Optimizing Expectations in Cardiac Surgery Patients
Condition: Coronary Artery Bypass Graft Surgery (CABG); Patients' Expectations; Coronary Heart Disease
MeSH terms: Heart Diseases; Coronary Disease; Coronary Artery Disease; Myocardial Ischemia
Study type: Interventional
Phase: Phase 2

Summary: 
      The purpose of this study is to evaluate the potential benefit of targeting patients'
      expectations before coronary artery bypass graft surgery through a brief psychoeducational
      intervention.
    

Detailed description: 
      Coronary artery bypass graft surgery (CABG) is an extremely invasive medical intervention.It
      is postulated that even under these conditions, treatment outcome is substantially determined
      by non-specific effects, e.g. patient's expectation. Targeting patients' expectations at an
      early stage might have potential to optimize outcomes after cardiac surgery. The purpose of
      this research project is to optimize patients' outcome expectations before undergoing cardiac
      surgery through a brief psycho-educational program. Using a randomized controlled design, 180
      patients who are scheduled to undergo elective CABG are randomly assigned either to standard
      medical information alone, or to an additional expectation manipulation intervention (EMI)
      during the two weeks before surgery, or to an attention-control group ("supportive therapy").
      The main goal is to enhance positive expectations (surgery 'non-specific effects') about
      favorable outcome through EMI, about coping abilities to deal with adverse events, and to
      reduce negative expectations and misconceptions. Assessment takes place before and after EMI,
      10 days after surgery and 6 months later; same assessment points are used for the 2 control
      conditions. Primary outcome is disability, which has been shown to be strongly determined by
      patient's expectation in previous studies. Moreover, psychological and biological predictors
      and mediators of treatment success are analyzed. A positive result for this expectation
      intervention would have major implications for clinical practice. In order to optimize
      treatment outcome, it is not only necessary to improve the treatment-specific procedures
      (e.g., cardiac surgery) but also to address non-specific factors such as patients'
      expectations.
    

Intervention name(s): Expectation Manipulation Intervention; Supportive Therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The Expectation Manipulation Intervention targets patients' expectations prior to surgery (2 individual sessions, 2 phone calls). Main goal is to enhance positive outcome expectancies, as well as to improve patients' control expectations about possible side effects of the surgery and about their personal management of their coronary heart disease. Further EMI tries to correct dysfunctional beliefs about the coronary heart disease and tries to minimize fears about expected negative consequences.; Supportive therapy employs common factors such as elicitation of affect, reflective listening, feeling understood, but provides no explicit theoretical formulation to the patient. Supportive therapy thus provides a control condition for common factors and therapist attention but lacks the specific intervention part. It will be delivered in the same frequency and at the same time points as the Expectation Manipulation Intervention (2 individual sessions, 2 phone calls).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Coronary Artery Bypass Graft Surgery (CABG); Patients' Expectations; Coronary Heart Disease; Illness Perception Intervention; Randomized Controlled Trial