title: Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention.
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.
authors.affiliation: a Department of Clinical Psychology and Psychotherapy , Philipps University of Marburg , Gutenbergstraße 18, 35032 Marburg , Germany.
authors.forename: Johannes A C
authors.initials: JA
authors.lastname: Laferton
authors.affiliation: a Department of Clinical Psychology and Psychotherapy , Philipps University of Marburg , Gutenbergstraße 18, 35032 Marburg , Germany.
authors.forename: Charlotte J
authors.initials: CJ
authors.lastname: Auer
authors.affiliation: b Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Hamburg Eppendorf , Hamburg , Germany.
authors.forename: Meike C
authors.initials: MC
authors.lastname: Shedden-Mora
authors.affiliation: c Department of Cardiovascular Surgery , Heart Centre, Philipps University of Marburg , Marburg , Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Moosdorf
authors.affiliation: a Department of Clinical Psychology and Psychotherapy , Philipps University of Marburg , Gutenbergstraße 18, 35032 Marburg , Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Rief
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011300:Preoperative Care; D011614:Psychotherapy, Brief; D016896:Treatment Outcome
keywords: cardiac surgery; disability; patients’ expectations; psychological intervention; randomized controlled trial