Psychological recovery from coronary artery bypass graft surgery: the use of complementary therapies

Complementary and alternative medicine use in coronary heart disease patients: a cross-sectional study from Palestine

BACKGROUND

There is a lack of data on the use of complementary and alternative medicine (CAM) in patients with coronary heart disease (CHD). This study examined the use of CAM among patients with CHD, the reasons and factors influencing their use, the types of CAM used, and the relationship between patient's demographics and the use of CAM.

METHODS

In order to determine the prevalence and usage of CAM among Palestinian patients with CHD, a cross-sectional descriptive study was performed from three different hospitals. Using a convenient sampling method, a questionnaire was completed in a face-to-face interview with the patients. Descriptive statistics were used for socio-demographic, and clinical variables. Siahpush scale was used to examine the attitude of CHD patients toward CAM use.

RESULTS

Of the 150 patients that were interviewed, 128 (85.3%) of the patients completed the questionnaire. The majority of CAM users reported CAM use for health problems other than CHD, while a total of 59 (45.9%) patients have used CAM for their heart problems. On the other hand, it was found that the place of residency and pattern of CHD were significantly associated with CAM use (p = 0.039 and 0.044, respectively). In addition, religious practices were found to be the most common form of CAM used by patients, while body and traditional alternative methods were the least being used. A significant association between the attitudes of patients with CHD and their use of CAM was found (patients' attitudes towards alternative medicine and natural remedies were p = 0.011 and 0.044, respectively).

CONCLUSIONS

CAM use among our respondents is common. Despite a lack of evidence-based research supporting its potential benefits and side effects. Understanding the factors that affect CAM use by CHD patients offers healthcare workers and policymakers an opportunity to better understand CAM use and ultimately improve patient-physician interactions.

Religion and the use of complementary and alternative medicine (CAM) among cardiac patients

This study investigates the prevalence and predictors of using complementary and alternative medicine (CAM) among middle-aged and older patients prior to cardiac surgery. Additionally, it addresses the correlates of using 10 commonly used CAM therapies. The influence of religion on itemized CAM usage is also explored. Comprehensive data were collected from adult patients undergoing cardiac surgery through a preoperative survey 2 weeks prior to surgery, followed by a telephone interview the day before surgery. More than two-thirds of participants (80.9 %) indicated at least one CAM use. Income, religiosity, education, BMI, employment, and congestive heart failure predicted greater CAM utility. After multiple controls, major cardiac indicators were significantly positively associated with greater utility of CAM. There was also a significant positive association between religiosity and CAM use. Findings suggest considerable CAM use in this cardiac sample and certain associations among cardiac conditions, religiosity, and itemized CAM utilization. Future research is needed to investigate the potential joint therapeutic and adverse effects of drug and herbal remedies in cardiac patients.

Spirituality and recovery from cardiac surgery: a review

A large research literature attests to the positive influence of spirituality on a range of health outcomes. Recently, a growing literature links spirituality to improved recovery from cardiac surgery. Cardiac surgery has become an increasingly common procedure in the United States, so these results may provide a promising indication for improved treatment of patients undergoing surgery. To our knowledge, a comprehensive review of the literature in this area does not exist. Therefore, this paper reviews the literature relevant to the influence of spirituality on recovery from cardiac surgery. In addition, it proposes a conceptual model that attempts to explicate relationships among the variables studied in the research on this topic. Finally, it discusses limitations, suggests directions for future research, and discusses implications for the treatment of patients undergoing cardiac surgery.

Physical conditioning and mental stress reduction--a randomised trial in patients undergoing cardiac surgery

BACKGROUND

Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery. This study involving cardiac surgery patients was primarily aimed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting. Secondary aims were to evaluate the effect of these programs on quality of life (QOL), rates of postoperative atrial fibrillation (AF) and length of stay (LOS) in hospital.

