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.

Keywords:

• patients’ expectations
• cardiac surgery
• psychological intervention
• randomized controlled trial
• disability

Acknowledgement

This study is part of the Transregional DFG Research Unit FOR 1328: ‘Expectation and Conditioning as basic processes of the placebo and nocebo response – From neurobiology to clinical applications’.

Disclosure statement

Johannes A. C. Laferton, Charlotte J. Auer and Meike C. Shedden-Mora declare that they have no conflict of interest.

Rainer Moosdorf has received a consultant honorarium from EUSA Pharm.

Winfried Rief declares that he has no conflict of interest that could have influenced the content of this manuscript.

Additional information

Funding

The development of study design and study content are supported by a grant of the German Research Foundation (DFG) to Dr Rief [Ri 574/21-1].