinflammation. These complex biochemical alterations, along with an aspecific response to stressful life events, might target the function of several brain areas, which are thought to represent a trigger factor for the onset of depression.
Collapse
Affiliation(s)
- Daniele Rovai
- aCNR, Institute of Clinical Physiology bBiomedicine, CNR, Institute of Clinical Physiology cClinical Psychology, Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa dCardiothoracic Department, Fondazione Toscana G. Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | | | | | | | | | | | | |
Collapse
|
68
|
Auer CJ, Kube T, Laferton JAC, Salzmann S, Shedden-Mora M, Rief W, Moosdorf R. Welche Erwartungen sagen postoperative Depressivität und Ängstlichkeit bei herzchirurgischen Patienten am stärksten vorher? ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2016. [DOI: 10.1026/1616-3443/a000358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Depressivität und Ängstlichkeit beeinträchtigen den Behandlungserfolg von herzchirurgischen Patienten. Fragestellung: Untersucht wurde, ob und wie präoperative Patientenerwartungen mit postoperativer Depressivität und Ängstlichkeit zusammenhängen und welche präoperativen Erwartungen hierbei den höchsten prädiktiven Wert haben. Methoden: 124 aortocoronare Bypass-Patienten bearbeiteten eine Woche vor der Operation einen Fragebogen, der verschiedene Aspekte von Erwartungen mischt (Positive Health Expectation Questionnaire; PHES) und einen Fragebogen, der einzelne Erwartungsaspekte getrennt erfasst (Expected Illness Perception Questionnaire, IPQ-E) und eine Woche vor sowie eine Woche nach der Operation Fragen zu ihrer Depressivität und Ängstlichkeit (Hospital Anxiety and Depression Scale (HADS)). Ergebnisse: Postoperative Depressivität wird durch präoperative Erwartungen vorhergesagt (R2 = 0.32, F = 3.13, p = .02). Der einzig signifikante Prädiktor hierbei sind positive Gesundheitserwartungen gemessen mit dem PHES. Auch postoperative Ängstlichkeit wird durch präoperative Erwartungen vorhergesagt (R2 = 0.27, F = 2.55, p < .05). Bei der Vorhersage postoperativer Ängstlichkeit haben erwartete Konsequenzen gemessen mit dem IPQ-E den stärksten prädiktiven Wert. Schlussfolgerungen: Die Studie belegt die Relevanz von präoperativen Erwartungen bei herzchirurgischen Patienten. Interventionen, die auf die Verringerung von Depressivität herzchirurgischer Patienten abzielen, sollten den Fokus auf verschiedene Aspekte von Erwartungen legen. Bei der Verringerung postoperativer Ängstlichkeit könnten hingegen einzeln erfasste Erwartungsaspekte von Bedeutung sein.
Collapse
Affiliation(s)
- Charlotte J. Auer
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Tobias Kube
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | | | - Stefan Salzmann
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Meike Shedden-Mora
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
| | - Winfried Rief
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Rainer Moosdorf
- Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Gießen-Marburg
| |
Collapse
|
69
|
Cao X, Wong EML, Chow Choi K, Cheng L, Ying Chair S. Interventions for Cardiovascular Patients with Type D Personality: A Systematic Review. Worldviews Evid Based Nurs 2016; 13:314-23. [DOI: 10.1111/wvn.12153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Xi Cao
- Doctoral candidate, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
| | - Eliza M. L. Wong
- Assistant Professor, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
| | - Kai Chow Choi
- Assistant Professor, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
| | - Li Cheng
- Doctoral candidate, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
| | - Sek Ying Chair
- Professor and Director, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
| |
Collapse
|
70
|
Development of the Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ). Qual Life Res 2016; 25:2077-86. [PMID: 26883817 DOI: 10.1007/s11136-016-1243-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Some variability in recovery and outcomes after cardiac surgery may be influenced by psychosocial aspects not routinely captured. Preliminary evidence suggests patient expectations impact health status, but there is no specific measure of expectations for cardiac surgery. The purpose of this study was to adapt an expectations scale to cardiac surgery and assess the psychometric properties of the scale. METHODS Before surgery, 93 patients awaiting non-emergent cardiac surgery completed questionnaires, including the adapted Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ). At 1 year after surgery, 68 patients completed questionnaires. RESULTS Mean C-SPEQ score was 39.4 ± 9.02, and scores were normally distributed (Cronbach's alpha = 0.86). Higher score indicated negative expectations. Higher presurgery C-SPEQ score was correlated with greater depression (r = 0.32, p = 0.01) and perceived stress (r = 0.36, p = 0.003), but not state anxiety (r = 0.18, p = 0.14), at one-year post-surgery. Higher C-SPEQ was associated with longer recovery time (B = 0.14, p = 0.006) and lower physical HRQL after surgery (B = -0.31, p = 0.005). Higher C-SPEQ was not related to greater odds for perioperative complications (OR 1.01, p = 0.68) or readmissions <30 days (OR 1.05, p = 0.31). C-SPEQ score was not related to survival. CONCLUSIONS Adaptation of an expectations questionnaire to cardiac surgery patients was successful with acceptable reliability and validity. Negative expectations had a detrimental impact on recovery and HRQL following cardiac surgery but were not related to clinical outcomes. Although focus is mainly on improving clinical outcomes, there are opportunities to improve non-clinical aspects of the patient experience. Presurgical education might better prepare patients, reduce negative expectations, and improve psychosocial outcomes after cardiac surgery.
