A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomised controlled trial

Guo, Ping (2012) A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomised controlled trial. PhD thesis, University of Nottingham.

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Background: Patients awaiting cardiac surgery typically experience physical and psychological stress. Although there is evidence that preoperative education can improve postoperative outcomes among general surgical patients, less is known about preoperative education for patients undergoing cardiac surgery, particularly in the context of healthcare delivered in China.

Aim: The aim of this study was to evaluate whether a preoperative education intervention designed for Chinese cardiac patients could reduce anxiety and improve recovery.

Methods: A randomised controlled trial was conducted between December 2009 and May 2010 at two public hospitals in Luoyang, China. Adult patients undergoing cardiac surgery were randomly allocated to usual care or preoperative education that included usual care plus an information leaflet and verbal advice. All outcomes were recorded at seven days following surgery. The primary outcome was change in anxiety measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes were change in depression (HADS), change in pain as measured by the Brief Pain Inventory short form (BPI-sf), length of ICU stay and postoperative hospital stay. A qualitative evaluation was carried out with a sample of 20 trial participants (ten from each group) to explore their views on preoperative education and their experiences of taking part in the trial.

Results: A total of 153 patients were recruited to the trial, 77 of which were randomly allocated to usual care and 76 to preoperative education. Of these, 135 (88.2%) completed the trial. The participants who received preoperative education experienced a greater decrease in anxiety score (mean difference -3.6 points, 95% CI -4.62 to -2.57; P<0.001) and a greater decrease in depression score (mean difference -2.1 points, 95% CI -3.19 to -0.92; P<0.001) compared with those who did not. There was no difference between groups in average pain, current pain, and interference in general activity, mood and walking ability. Patients in the preoperative education group reported less interference from pain in sleeping (mean difference -0.9 points, 95% CI -1.63 to -0.16; P=0.02). There was borderline evidence to suggest a reduced number of hours spent in the ICU among preoperative education patients (P=0.05) but no difference in length of postoperative hospital stay (P=0.17).

Eleven themes were generated from the qualitative interviews. These were collapsed into three categories: the process and context of information giving and trial experience. Most interview participants commented that communication between patients and healthcare providers was limited, reactive and rarely interactive. Those who received the preoperative education intervention reported that they valued both the written and verbal information. Participants welcomed the opportunity to engage with the trial, and made suggestions concerning future preoperative education.

Conclusions: This form of preoperative education is effective in reducing anxiety and depression among Chinese cardiac patients. Preoperative education should be incorporated into routine practice to prepare Chinese cardiac patients for surgery. More trials of complex interventions delivered in China are needed to provide evidence for Chinese healthcare.

Trial registration: Current controlled trials ISRCTN87451169.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Arthur, A.
East, L.A.
Subjects: W Medicine and related subjects (NLM Classification) > WG Cardiocascular system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Nursing
Item ID: 12906
Depositing User: EP, Services
Date Deposited: 08 Apr 2013 13:48
Last Modified: 14 Sep 2016 11:01
URI: http://eprints.nottingham.ac.uk/id/eprint/12906

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