Patients perceptions of information about risks at cardiac surgery

Patient and caregiver preferences and prioritized outcomes for cardiac surgery: A scoping review and consultation workshop

OBJECTIVE(S)

In light of the absence of patient and caregiver input in Enhanced Recovery After Surgery Cardiac Surgery guideline development, we conducted a scoping review to identify patient and caregiver preferences and prioritized outcomes related to perioperative care in cardiac surgery and its lifelong impact.

METHODS

Five electronic databases were searched to retrieve studies investigating patient or caregiver preferences and prioritized outcomes. Information was charted in duplicate and analyzed using descriptive statistics or thematic analysis. A patient and caregiver consultation workshop validated scoping review findings and solicited novel preferences and outcomes.

RESULTS

Of the 5292 articles retrieved, 43 met inclusion criteria. Most were from Europe (n = 19, 44%) or North America (n = 15, 35%) and qualitative and quantitative designs were represented in equal proportions. Fifty-two methods were used to obtain stakeholder preferences and prioritized outcomes, the majority being qualitative in nature (n = 32, 61%). Based on the collective preferences of 3772 patients and caregivers from the review and 17 from the consultation workshop, a total of 108 patient preferences, 32 caregiver preferences, and 19 prioritized outcomes were identified. The most commonly identified theme was "information and education." Improved quality of life was the most common patient-prioritized outcome, and all caregiver-prioritized outcomes were derived from the consultation workshop.

CONCLUSIONS

Patient and caregiver preferences overlap with Enhanced Recovery After Surgery Cardiac Surgery recommendations targeting preoperative risk reduction strategies, prehabilitation, patient engagement technology, and intra- and postoperative strategies to reduce discomfort. To support clinical practice, future research should investigate associations with key surgical outcomes.

The Motivations of Iranian Patients With Cardiovascular Disease to Seek Health Information: A Qualitative Study

Background

Cardiovascular patients need information to preserve and promote their health, but not all of them have the necessary motivation to seek relevant health knowledge.

Objectives

The present study analyzed experiences of patients, family caregivers, and healthcare providers to explore the motivating factors that cause cardiovascular patients to seek important health information.

Patients and Methods

This study was conducted using a qualitative approach and conventional qualitative content analysis method. Thirty-six people, including 18 cardiovascular patients, 7 family caregivers, and 11 healthcare providers (from multidisciplinary backgrounds) participated in the study. The data were collected through semi-structured interviews and purposeful sampling and continued until data saturation. Data collection and analysis proceeded simultaneously and with constant comparison; this study was carried out from May 2012 to May 2013.

Results

During the analysis process, three main themes were extracted that characterized participants’ experiences, perceptions, and motivations to seek health information. The themes were “Optimizing quality of life, “Desire for personal rights to be respected,” and “Gaining confidence through consultation.”

Conclusions

Our findings showed that, through seeking information, patients try to achieve well-being and realize their personal rights as well as their right to security. They should also be encouraged to enhance their quality of life by using the Knowles’ learning theory to formulate their needs and learning priorities.

Association Between Characteristics of Hospitalized Heart Failure Patients With Their Needs

Introduction:

During recent years that life expectancy of heart failure patients has been increased, health professionals put more emphasis on assessing their needs in daily clinical practice. The aim of the present study was to explore the association between characteristics of hospitalized heart failure patients with their needs.

Methods:

A sample of 190 hospitalized patients with HF, recruited from public hospitals in Greece, was enrolled in the study. Data were collected by the completion of a questionnaire which included socio-demographic and clinical characteristics and the questionnaire “Needs of hospitalized patients with coronary artery disease” which is consisted of 6 subscales. Statistical methods used were Kruskal wallis-test or Mann-Whitney test and Spearmans’ rho coefficient. Multiple regression analysis was performed in order to evaluate the association between patients’ characteristics and the significance of their needs.

Results:

124 (65.3%) of hospitalized heart failure participants were men and 89 (46.8%) of participants were more than 70 years old. 145 (76.3%) had prior experience of hospitalization due to heart failure. The need for support and guidance was statistically significantly associated with the degree of information, (p=<0.001). The need for information from the medical and nursing staff was significantly associated with marital status and degree of information (p=0.001 and p<0.001 respectively). The need for need for being in contact with other patient groups, and ensuring communication with relatives was statistically significantly associated with the professional status and degree of information, (p=0.037 and p=<0.001 respectively). The need for individualized treatment and the need for patient’s personal participation to his/her treatment as well as the need to meet the emotional and physical needs were statistically significant associated with the degree of information, (p=<0.001, p=<0.001 respectively). Lastly, the need to trust the medical and nursing staff was statistically significantly associated with the place of residence and the degree of information, (p=0.023 and p<0.001). These results were confirmed by the multiple linear regression after controlling for potential confounders.