Collapse
|
71
|
Abstract
BACKGROUND Despite an increasing prevalence of adults living with a CHD, little is known about the psychosocial impact of CHD. We sought to investigate the relative impact of disease severity and patients' perceptions about their condition on depression, anxiety, and quality of life over a period of a year. METHODS A total of 110 patients aged over 16 years completed an initial questionnaire containing measures for anxiety, depression, quality of life, and illness perceptions when they attended the Adult Congenital Heart Disease Clinic. Cardiologists rated the patients' disease severity and illness course. A year later, patients were invited to complete the same measures. Regression analyses were performed to determine the relative impact of illness perceptions and disease severity on psychological outcomes a year later. RESULTS At baseline, 23% of the study population had depressive symptoms and 30% had elevated trait anxiety. After controlling for associations with disease-related variables, illness perceptions explained 28% of the variance in depression, 40% anxiety, and 27% overall quality of life at baseline. Baseline illness perceptions bivariately predicted quality of life, cardiac anxiety, and depression 1 year later, and regression analyses controlling for other factors showed that they were significant predictors of outcomes 1 year later. CONCLUSION Symptoms of depression and anxiety are common among adults with CHD. Patients' illness perceptions are related to psychological outcomes, especially cross-sectionally. Future research could investigate whether an intervention to discuss patients' perceptions about their CHD can improve mental health and quality of life.
Collapse
|
72
|
Marke V, Bennett P. Predicting negative emotional states following first onset acute coronary syndrome. J Health Psychol 2015; 22:765-775. [PMID: 26613707 DOI: 10.1177/1359105315614996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study identified predictors of anxiety and depression in patients with acute coronary syndrome. Predictors included illness beliefs, fear/threat at the time of the cardiac event, threat reappraisal over time and social support. A total of 97 participants completed questionnaires in hospital and 1- and 6-month follow-up. Perceived threat and fear at the time of the cardiac event predicted affective response at both time points, partly mediated by threat reappraisal. Contemporaneous measures of illness beliefs contributed additional variance, although not always in the predicted direction: high concern and control over the illness were associated with emotional distress. Assessment of patients for risk of negative emotional outcomes of acute coronary syndrome needs to consider their beliefs about their illness and the degree of threat and fear experienced at the time of the event. Interventions need to help people cope with negative emotional states as well as challenging inappropriate illness beliefs.
Collapse
|
73
|
Health-related personal control predicts depression symptoms and quality of life but not health behaviour following coronary artery bypass graft surgery. J Behav Med 2015; 39:120-7. [PMID: 26341356 PMCID: PMC4720702 DOI: 10.1007/s10865-015-9677-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/26/2015] [Indexed: 01/08/2023]
Abstract
To determine the prospective association between health-related control beliefs, quality of life (QOL), depression symptoms, and health behaviours in coronary artery bypass graft (CABG) patients 6-8 weeks following surgery. 149 patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring health related personal control, treatment control, depression symptoms, QOL, and health behaviours prior to and 6-8 weeks after surgery. Higher levels of health-related personal control predicted better QOL, and lower levels of depression symptoms, but not adherence to medication, cardiac rehabilitation attendance, or physical activity. These results were independent of demographic, behavioural, and clinical covariates. Treatment control was not associated with any outcome. These results suggest that perceived health-related personal control is associated with key aspects of short-term recovery from CABG surgery. Targeted interventions aimed at improving perceptions of health-related personal control may improve health outcomes in this cardiac population.
Collapse
|
74
|
Auer CJ, Glombiewski JA, Doering BK, Winkler A, Laferton JAC, Broadbent E, Rief W. Patients’ Expectations Predict Surgery Outcomes: A Meta-Analysis. Int J Behav Med 2015. [DOI: 10.1007/s12529-015-9500-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
75
|
Laferton JAC, Auer CJ, Shedden-Mora MC, Moosdorf R, Rief W. Factors associated with disability expectations in patients undergoing heart surgery. Int J Behav Med 2015; 22:85-91. [PMID: 25187112 DOI: 10.1007/s12529-014-9434-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Heart surgery patients' expectations have been shown to be related to surgery outcome, independent of medical status. However, it is unclear which factors determine patients' expectations about disability following heart surgery. PURPOSE Investigating the associations of patients' disability expectations with demographic, medical, and psychosocial factors as well as other aspects of patients' expectations might help to tailor psychological interventions more specifically to optimize patient's expectations. METHODS Eighty-three patients were invited to a psycho-educational intervention to optimize expectations prior to elective coronary artery bypass graft (CABG). Before the psychological intervention and before surgery, disability expectations, demographical, medical, psychosocial variables as well as patient and treatment related expectations were collected via questionnaires and patients' files. Associations with disability expectations were assessed using hierarchical linear multiple regression analysis. RESULTS Patients self-rated disability (β = 0.50; p < 0.001) and beliefs about treatment efficacy (β = -0.42; p < 0.001) was independently associated with disability expectations. Expectations about the efficacy of patients' own health behavior as well as demographical variables, psychological distress, perceived social support, and measures of medical morbidity did not explain any additional variance in patients' disability expectations. CONCLUSION CABG patients seem to form their disability expectations upon their perceptions about their current disability and their expectations about the efficacy of treatment. Patients' disability expectations appear to be independent from scientifically established risk factors and other psychosocial patient characteristics in heart surgery. Future research is necessary to further determine what factors psychological interventions should focus on to modify patients' disability expectations.
