The affective and medical effects of different preoperative interventions with heart surgery patients



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A growing area of interest in psychosomatic medicine is the relationship between psychological variables and reaction to major surgery. Research has demonstrated beneficial effects of providing patients with information or emotional support prior to surgery. However, previous research has left ambiguous results and reasoning to explain why or how preoperative interventions help improve patients' recovery from surgery. This study used a four group design to (a) investigate the medical and psychological effects of different modes of preoperative interventions with heart surgery patients, and (b) explore relationships between emotional states and medical recovery. Patients in Group I received a preoperative intervention actively focusing on plans for recovery and future life; Group II patients were asked to merely think about recovery and future plans; Group III patients were given an attention placebo; and Group IV patients were no treatment controls. It was hypothesized that (a) presurgical patients who experience more active, encouraging, and specific planning show better recovery, and (b) there is a relationship between positive affective state and better recovery. Analysis of results showed no significant difference among the four groups on the medical measures of recovery. However, treatment (Groups I, II, and III) versus no treatment (Group IV) analysis showed significant difference in the expected direction. No consistent pattern of relationships was found between patients' psychological state immediately following intervention just prior to surgery or during recovery with indices of medical recovery. Initial, pre-intervention testing of anxiety and mood state did show significant correlations with later medical recovery. Although the levels of interventions used did not distinguish groups, the results support the notion that attention prior to surgery in itself contributes to improved recovery. This effect cautions against research using two group, treatment and control intervention designs that then argue for the effectiveness of the content of the intervention. Data from anxiety and mood testing suggest that the relationship between current mood and current medical recovery is not clear, and that patients' emotional state a few days prior to surgery is a better indicator of recovery than emotional state immediately prior to surgery. This study suggests (a) the need for further clarification of the attention effects during preoperative interventions, and (b) the investigation of emotional support or information at a point when patients first learn they will have surgery rather than immediately prior to the operative procedure.