Conclusions:

Information seems to be of vital importance when assessing the needs of heart failure patients. Therefore, providing elaborate information should be an integral part of their therapeutic regimen.

Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation

PURPOSE

To describe what knowledge heart failure patients expect to acquire in relation to their upcoming cardiac resynchronization therapy (CRT) device implantation, to describe their self-care and health complaints, and to explore the relationship between knowledge expectations and self-care, health complaints, and background factors.

PATIENTS AND METHODS

Cross-sectional multicenter study with 104 patients scheduled for a first-time, elective CRT implantation in Swedish and Icelandic hospitals. Data were collected with the Knowledge Expectations of hospital patient Scale, European Heart Failure Self-care Behavior Scale, and Adjusted Postoperative Recovery Profile.

RESULTS

Patients expected most knowledge related to their disease and its treatment (median 4.0, interquartile range 0.13) and least on social issues (median 3.5, interquartile range 0.83). Their self-care was average (standardized mean 51.0±19.6) before the procedure. Patients had on average 8.2 (±4.7) health complaints and rated fatigue and sexual problems as the most severe. Age was independently associated with knowledge expectations (Expβ 0.049, P=0.033).

CONCLUSION

Heart failure patients waiting for a CRT device implantation have high expectations for multiple aspects of knowledge, including self-care issues, before their procedure. These expectations are similar to those of other surgical patients and they increase with age.

The Impact of Peplau's Therapeutic Communication Model on Anxiety and Depression in Patients Candidate for Coronary Artery Bypass

BACKGROUND AND OBJECTIVE

Anxiety and depression are among the psychological disorders in heart surgeries. Establishing a simple communication is essential to reduce anxiety and depression. Hence, the objective of the present studywas to examine the impact of Peplau therapeutic communication model on anxiety and depression in patients, who were candidate for coronary artery bypass in Al-Zahra Heart Hospital, Shiraz during 2012-2013.

METHODS

This is a clinical trial in which 74 patients were randomly divided into intervention and control groups, each consisted of 37 patients. Anxiety and depression levels were assessed before, and two and four months after intervention using the Hospital Anxiety and Depression Scale (HADS). Seven therapeutic communication sessions were held in four stages. Data were analyzed with the SPSS (version 16) using analysis of covariance.

RESULTS

The mean anxiety and depression levels decreased in the intervention group after the therapeutic communication (p<0.01). Anxiety scores in the intervention group before and after intervention were 10.23 and 9.38, respectively. While the corresponding scores in the control group were 10.26 and 11.62, respectively. Depression scores in the intervention group before and after intervention were 11 and 9.13, respectively. The corresponding scores in the control group were 11.30 and 12.08, respectively.

CONCLUSION

The results demonstrated the positive role of therapeutic communication in reducing anxiety and depression of the patients. Therefore, the therapeutic communication is recommended as a simple, cost effective and efficient method in this area.

Patient experiences with intrathecal baclofen as a treatment for spasticity - a pilot study

PURPOSE

This study describes how patients experience intrathecal baclofen (ITB) treatment.

METHODS

Data were collected from interviews with 14 patients (19-76 years old) who were diagnosed with spinal cord injury (SCI), multiple sclerosis (MS), or cerebral palsy (CP). Data were analyzed using conventional content analysis.

RESULT

The analysis resulted in 16 subcategories arranged into five main categories: procedures before treatment, the effect of ITB on daily life and activities, continuous follow-up, expected and unexpected consequences of ITB, and overall level of satisfaction with ITB. Together these categories described the patients' experiences with ITB treatment. When the patients were asked whether they would undergo ITB again, they all stated that they would.

CONCLUSION

Patients stated that they were highly satisfied with the ITB treatment. However, the patients identified several areas that could be improved. Specifically, the patients wanted more information about the different steps in the treatment process and what to expect from ITB treatment.

Perceived learning needs of Syrian patients postcoronary artery bypass graft surgery

AIMS AND OBJECTIVES

To describe the perceived learning needs of Syrian patients who underwent coronary artery bypass graft surgery before hospital discharge and to examine the differences in the mean scores of the categories (subscales) of the modified Cardiac Patients Learning Needs Inventory according to the demographic characteristics of the participants.