Collapse
Affiliation(s)
- Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany,
| | | | | | | | | |
Collapse
|
76
|
Laferton JAC, 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 2015; 21:272-85. [PMID: 26042657 DOI: 10.1080/13548506.2015.1051063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients' expectations have shown to be a major psychological predictor of health outcome in cardiac surgery patients. However, it is unclear whether patients' expectations can be optimized prior to surgery. This study evaluates the development of a brief psychological intervention focusing on the optimization of expectations and its effect on change in patients' expectations prior to cardiac surgery. Ninety patients scheduled for coronary artery bypass graft were randomly assigned to (1) standard medical care, (2) additional expectation manipulation intervention (EMI), and (3) additional attention control group. Therapists' fidelity to intervention manuals and patients satisfaction with the intervention were assessed for both active intervention conditions. Patients' expectations about post-surgical disability, treatment control, personal control, and disease duration were assessed before and after the psychological intervention. Demographical, medical, and psychosocial characteristics and disability were assessed at baseline. Treatment fidelity and patient satisfaction was very high in both intervention conditions. Only patients receiving EMI developed higher personal control expectations and longer (more realistic) expectations of disease duration. The effect of intervention group on patients' disability expectations and patients' personal control expectations was moderated by patient's level of disability. EMI patients with low to moderate disability developed positive expectations whereas patients with high disability did not. This study shows the successful development of a short psychological intervention that was able to modify patients' expectations, especially in those with low to moderate disability. Given the robust association of expectations and surgery outcome, such an intervention might offer the opportunity to enhance patients' health following cardiac surgery.
Collapse
Affiliation(s)
- Johannes A C Laferton
- a Department of Clinical Psychology and Psychotherapy , Philipps University of Marburg , Gutenbergstraße 18, 35032 Marburg , Germany
| | - Charlotte J Auer
- a Department of Clinical Psychology and Psychotherapy , Philipps University of Marburg , Gutenbergstraße 18, 35032 Marburg , Germany
| | - Meike C Shedden-Mora
- b Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Hamburg Eppendorf , Hamburg , Germany
| | - Rainer Moosdorf
- c Department of Cardiovascular Surgery , Heart Centre, Philipps University of Marburg , Marburg , Germany
| | - Winfried Rief
- a Department of Clinical Psychology and Psychotherapy , Philipps University of Marburg , Gutenbergstraße 18, 35032 Marburg , Germany
| |
Collapse
|
77
|
Figueiras MJ, Maroco J, Monteiro R, Caeiro R. Cardiac misconceptions among healthy adults: implications for the promotion of health in the community. CIENCIA & SAUDE COLETIVA 2015; 20:841-50. [PMID: 25760124 DOI: 10.1590/1413-81232015203.10932014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/28/2014] [Indexed: 11/22/2022] Open
Abstract
This study sought to confirm the structure and to investigate the psychometric properties of an experimental Portuguese version of the York Cardiac Beliefs Questionnaire (YCBQ) in a general population sample. It also set out to identify the prevalent misconceptions in the community and to assess the differences according to socio-demographic characteristics. It involved a cross-sectional survey in which both test and validation samples were collected (n = 476), including participants aged between 18 and 40, recruited via e-mail and social networks. The Confirmatory Factor Analysis on both samples suggested a shorter, three factor version of the YCBQ. Also, misconceptions differed significantly according to sociodemographic variables. The validation of the YCBQ for samples in the community constitutes an important starting point to promote research on misconceptions held in the community by specific groups, as well as to provide key points for health promotion.