METHODS

Elective patients scheduled for coronary artery bypass graft and/or valve surgery at a public hospital in Melbourne, Australia were enrolled. Patients were randomized to receive either holistic therapy (HT) or usual care (UC). HT consisted of a series of light physical exercise sessions together with a mental stress reduction program administered in an outpatient setting for the first two weeks after placement on the waiting list for surgery. A self-administered SF-36 questionnaire was used to measure QOL and hospital records to collect data on LOS and rate of postoperative AF.

RESULTS

The study population comprised 117 patients of whom 60 received HT and 57 received UC. Both programs were able to be delivered within the hospital setting but ongoing therapy beyond the two week duration of the program was not carried out due to long waiting periods and insufficient resources. HT, as delivered in this study, compared to UC did not result in significant changes in QOL, LOS or AF incidence.

CONCLUSIONS

Preoperative holistic therapy can be delivered in the hospital setting, although two weeks is insufficient to provide benefits beyond usual care on QOL, LOS or postoperative AF. Further research is now required to determine whether a similar program of longer duration, or targeted to high risk patients can provide measurable benefits.

TRIAL REGISTRATION

This trial was conducted as part of a larger study and according to the principles contained in the CONSORT statement 2001.

Use of complementary and alternative medicine and self-tests by coronary heart disease patients

Background

Coronary heart disease patients have to learn to manage their condition to maximise quality of life and prevent recurrence or deterioration. They may develop their own informal methods of self-management in addition to the advice they receive as part of formal cardiac rehabilitation programmes. This study aimed to explore the use of complementary and alternative medicines and therapies (CAM), self-test kits and attitudes towards health of UK patients one year after referral to cardiac rehabilitation.

Method

Questionnaire given to 463 patients attending an assessment clinic for 12 month follow up in four West Midlands hospitals.

Results

91.1% completed a questionnaire. 29.1% of patients used CAM and/or self-test kits for self-management but few (8.9%) used both methods. CAM was more often used for treating other illnesses than for CHD management. Self-test kit use (77.2%,) was more common than CAM (31.7%,) with BP monitors being the most prevalent (80.0%). Patients obtained self-test kits from a wide range of sources, for the most part (89.5%) purchased entirely on their own initiative. Predictors of self-management were post revascularisation status and higher scores on 'holism', 'rejection of authority' and 'individual responsibility'. Predictors of self-test kit use were higher 'holism' and 'individual responsibility' scores.

Conclusion

Patients are independently using new technologies to monitor their cardiovascular health, a role formerly carried out only by healthcare practitioners. Post-rehabilitation patients reported using CAM for self-management less frequently than they reported using self-test kits. Reports of CAM use were less frequent than in previous surveys of similar patient groups. Automatic assumptions cannot be made by clinicians about which CHD patients are most likely to self-manage. In order to increase trust and compliance it is important for doctors to encourage all CHD patients to disclose their self-management practices and to continue to address this in follow up consultations.

Effects of Spirituality in Breast Cancer Survivors

PURPOSE/OBJECTIVES

To examine the effects of spirituality (meaning in life and prayer) on a sense of well-being among women who have had breast cancer.

DESIGN

Descriptive, correlational, cross-sectional.

SETTING

Rural and urban communities in central Texas.

SAMPLE

Convenience sample of 84 women, 34-80 years of age diagnosed less than one year previously (36%), within the previous one to five years (38%), and more than five years previously (26%).

METHODS

The study approach consisted of completing a questionnaire assessing personal and cancer characteristics, aspects of spirituality (meaning in life and prayer), and physical and psychological responses to breast cancer.

MAIN RESEARCH VARIABLES

Meaning in life, prayer, and physical and psychological responses to breast cancer.

FINDINGS

Meaning in life was positively related to psychological responses and negatively related to physical responses. Prayer was positively related to psychological well-being. Women with higher prayer scale scores reported lower education levels, less income to meet their needs, and closer relationships with God. Meaning in life mediated the impact of breast cancer on physical and psychological well-being.