BACKGROUND

Knowledge about the learning needs of patients who underwent coronary artery bypass graft surgery can help nurses in coronary care units to provide them with the information that they need. This might improve their quality of life through decreasing complications, length of stay in the hospital and hospital readmissions.

DESIGN

A descriptive design was used for this study.

METHODS

A convenience sample of 135 patients participated in this study and completed the demographic form and the modified Cardiac Patients Learning Needs Inventory.

RESULTS

Information about chest and leg wound care, complications, medication and physical activity was the most important learning needs. There were significant differences between patients' perceptions of learning needs and their age, chronic illnesses and their working status.

CONCLUSION

Syrian patients who underwent coronary artery bypass graft surgery were able to identify their learning needs that should be the focus of nursing practice.

RELEVANCE TO CLINICAL PRACTICE

Meeting the needs of patients who underwent coronary artery bypass graft surgery should be emphasised in nursing practice. Meeting these needs might enhance their self-care behaviours.

Weight and patients' decision to undergo cardiac surgery

Obese patients are less likely to have cardiac surgery than normal weight patients. This could be due to physician or patient decision-making. We undertook a qualitative descriptive study to explore the influence of obesity on patients' decision-making to have cardiac surgery. Forty-seven people referred for coronary artery bypass graft (CABG) surgery were theoretically sampled. Twelve people had declined cardiac surgery. Participants underwent in-depth interviews aimed at exploring their decision-making process. Data were analyzed using conventional content analysis. Though patients' weight did not play a role in their decision, their relationship with their cardiologist/surgeon, the rapidity and orchestration of the diagnosis and treatment, appraisal of risks and benefits, previous experience with other illness or others who had cardiac surgery, and openness to other alternatives had an impact. It is possible that there is a lack of comfort or acknowledgment by all parties in discussing the influence of weight on CABG surgery risks.

Reliability of the Cardiac Patients Learning Needs Inventory (CPLNI) for use in Portugal

AIMS AND OBJECTIVES

To perform the semantic validation and to evaluate the reliability and the presence of ceiling and floor effects of the Cardiac Patients Learning Needs Inventory in Portuguese patients with coronary artery disease.

BACKGROUND

Information should be selected based on what patients know and need to learn, which means that the teaching process should be based on each person's needs. The Cardiac Patients Learning Needs Inventory is aimed at identifying the cardiac patients' individual learning needs.

DESIGN

Methodological research design.

METHODS

Two hundred patients hospitalised at the coronary intensive care unit or at the cardiothoracic surgery unit of a public hospital in Lisbon answered the adapted version of the Cardiac Patients Learning Needs Inventory. Internal consistency was estimated based on Cronbach's alpha. Scores above 0·50 were considered acceptable. Stability was measured through test-retest and calculated using student's t test. Significance was set at 0·05.

RESULTS

Patients' mean age was 65 years (SD = 11·8), and most were men (152; 76%). Cronbach's alpha for the total scale was high in the first and second measurement (0·91), and for seven domains, it was acceptable in the first and second measurement (range from 0·50-0·89). No statistically significant difference was found between mean scores on the first and second measurement. Lower diversity was observed in the answers, most of which ranged between important and very important (ceiling-effect).

CONCLUSION

The adapted version for use in Portugal maintained the conceptual, semantic and idiomatic equivalences of the original version and showed adequate reliability. RELEVANCE TO CLINICAL PRACTICES: Owing to the lack of validated instruments translated into Portuguese, to measure cardiac patients' learning needs, this study entails important clinical and theoretical implications.

[Semantic validation of the Cardiac Patients Learning Needs Inventory for Brazilians and Portuguese]

The Cardiac Patients Learning Needs Inventory (CPLNI) was constructed to assess the learning needs of patients with cardiac disease. This study aimed to compare the results of semantic validations of the CPLNI version adapted to Portuguese, involving 40 Brazilian and 16 Portuguese patients hospitalized for coronary artery disease treatment. The participants were individually interviewed and answered to sociodemographic and clinic characterization instrument, to the adapted CPLNI, and to the semantic validation instrument. In CPLNI's general assessment, most patients, both Brazilians and Portuguese, considered the instrument adequate, easy to understand and complete. The semantic validation of the CPLNI showed the need for some changes in its writing with a view to the semantic adaptation of the instrument for use in Portugal and Brazil.