Collapse
Affiliation(s)
| | | | | | - Raul Caeiro
- Departamento de Psicologia, Instituto Piaget, ,
| |
Collapse
|
78
|
Panzaru GM, Holman A. Type of treatment of cardiac disorders – quality of life and heart-focused anxiety: The mediating role of illness perceptions. PSYCHOL HEALTH MED 2014; 20:551-9. [DOI: 10.1080/13548506.2014.989863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
79
|
Marcus E, Garety P, Weinman J, Emsley R, Dunn G, Bebbington P, Freeman D, Kuipers E, Fowler D, Hardy A, Waller H, Jolley S. A pilot validation of a modified Illness Perceptions Questionnaire designed to predict response to cognitive therapy for psychosis. J Behav Ther Exp Psychiatry 2014; 45:459-66. [PMID: 25011076 PMCID: PMC4157321 DOI: 10.1016/j.jbtep.2014.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/18/2014] [Accepted: 06/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Clinical responsiveness to cognitive behavioural therapy for psychosis (CBTp) varies. Recent research has demonstrated that illness perceptions predict active engagement in therapy, and, thereby, better outcomes. In this study, we aimed to investigate the psychometric properties of a modification of the Illness Perceptions Questionnaire (M-IPQ) designed to predict response following CBTp. METHODS Fifty-six participants with persistent, distressing delusions completed the M-IPQ; forty before a brief CBT intervention targeting persecutory ideation and sixteen before and after a control condition. Additional predictors of outcome (delusional conviction, symptom severity and belief inflexibility) were assessed at baseline. Outcomes were assessed at baseline and at follow-up four to eight weeks later. RESULTS The M-IPQ comprised two factors measuring problem duration and therapy-specific perceptions of Cure/Control. Associated subscales, formed by summing the relevant items for each factor, were reliable in their structure. The Cure/Control subscale was also reliable over time; showed convergent validity with other predictors of outcome; predicted therapy outcomes; and differentially predicted treatment effects. LIMITATIONS We measured outcome without an associated measure of engagement, in a small sample. Findings are consistent with hypothesis and existing research, but require replication in a larger, purposively recruited sample. CONCLUSIONS The Cure/Control subscale of the M-IPQ shows promise as a predictor of response to therapy. Specifically targeting these illness perceptions in the early stages of cognitive behavioural therapy may improve engagement and, consequently, outcomes.
Collapse
Affiliation(s)
- Elena Marcus
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Philippa Garety
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - John Weinman
- King's College London, Institute of Pharmaceutical Science, 5th Floor Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 4.304 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 4.304 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Paul Bebbington
- Division of Psychiatry, University College, London, 67-73 Riding House Street, London W1W 7EJ, UK.
| | - Daniel Freeman
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Elizabeth Kuipers
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - David Fowler
- School of Psychology, University of Sussex, Pevensey Building, Falmer BN1 9QH, UK.
| | - Amy Hardy
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Helen Waller
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Suzanne Jolley
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| |
Collapse
|
80
|
Zech N, Seemann M, Hansen E. Noceboeffekte und Negativsuggestionen in der Anästhesie. Anaesthesist 2014; 63:816-24. [DOI: 10.1007/s00101-014-2386-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
81
|
Abstract
OBJECTIVES Coronary artery disease constitutes a public health issue involving high mortality rates. The objectives of this study were to evaluate the feelings and perception of patients hospitalized before myocardial revascularization and to explore doctor-patient interactions before cardiac surgery with special attention to existential challenges. STUDY DESIGN A qualitative, exploratory study involving patients admitted to a university teaching hospital in the city of Salvador, Bahia, Brazil, awaiting myocardial revascularization. METHODS The data were obtained from in-depth interviews that followed a previously defined script based on the study objectives. The data collected at each interview were allocated into content blocks in common with the selected categories and illustrated by quotations from the patients' speech. Twelve patients were interviewed. Data collection was closed when saturation was achieved, in the sense that new main issues did not appear in subsequent dialogues. RESULTS The various strategies used by the patients to administer their emotions during the period preceding myocardial revascularization highlight the importance that factors of a subjective nature acquire at this specific time in their lives. The patients recognized the benefit of being able to discuss their heart problems as a means of diminishing their fear and anxiety. CONCLUSIONS It is vital for the medical team to be more supportive and understanding concerning the emotions experienced by the patients in the period preceding myocardial revascularization. This study emphasizes the importance of the task of helping patients administer their perceptions and feelings and even planning their life while awaiting myocardial revascularization.
Collapse
|
82
|
Changing illness perceptions and adherence to dual antiplatelet therapy in patients with stable coronary disease. J Cardiovasc Nurs 2014; 28:573-83. [PMID: 22785086 DOI: 10.1097/jcn.0b013e31825d6060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Platelet inhibition with dual antiplatelet therapy (DAPT) is an important component of medical management in patients with stable coronary artery disease (CAD). Dual antiplatelet therapy nonadherence is associated with increased mortality. Little is known about illness perceptions (IPs) surrounding the use of antiplatelet medications and whether they differ in stable CAD patients treated with medical and/or interventional approaches. OBJECTIVE The aim of this study was to examine temporal changes in IP scores for patients with stable CAD and examine the influence of clinical and demographic variables, IP, and depressive symptoms on adherence to DAPT. METHODS Patients (n = 180, 71.7% men; mean [SD] age, 65.1 [8.3] years) were recruited after coronary angiography and optimal medical therapy (OMT) (n = 90) or after percutaneous coronary intervention with initiation of OMT (n = 90). The Illness Perception Questionnaire-Revised and Patient Health Questionnaire-9 were administered at baseline and 30 days after treatment, with a response rate of 52.8% (n = 95) at 30 days. Adherence to DAPT (aspirin and thienopyridine) at 30 days was collected using a health history update. RESULTS Patients with stable CAD experienced shifts in IP within the first 30 days after treatment. Patients treated with OMT demonstrated increased symptoms after treatment (timeline cyclical) and reduced beliefs in the level of control provided by their prescribed regimen (treatment control, t = 3.26, P = .002). Both groups demonstrated an increase in perceived understanding of illness (illness coherence subscale) from baseline to 30 days (percutaneous coronary intervention/OMT, t = -4.43, P < .001; OMT, t = -3.74, P = .001). Chronic IPs were associated with 5.7% increased odds for improved adherence to thienopyridine agents (B = 0.509, P = .009, Exp(B) = 1.66) and 5.6% increased odds for aspirin use (B = 0.265, P = .031, Exp(B) = 1.30). Depressive symptoms were predictive of adherence for thienopyridine medications (B = 0.509, P = .009, Exp(B) = 1.66). CONCLUSIONS Illness perceptions influence adherence to DAPT in patients with stable CAD. Understanding patterns in IP after treatment may help identify the best strategies to promote a tailored approach for improving adherence to DAPT.