CONCLUSIONS

Strong relationships exist among spirituality and personal and cancer characteristics. Meaning in life mediated the effects of breast cancer on well-being in breast cancer survivors.

IMPLICATIONS FOR NURSING

The findings support healthcare providers encouraging women diagnosed with breast cancer to explore their spirituality as an effective resource for dealing with the physical and psychological responses to cancer.

Complementary therapy in critical care settings: a review of surveys and implications for nurses

Critical care nurses have been leaders in this field and need to further expand their influence in the work environment and healthcare system. The time is ideal for initiating meaningful system-wide changes in policy and practice. This review provides an historical context of surveys conducted in a variety of critical care settings in this country. It is important for nurses to become familiar with these studies to communicate better with others and make recommendations based on research. Critical care nurses can maintain their lead by becoming principal investigators in this area of research. In this day and age there is no reason to dismiss or arbitrarily evaluate the use of CAM. Consumer use does not end when crossing over the threshold of a healthcare setting. The focus should be equally spread over safety issues and modalities that can enhance an individual's quality of life. The staff has an ethical and legal responsibility to be aware of and knowledgeable about any healthcare modality practiced by their patients regardless of whether "sufficient" randomized, double-blind controlled studies have been completed.

Healing the heart: integrating complementary therapies and healing practices into the care of cardiovascular patients

Complementary therapies and healing practices have been found to reduce stress, anxiety, and lifestyle patterns known to contribute to cardiovascular disease. Promising therapies include imagery and hypnosis, meditation, yoga, tai chi, prayer, music, exercise, diet, and use of dietary supplements. Many of these complementary approaches to healing have been within the domain of nursing for centuries and can readily be integrated into the care of patients with cardiovascular disease. While individual complimentary modalities hold considerable merit, it is critical that the philosophy underlying these therapies--caring, holism, and harmony--also be understood and honored.

Prayer in people with cancer

The purpose of this study was to adapt an instrument to assess prayer activities, experiences, and attitudes for people with cancer. A cross-sectional correlational research design was used to study 32 adults (24 women and 8 men) at 3 urban oncology and 2 radiation clinics. The prayer scale was adapted for people with cancer by the author, reviewed by measurement and content experts, and tested by administration to 32 people with a variety of cancers. Expert review supported the content validity of the adapted instrument. Instrument subscales had acceptable reliability for internal consistency. The 3 prayer scale subscales were moderately correlated to perceived relationship with God. Results demonstrated that high scores on the frequency of prayer subscale were associated with low levels of education and functional status and high presence of metastasis at diagnosis. Reports of more prayer activity were related to low levels of functional status. Additionally, those reporting low levels of physical health status had more prayer experiences. The prayer scale is a sensitive instrument for assessing prayer activities, experiences, and attitudes of people with cancer. Prayer is a valuable internal resource, which can lessen the effect of cancer.

The use of complementary and alternative therapies among middle-aged and older cardiac patients

This study investigated the prevalence, pattern, perceived benefits, and predictors of the use of complementary and alternative therapies (CAM) among middle-aged and older patients prior to cardiac surgery. Comprehensive information of 246 patients who came for preoperative medical assessment was obtained through face-to-face interviews. CAM utility of 225 was obtained by telephone the day before surgery. A computerized STS Adult Cardiac Database of Cardiac Surgery provided patients' medical information. One hundred eighty-two patients (80.9%) confirmed CAM use, including relaxation techniques, lifestyle-diet modification, spiritual healing, megavitamin therapy, massage, herbs or folk remedies, and imagery. Education, functional status, the number of non-cardiac chronic conditions, status as former cigarette smoker, public religiosity, and congestive heart failure predicted greater CAM utility, whereas cerebrovascular diseases and arrhythmia tended to predict less use. Findings suggest that there is considerable CAM use in this cardiac sample. Physicians and other health providers should investigate patients' CAM utility and promote collaborative medical care.