Impact of Psychological intervention on adherence and prognosis in patients undergoing coronary artery bypass grafting

Abstract

Coronary Artery Bypass Grafting (CABG) is an invasive surgical procedure for patients with Coronary Artery Disease. Given the intensity of pain, dependency and medical protocols during the period of CABG, patients tend to experience psychological distress which may lower their adherence and prognosis after surgery. This research study examined the impact of psychosocial intervention, facilitated in conjunction with standard hospital treatment, on adherence and prognosis in patients undergoing CABG. Using a pretest-posttest non-equivalent control groups design, three groups of patients were compared. The first group received the Programme for Affective and Cognitive Education (PACE) intervention, the second was given the Relaxation intervention, and the third formed the Control group with standard hospital treatment only. The participants were assessed using Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Locus of Control checklist for CABG, Adherence Scale for Cardiac Patients, and Biopsychosocial Prognosis Scale for CABG. A sample of 300 participants was sequentially assigned to the three groups (100 in each) in the order of PACE, Relaxation, and Control. The interventions were administered twice to the participants. They were also given the intervention CD or DVD, to be used for reinforcement after discharge. A day before CABG, the pre-surgery assessment was carried out to measure psychological distress, perceived social support and health locus of control. Following this on the same day, the PACE and Relaxation groups received their respective intervention. CABG was performed the next day as per schedule. A day before discharge from hospital (pre- discharge phase), the PACE and Relaxation groups received the second part of their respective intervention. All participants were followed up for six weeks afterdischarge. Psychological distress was assessed during participants’ first and second medical reviews, while adherence and prognosis were measured at the second medical review. A sub-sample of 100 participants was followed up five months after discharge as part of the assessment of prognosis. Semi-structured interviews were individually conducted with a sub-sample of 15 participants to gain deeper insight into their feelings, experiences, and opinions. Results showed that the PACE group had the highest adherence and prognosis as well as the highest reduction in psychological distress from pre-surgery to second review assessments. The Control group had the lowest adherence and prognosis as well as the lowest reduction in psychological distress from pre-surgery to second review assessments. Further, the study attempted to trace the pathway between interventions, adherence and prognosis. By means of pathway modelling using multiple linear regression analyses, adherence was found to be independently and positively predicted by the PACE intervention, the Relaxation intervention and perceived social support, and negatively predicted by psychological distress at second review. The PACE intervention was the only positive independent predictor of prognosis, while psychological distress before surgery, psychological distress at second review and female gender were negative independent predictors. Thematic analysis of qualitative data indicated three themes in participants’ experiences: relief through psychosocial intervention, differential impact of psychosocial interventions, and finding solace in interaction and assessment. The results consistently indicated that psychosocial intervention, namely PACE, was effective in optimising adherence and prognosis after CABG, primarily by reducing psychological distress prior to surgery and during convalescence. The indispensability of integrating psychosocial care into CABG alongside biomedical treatment is the key conclusion. Implications, strengths, and limitations of the study are also discussed