Collapse
|
83
|
Hanusch BC, O'Connor DB, Ions P, Scott A, Gregg PJ. Effects of psychological distress and perceptions of illness on recovery from total knee replacement. Bone Joint J 2014; 96-B:210-6. [PMID: 24493186 DOI: 10.1302/0301-620x.96b2.31136] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This cohort study investigated the influence of psychological factors, including perception of illness, anxiety and depression on recovery and functional outcome after total knee replacement surgery. A total of 100 patients (55 male; 45 female) with a mean age of 71 (42 to 92) who underwent a primary total knee replacement for osteoarthritis were recruited into this study. In all 97 participants completed the six week and 87 the one year follow-up questionnaires. Pre-operatively patients completed the revised Illness Perception Questionnaire, Hospital Anxiety and Depression Scale and Recovery Locus of Control Scale. Function was assessed pre-operatively, at six weeks and one year using Oxford Knee Score (OKS) and the goniometer-measured range of movement (ROM). The results showed that pre-operative function had the biggest impact on post-operative outcome for ROM and OKS. In addition questionnaire variables and depression had an impact on the OKS at six weeks. Depression and anxiety were also associated with a higher (worse) knee score at one year but did not influence the ROM at either six weeks or one year. Recovery from total knee replacement can be difficult to predict. This study has identified psychological factors that play an important role in recovery from surgery and functional outcome. These should be taken into account when considering patients for total knee replacement.
Collapse
Affiliation(s)
- B C Hanusch
- The James Cook University Hospital, Academic Centre, Marton Road, Middlesbrough, TS4 3BW, UK
| | | | | | | | | |
Collapse
|
84
|
Habibović M, Pedersen SS, van den Broek KC, Denollet J. Monitoring treatment expectations in patients with an implantable cardioverter-defibrillator using the EXPECT-ICD scale. Europace 2014; 16:1022-7. [PMID: 24596397 DOI: 10.1093/europace/euu006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Patient treatment expectations may affect cardiac outcomes; however, till date, no validated instruments have been developed to monitor treatment expectations in patients with an implantable cardioverter-defibrillator (ICD). This study evaluates the predictive value of the newly developed 10-item EXPECtations Towards ICD therapy (EXPECT-ICD) in relation to anxiety, depression, and ICD related concerns 3 months post-implant. METHODS AND RESULTS Consecutive implanted ICD patients were included as part of the WEB-based distress management programme for ICD patients (WEBCARE) trial from six Dutch referral hospitals. The patients completed the baseline questionnaires briefly after ICD implantation. Information on clinical variables was captured from the patients' medical records. Patients' treatment expectations as assessed with the EXPECT-ICD questionnaire could best be represented with a two-factor model involving both negative (α = 0.84) and positive expectations (α = 0.77) with a score range of 0-20 for each factor. Negative treatment expectations were associated with higher levels of anxiety (β = 0.443; P < 0.001), depression (β = 0.506; P < 0.001), and ICD concerns (β = 0.428; P < 0.001) 3 months post-implant after controlling for demographic and clinical factors. Positive expectations were not related to any of the distress outcomes. CONCLUSION Negative expectations were associated with anxiety, depression, and ICD concerns 3 months post-implant. The current findings indicate that the EXPECT-ICD scale is a reliable, valid, and disease-specific measure of the treatment expectations in ICD patients. Future research needs to investigate whether addressing the patients' expectations might improve the outcome and the subjective well-being of ICD patients.
