Psychosocial coping strategies and cardiac capacity before and after coronary artery bypass surgery

Dysphagic independent feeders' justifications for noncompliance with recommendations by a speech-language pathologist

The purpose of this study was to examine the various ways in which independent-feeding patients with dysphagia justified their noncompliance with swallowing recommendations suggested by a speech-language pathologist (SLP). Sixty-three independent-feeding dysphagia patients between the ages of 65 and 100 years who had been identified by the SLP or staff as noncompliant with SLP recommendations were interviewed about their reasons for noncompliance. Reasons were classified into 8 categories: (a) denial of a swallowing problem, (b) dissatisfaction with the preparations such as thickened liquids or pureed foods, (c) assuming a calculated risk for noncompliant behaviors, (d) rationalizing their noncompliance in the face of contradictory evidence, (e) minimization of the severity of their problem, (f) verbal accommodation while maintaining noncompliance, (g) projection of blame toward the SLP, and (h) deflection of noncompliance by referring to an external authority. Reasons for noncompliance were discussed in light of theory and research on denial, coping mechanisms, and the social-cognitive transition model. Implications were drawn for SLP practice in dealing with noncompliant independent-feeding patients with dysphagia.

Psychosocial adjustment before and after coronary artery bypass surgery

Twenty-eight consecutive male patients were examined a few days before, and again twelve months after, coronary artery bypass surgery. The evaluation included the patients' psychological distress, psychosocial adjustment, cardiac state, personality and family relations. Before surgery the patients were relatively well adjusted, despite being severely disabled physically. On the follow-up evaluation the cardiac state improved significantly on every index examined. On the other hand no change occurred in the psychological distress, personality and family relations. Significant post-operative improvement was found in some of the domains of the psychosocial adjustment, but not in others.

Psychosomatic aspects of coronary artery bypass graft surgery. A prospective study of 101 male patients

101 consecutive male patients were examined by means of clinical interviews and depression, anxiety, personality, psychometric and life stress tests. The examinations took place preoperatively, on the 9th postoperative day (average) and 7.5 months after surgery. The mean age of the patients was 52.2 years and the mean duration of CHD was 6.7 years. Prior to surgery 77% had experienced myocardial infarction and 85% belonged to NYHA class III or IV. 74% had a 3-vessel disease. When the NYHA classification was used as criterion for rehabilitation the result was excellent. Postoperatively 80% belonged to NYHA class I or II. Hospital mortality rate was 4% and one patient died from myocardial infarction prior to the final follow-up. Preoperatively 17% of the study group were working. 87% of the patients experienced negative effects on work life, caused by CHD. Postoperatively 33% worked regularly. The postoperative work situation correlated with the duration of preoperative unemployment (p less than 0.0001), the patient's own opinion about work return (willingness/unwillingness to return to work) (p less than 0.01), as well as with the amount of negative life stress experienced preoperatively (p less than 0.01). Only 13% of the series experienced positive effects on work life, caused by CABG surgery. The majority of the patients had experienced negative effects on social and economic life (51%), as well as on sexual life (70%), caused by CHD. After surgery improvements were noted by 36% on social life and by 27% on sexual life. 15% experienced impairment of sexual life postoperatively. According to the Beck Depression Inventory 29% showed depression preoperatively, and 10% postoperatively. The difference is significant (p less than 0.0001). Clinically the figures tended to be higher. The same tendency holds for anxiety scores as measured by the Hamilton anxiety scale. The incidence of postoperative psychoses was 35%. Higher age (p less than 0.01) and/or absence of psychosomatic diseases (p less than 0.05) correlated with higher frequency of psychoses. Even though cardiological rehabilitation according to the NYHA classification was excellent, 22% of the series did not think their expectations were fulfilled. Psychic and social rehabilitation was in several aspects unsatisfactory, and the patients did not seem prepared for this. The importance to consider rehabilitation from a psychosomatic standpoint is clearly shown. To predict the result of rehabilitation preoperatively is not possible.

Impending surgery: the expectations of male coronary patients and their wives

Waiting to receive coronary graft surgery presents patients and their spouses with a stressful episode which nevertheless holds out the possibilities of symptom relief and improved quality of life. This study examines differences between couples in their experience of waiting, approach to surgery and expectations of treatment benefit. These differences, conceptualized in terms of a theory of adjustment to illness, are discussed in relation to their practical implications for helping patients and spouses to prepare for surgery and its possible outcomes.

Relationships of working status and cardiac capacity to functional age before and after coronary bypass surgery

In 77 patients having coronary bypass surgery, we evaluated the interaction between chronological age, functional age, and working status pre- and postoperatively. Preoperatively the chronological age of those not working compared to those working was 60.7 +/- 8.4 years versus 53.0 +/- 8.3 years (P less than 0.001). The preoperative functional ages were 93.5 +/- 11.5 versus 87.6 +/- 10.9 years (P less than 0.05). Postoperatively no patient who was not working preoperatively started work, although functional age improved from 93.5 +/- 11.5 to 83.2 +/- 12.8 years (P less than 0.001). Postoperatively subjects who stopped working showed similar improvement in maximal cardiac output, and maximal oxygen consumption compared to those who continued working; however, the functional age after surgery was 80.6 +/- 9.4 versus 69.6 +/- 11.6 years (P less than 0.01). This study showed a poor relationship between degree of improvement in cardiac function after bypass surgery and change in working status. However, functional age and chronological age contribute to the poor results with regard to return to work.

Sociocultural factors in MI recovery: an exploratory study

The reported study examines the influence of socioeconomic status (SES) and ethnicity in coping with a first acute myocardial infarction (MI). The study employed a panel design in which seventy-five patients were interviewed during acute hospitalization and six months later, and sixty of those were interviewed again at one year post-MI. Using the analysis of variance test, gradients in anxiety, functional status, and self-reported health status were found among lower SES Blacks, Hispanics, Anglos and upper SES Anglos as well as statistically significant differences in personal sense of control, beliefs about recovery, coping responses, and social support systems. More important, analysis of covariance documents that associations between coping variables and post-MI recovery outcomes vary among the different sociocultural groups.

Coping with serious illness: on integrating constructs to enhance clinical research, assessment and intervention

Empirical research suggests that given relatively similar illness contingencies, patients who cope successfully with serious illness have access to and use effectively social network support, believe events are to some extent within their control, perceive themselves to be effective, and employ an array of flexible coping strategies. Based on a selective literature review, the argument is made that more integrative conceptual frameworks are needed to advance theory and to enhance the applied value of research data. Clinical implications for assessment, intervention, and evaluation are set forth.