Erwartungs-Optimierung bei Patienten vor der Herzoperation: Eine randomisiert-kontrollierte Studie zur Wirksamkeit einer präoperativen psychologischen Intervention auf die Erwartungen herzchirurgischer Patienten

Präoperative Erwartungen stellen einen wichtigen psychologischen Prädiktor der Genesung und des Behandlungsergebnises bei Patienten nach der Herzoperation dar. Weiterhin konnte bereits bei anderen Behandlungsformen gezeigt werden, dass sich die Erwartungen der Patienten mittels psychologischer Inter...

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1. Verfasser: Laferton, Johannes Andreas Christoph
Beteiligte: Rief, Winfried (Prof. Dr.) (BetreuerIn (Doktorarbeit))
Format: Dissertation
Sprache:Deutsch
Veröffentlicht: Philipps-Universität Marburg 2014
Psychologie
Ausgabe:http://dx.doi.org/10.17192/z2014.0248
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description Präoperative Erwartungen stellen einen wichtigen psychologischen Prädiktor der Genesung und des Behandlungsergebnises bei Patienten nach der Herzoperation dar. Weiterhin konnte bereits bei anderen Behandlungsformen gezeigt werden, dass sich die Erwartungen der Patienten mittels psychologischer Interventionen beeinflussen lassen. Im Bereich der Herzchirurgie gibt es jedoch bisher noch kaum Studien, die sich spezifisch mit der Optimierung verschiedener Aspekte präoperativer Erwartungen bei Patienten vor der Herzoperation befasst haben. Die vorliegende Dissertation verfolgte daher zwei Ziele. Erstens wurde eine kurze psycho-edukative Intervention zur Optimierung der präoperativen Erwartungen bei herzchirurgischen Patienten entwickelt (Studie I) und diese im Vergleich zur medizinischen Standardbehandlung und zu einer Aufmerksamkeits-Kontrollgruppe anhand von N = 90 Patienten vor dem aortokoronaren Bypass evaluiert (Studie III). Durch die kurze psychologische Intervention war es möglich die Erwartungen der Patienten vor der Operation zu optimieren. Die Patienten entwickelten höhere persönliche Kontrollerwartungen, eine realistischere Erwartung der Krankheitsdauer und zum Teil positivere Beeinträchtigungserwartungen. Dabei profitierten vor allem Patienten mit niedriger bis mittlerer aktueller krankheitsbedingter Beeinträchtigung von der Intervention. Zweitens wurden Zusammenhänge verschiedener Aspekte von Erwartungen untereinander sowie Zusammenhänge von Erwartungen mit weiteren Charakteristika bei N = 83 Patienten vor dem aortokoronaren Bypass untersucht (Studie II). Dabei zeigte sich, dass die Beeinträchtigungserwartungen der Patienten in keinem Zusammenhang mit der tatsächlichen Ausprägung herzchirurgie-bezogener Risikofaktoren standen. Vielmehr stand das Ausmaß der Beeinträchtigungserwartung mit Behandlungskontrollerwartungen und dem selbst eingeschätzten Ausmaß der aktuellen krankheitsbedingten Beeinträchtigung im Zusammenhang, nicht aber mit den persönlichen Kontrollerwartungen. Die vorliegende Arbeit konnte erste Belege für die Wirksamkeit einer psychologischen Intervention auf die Veränderung der präoperativen Erwartungen herzchirurgischer Patienten liefern. Weiterhin gibt sie erste Anhaltspunkte für mögliche Einflussfaktoren auf die Erwartungen von Patienten vor der Herzoperation. Ob die optimierten Erwartungen zu einem verbesserten Operationsergebnis führen, kann jedoch erst mit der Erhebung der Katamnese-Daten beantwortet werden.