Collapse
Affiliation(s)
- Mirela Habibović
- CoRPS-Department of Medical and Clinical Psychology, Tilburg University, 90153, 5000 LE Tilburg, The Netherlands
| | - Susanne S Pedersen
- CoRPS-Department of Medical and Clinical Psychology, Tilburg University, 90153, 5000 LE Tilburg, The Netherlands Department of Cardiology, Thoraxcenter, Erasmus Medical Center, 2040, 3000 CA Rotterdam, The Netherlands Department of Psychology, University of Southern Denmark, DK-5230 Odense, Denmark Department of Cardiology, Odense University Hospital, DK-5000 Odense, Denmark
| | - Krista C van den Broek
- CoRPS-Department of Medical and Clinical Psychology, Tilburg University, 90153, 5000 LE Tilburg, The Netherlands
| | - Johan Denollet
- CoRPS-Department of Medical and Clinical Psychology, Tilburg University, 90153, 5000 LE Tilburg, The Netherlands
| |
Collapse
|
85
|
Schulze T, Maercker A, Horn AB. Mental Health and Multimorbidity: Psychosocial Adjustment as an Important Process for Quality of Life. Gerontology 2014; 60:249-54. [DOI: 10.1159/000358559] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/13/2014] [Indexed: 11/19/2022] Open
|
86
|
Ashley L, Smith AB, Keding A, Jones H, Velikova G, Wright P. Psychometric evaluation of the revised Illness Perception Questionnaire (IPQ-R) in cancer patients: confirmatory factor analysis and Rasch analysis. J Psychosom Res 2013; 75:556-62. [PMID: 24290046 DOI: 10.1016/j.jpsychores.2013.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/23/2013] [Accepted: 08/07/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide new insights into the psychometrics of the revised Illness Perception Questionnaire (IPQ-R) in cancer patients. To undertake, for the first time using data from breast, colorectal and prostate cancer patients, a confirmatory factor analysis (CFA) to assess the validity of the IPQ-R's core seven-factor structure. Also, for the first time in any illness group, to undertake Rasch analysis to explore the extent to which the IPQ-R factors form unidimensional scales, with linear measurement properties and no Differential Item Functioning (DIF). METHODS Patients with potentially curable breast, colorectal or prostate cancer, within 6months post-diagnosis, completed the IPQ-R online (N=531). CFA was conducted, including multi-sample analysis, and for each IPQ-R factor fit to the Rasch model was assessed by examining, amongst other things, item fit, DIF and unidimensionality. RESULTS The CFA showed a moderate fit of the data to the IPQ-R model, and stability across diagnosis, although fit was significantly improved following the removal of selected items. All seven factors achieved fit to the Rasch model, and exhibited unidimensionality and minimal DIF, although in most cases this was after some item rescoring and/or deletion. In both analyses, IPQ-R items 12, 18 and 24 were indicated as misfitting and removed. CONCLUSION Given the rigorous standard of Rasch measurement, and the generic nature of the IPQ-R, it stood up well to the demands of the Rasch model in this study. Importantly, the results show that with some relatively minor, pragmatic modifications the IPQ-R could possess Rasch-standard measurement in cancer patients.
Collapse
Affiliation(s)
- Laura Ashley
- School of Social, Psychological & Communication Sciences, Faculty of Health & Social Sciences, Leeds Metropolitan University, Leeds, UK.
| | | | | | | | | | | |
Collapse
|
87
|
Foxwell R, Morley C, Frizelle D. Illness perceptions, mood and quality of life: a systematic review of coronary heart disease patients. J Psychosom Res 2013; 75:211-22. [PMID: 23972409 DOI: 10.1016/j.jpsychores.2013.05.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine published literature investigating the relationship between illness perceptions, mood and quality of life (QoL) in coronary heart disease (CHD) populations. METHODS Key databases were systematically searched (CINAHL, Medline, PsycINFO, Scopus and Web of Science) for studies matching the inclusion criteria between November 2011 and February 2012. References of included studies were examined and key authors contacted. Studies were subject to a quality control check. RESULTS 21 studies met the inclusion criteria. A synthesis of the results found that illness perceptions were correlated to and predicted QoL and mood across CHD diagnoses. Specific illness perceptions (control, coherence and timeline) were found to be important for patients that had experienced an unexpected medical event, such as myocardial infarction. CONCLUSION The results of this study provide support that illness perceptions are related to outcomes across CHD populations and disease progression, however the results do not selectively support one particular model. Recommendations are consistent with cardiac rehabilitation guidelines. Further research should focus on the systemic impact of illness perceptions.
Collapse
Affiliation(s)
- Rachel Foxwell
- Department of Clinical Psychology, University of Hull, UK.
| | | | | |
Collapse
|
88
|
Abstract
BACKGROUND There is some evidence for the benefits of leukodepletion in patients undergoing coronary artery surgery. Its effectiveness in higher risk patients, such as those undergoing heart valve surgery, particularly in terms of overall clinical outcomes, is currently unclear. OBJECTIVES To assess the beneficial and harmful effects of leukodepletion on clinical, patient-reported and economic outcomes in patients undergoing heart valve surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 3 of 12) in The Cochrane Library, the NHS Economic Evaluations Database (1960 to April 2013), MEDLINE Ovid (1946 to April week 2 2013), EMBASE Ovid (1947 to Week 15 2013), CINAHL (1982 to April 2013) and Web of Science (1970 to 17 April 2013) on 19 April 2013. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), the US National Institutes of Health (NIH) clinical trials database and the International Standard Randomised Controlled Trial Number Register (ISRCTN) in April 2013 for ongoing studies. No language or time period restrictions were applied. We examined the reference lists of all included randomised controlled trials and contacted authors of identified trials. We searched the 'grey' literature at OpenGrey and handsearched relevant conference proceedings. SELECTION CRITERIA Randomised controlled trials comparing a leukocyte-depleting arterial line filter with a standard arterial line filter, on the arterial outflow of the heart-lung bypass circuit, in elective patients undergoing heart valve surgery. DATA COLLECTION AND ANALYSIS Data were collected on the study characteristics, three primary outcomes (1. post-operative in-hospital all-cause mortality within three months, 2. post-operative all-cause mortality excluding inpatient mortality < 30 days, 3. length of stay in hospital, 4. adverse events and serious adverse events) and seven secondary outcomes (1. tubular or glomerular kidney injury, 2. validated health-related quality of life scales, 3. validated renal injury scales, 4. use of continuous veno-venous haemo-filtration, 5. length of stay in intensive care, 6. costs of care). Data were extracted by one author and verified by a second author. Insufficient data were available to perform a meta-analysis or sensitivity analysis. MAIN RESULTS Eight studies were eligible for inclusion in the review but data on prespecified review outcomes were available from only one, modestly powered (24 participants) study (Hurst 1997). There were no differences between a leuko-depleting versus standard filter in length of stay in the intensive care unit (ICU) (mean difference (MD) 0.80 days; 95% confidence interval (CI) -0.24 to 1.84) or length of hospital stay (MD 0.20 days; 95% CI -1.78 to 2.18). AUTHORS' CONCLUSIONS There are currently insufficient good quality trials with valve surgery patients to inform recommendations for changes in clinical practice. A future National Institute for Health Research (NIHR)-funded feasibility study (recruiting mid-year 2013) comparing leukodepletion with a standard arterial line filter in patients undergoing elective heart valve surgery (the ROLO trial) will be the largest study to date and will make a significant contribution to future updates of this review.
Collapse
Affiliation(s)
- Sally Spencer
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | | | | |
Collapse
|
89
|
Parfeni M, Nistor I, Covic A. A systematic review regarding the association of illness perception and survival among end-stage renal disease patients. Nephrol Dial Transplant 2013; 28:2407-14. [DOI: 10.1093/ndt/gft194] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
90
|
Enck P, Bingel U, Schedlowski M, Rief W. The placebo response in medicine: minimize, maximize or personalize? Nat Rev Drug Discov 2013; 12:191-204. [PMID: 23449306 DOI: 10.1038/nrd3923] [Citation(s) in RCA: 435] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
91
|
Laferton JAC, Shedden Mora M, Auer CJ, Moosdorf R, Rief W. Enhancing the efficacy of heart surgery by optimizing patients' preoperative expectations: study protocol of a randomized controlled trial. Am Heart J 2013; 165:1-7. [PMID: 23237127 DOI: 10.1016/j.ahj.2012.10.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/05/2012] [Indexed: 12/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, Marburg, Germany.
| | | | | | | | | |
Collapse
|
92
|
Le Grande MR, Elliott PC, Worcester MU, Murphy BM, Goble AJ, Kugathasan V, Sinha K. Identifying illness perception schemata and their association with depression and quality of life in cardiac patients. PSYCHOL HEALTH MED 2012; 17:709-22. [DOI: 10.1080/13548506.2012.661865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
93
|
Figueiras MJ, Monteiro R, Caeiro R. Misconceptions and Illness Perceptions in Cardiac Patients and Their Spouses: A Pilot Study. PSYCHOLOGY, COMMUNITY & HEALTH 2012. [DOI: 10.5964/pch.v1i3.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
94
|
Boyer BA, Matour SJ, Crittenden KB, Larson KA, Cox JM, Link DD. Appraisals of Fear, Helplessness, and Perceived Life-Threat During Emergent Cardiac Surgery: Relationship to Pre-surgical Depression, Trauma History, and Posttraumatic Stress. J Clin Psychol Med Settings 2012. [DOI: 10.1007/s10880-012-9330-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
95
|
Marke V, Bennett P. Predicting post-traumatic stress disorder following first onset acute coronary syndrome: Testing a theoretical model. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2012; 52:70-81. [DOI: 10.1111/bjc.12001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 05/24/2012] [Indexed: 11/27/2022]
|
96
|
Rief W, Glombiewski JA. The hidden effects of blinded, placebo-controlled randomized trials: an experimental investigation. Pain 2012; 153:2473-2477. [PMID: 23084328 DOI: 10.1016/j.pain.2012.09.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 09/18/2012] [Indexed: 12/19/2022]
Abstract
The knowledge of having only a 50% chance of receiving an active drug can result in reduced efficacy in blinded randomized clinical trials (RCTs) compared to clinical practice (reduced external validity). Moreover, minor onset sensations associated with the drug (but not with an inert placebo) can further challenge the attribution of group differences to drug-specific efficacy (internal validity). We used a randomized experimental study with inert placebos (inert substance) vs active placebos (inducing minor sensations), and different instructions about group allocation (probability of receiving drug: 0%, 50%, 100%). One hundred forty-four healthy volunteers were informed that a new application method for a well-known painkiller would be tested. Pain thresholds were assessed before and after receiving nasal spray. Half of the nasal sprays were inert placebos (sesame oil), while the other half were active placebos inducing prickling nasal sensations (sesame oil with 0.014% capsaicin). The major outcome was pain threshold after placebo application. A substantial expectation effect was found for the inert placebo condition, with participants who believed they had received an active drug reporting the highest pain thresholds. Active placebos show substantial differences to passive placebos in the 50% chance group. Therefore, patient expectations are significantly different in placebo-controlled clinical trials (50% chance) vs clinical practice (100% chance). Moreover, minor drug onset sensations can challenge internal validity. Effect sizes for these mechanisms are medium, and can substantially compete with specific drug effects. For clinical trials, new study designs are needed that better control for these effects.
Collapse
Affiliation(s)
- Winfried Rief
- Department of Clinical Psychology, University of Marburg, Marburg, Germany
| | | |
Collapse
|
97
|
Patient recovery and transitions after hospitalization for acute cardiac events: an integrative review. J Cardiovasc Nurs 2012; 27:175-91. [PMID: 22210146 DOI: 10.1097/jcn.0b013e318239f5f5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.
Collapse
|
98
|
Campbell AT, Aulisio MP. The stigma of "mental" illness: end stage anorexia and treatment refusal. Int J Eat Disord 2012; 45:627-34. [PMID: 22331823 DOI: 10.1002/eat.22002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To answer the questions of whether psychiatric patients should ever be allowed to refuse life-sustaining treatment in favor of comfort care for a condition that is caused by a psychiatric disorder, and if so, under what conditions. METHOD Case discussion and normative ethical and legal analysis. RESULTS We argue that psychiatric patients should sometimes be allowed to refuse life-sustaining treatment in favor of comfort care for a condition that is caused by that psychiatric disorder and articulate the core considerations that should be taken into account when such a case arises. DISCUSSION We also suggest that unwillingness among many, especially mental health professionals, to consider seriously both of these questions risks perpetuating stigmatization of persons with psychiatric disorders, i.e., that the "mentally" ill should not be allowed to make significant decisions for themselves-a-a stigmatization that can result in persons with mental disorders both being prevented from exercising autonomous choice even when they are capable of it, and being denied good comfort care at the end of life--care which would be offered to patients with similarly life-threatening conditions that were not deemed to be the result of "mental" illness.
Collapse
Affiliation(s)
- Amy T Campbell
- Center for Bioethics and Humanities, SUNY Upstate Medical University and Syracuse University College of Law (courtesy), Syracuse, NY, USA.
| | | |
Collapse
|
99
|
Kohlmann S, Rimington H, Weinman J. Profiling illness perceptions to identify patients at-risk for decline in health status after heart valve replacement. J Psychosom Res 2012; 72:427-33. [PMID: 22656438 DOI: 10.1016/j.jpsychores.2012.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Identification of risk factors for decline in health status by profiling illness perceptions before and one year after heart valve replacement surgery. METHODS Prospective data from N=225 consecutively admitted first time valve replacement patients was assessed before and one year after surgery. Patients were asked about their illness perceptions (Illness Perception Questionnaire-Revised) and mood state (Hospital Anxiety and Depression Scale). Health status was defined by quality of life (Short-Form 36) and New York Heart Association (NYHA) class. Cluster analyses were conducted to identify illness perception profiles over time. Predictors of health status after surgery were analyzed with multivariate methods. RESULTS Patients were grouped according to the stability and nature (positive, negative) of their illness perception profile over one year. One year after surgery patients holding a negative illness perception profile showed a lower physical quality of life and were diagnosed in a higher New York Heart Association class than patients changing to positive and patients with stable positive illness perceptions (P<.001). Over and above biological determinants, post-surgery physical quality of life and NYHA class were both predicted by pre-surgery illness perception profiles (P<.05). CONCLUSION Patients going for heart valve replacement surgery can be easily categorized into illness perception profiles that predict health status one year after surgery. These patients could benefit from early screening as negative illness perceptions are modifiable risk factors.
Collapse
Affiliation(s)
- Sebastian Kohlmann
- Department of Psychological Medicine and University Heart Center, University Medical Centre Hamburg-Eppendorf, Germany.
| | | | | |
Collapse
|
100
|
Spruill TM, Gerber LM, Schwartz JE, Pickering TG, Ogedegbe G. Race differences in the physical and psychological impact of hypertension labeling. Am J Hypertens 2012; 25:458-63. [PMID: 22258335 DOI: 10.1038/ajh.2011.258] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Blood pressure screening is an important component of cardiovascular disease prevention, but a hypertension diagnosis (i.e., label) can have unintended negative effects on patients' well-being. Despite persistent disparities in hypertension prevalence and outcomes, whether the impact of labeling differs by race is unknown. The purpose of this study was to evaluate possible race differences in the relationship between hypertension labeling and health-related quality of life and depression. METHODS The sample included 308 normotensive and unmedicated hypertensive subjects from the Neighborhood Study of Blood Pressure and Sleep, a cross-sectional study conducted between 1999 and 2003. Labeled hypertension was defined (by self-report) as having been diagnosed with high blood pressure or prescribed antihypertensive medications. Effects of labeling and race on self-reported physical and mental health and depressive symptoms were tested using multivariate analysis of covariance, controlling for age, sex, body mass index (BMI), previous medication use, and "true" hypertension status, defined by average daytime ambulatory blood pressure (ABP). RESULTS Both black and white subjects who had been labeled as hypertensive reported similarly poorer physical health than unlabeled subjects (P = 0.001). However, labeling was associated with poorer mental health and greater depressive symptoms only among blacks (Ps < 0.05 for the interactions). These findings were not explained by differences in socioeconomic status. CONCLUSIONS These results are consistent with previous studies showing negative effects of hypertension labeling, and demonstrate important race differences in these effects. Clinical approaches to communicating diagnostic information that avoid negative effects on well-being are needed, and may require tailoring to patient characteristics such as race.
Collapse
|