title_alt Optimizing heart surgery patients´ expectations: a randomized controlled trial evaluating the effect of a preoperative psychological intervention on heart surgery patients´ expectations
topic Psycho cardiology
Klinische Psychologie
Medizinische Psychologie
Herzchirurgie
placebo effect
expectations
Psychologie
Erwartung
Präoperative Erwartungen
Psychologische Intervention
preoperative expectations
Psycho-Kardiologie
psychological intervention
Placebo-Effekt
Verhaltensmedizin
spellingShingle Psycho cardiology
Klinische Psychologie
Medizinische Psychologie
Herzchirurgie
placebo effect
expectations
Psychologie
Erwartung
Präoperative Erwartungen
Psychologische Intervention
preoperative expectations
Psycho-Kardiologie
psychological intervention
Placebo-Effekt
Verhaltensmedizin
Erwartungs-Optimierung bei Patienten vor der Herzoperation: Eine randomisiert-kontrollierte Studie zur Wirksamkeit einer präoperativen psychologischen Intervention auf die Erwartungen herzchirurgischer Patienten
Patients‘ expectations have been identified as a major psychological predictor of course and outcome following cardiac surgery procedures. In addition, patients’ expectations have been shown to be modifiable through psychological interventions. However, few studies have tried to specifically change different aspects of patients’ expectations prior to cardiac surgery. This dissertation had two main purposes. First, a brief psychological intervention was developed in order to optimize different aspects of preoperative expectations in cardiac surgery patients (study I). The effect of the intervention on change in expectations was compared to a standard medical care condition and an active control condition in N = 90 patients undergoing coronary artery bypass graft surgery (study III). The brief psychological intervention was able to optimize patients’ preoperative expectations. Patients developed higher expectations of personal control, more realistic expectations of disease duration and partially lower disability expectations. The beneficial effect of the intervention was predominant in patients with low to moderate disability. Second, the associations of different aspects of patients’ expectations among each other as well as the associations of patients’ expectations with other preoperative characteristics were investigated in N = 63 patients before coronary artery bypass graft surgery (study II). Interestingly, patients’ disability expectations were unrelated to patients’ actual surgery related risk factors. Patients’ disability expectations were associated with patients’ expectations of treatment control and patients’ self rated disability. Expectations about personal control, however, were not associated with patients’ disability expectations. In conclusion, this dissertation provides first evidence that a brief psychological intervention can optimize patients’ expectations prior to cardiac surgery. Further, it identifies factors possibly influencing preoperative expectations in cardiac surgery patients. Whether the optimized expectations will lead to benefits in terms of patients health has to be answered after collecting the follow up data of the ongoing trial.
Laferton, Johannes Andreas Christoph
format Dissertation
oai_set_str_mv doc-type:doctoralThesis
open_access
ddc:150
xMetaDissPlus
title Erwartungs-Optimierung bei Patienten vor der Herzoperation: Eine randomisiert-kontrollierte Studie zur Wirksamkeit einer präoperativen psychologischen Intervention auf die Erwartungen herzchirurgischer Patienten
title_short Erwartungs-Optimierung bei Patienten vor der Herzoperation: Eine randomisiert-kontrollierte Studie zur Wirksamkeit einer präoperativen psychologischen Intervention auf die Erwartungen herzchirurgischer Patienten
title_full Erwartungs-Optimierung bei Patienten vor der Herzoperation: Eine randomisiert-kontrollierte Studie zur Wirksamkeit einer präoperativen psychologischen Intervention auf die Erwartungen herzchirurgischer Patienten
title_fullStr Erwartungs-Optimierung bei Patienten vor der Herzoperation: Eine randomisiert-kontrollierte Studie zur Wirksamkeit einer präoperativen psychologischen Intervention auf die Erwartungen herzchirurgischer Patienten
title_full_unstemmed Erwartungs-Optimierung bei Patienten vor der Herzoperation: Eine randomisiert-kontrollierte Studie zur Wirksamkeit einer präoperativen psychologischen Intervention auf die Erwartungen herzchirurgischer Patienten
title_sort Erwartungs-Optimierung bei Patienten vor der Herzoperation: Eine randomisiert-kontrollierte Studie zur Wirksamkeit einer präoperativen psychologischen Intervention auf die Erwartungen herzchirurgischer Patienten
author2 Rief, Winfried (Prof. Dr.)
author2_role ths
ref_str_mv references
url http://archiv.ub.uni-marburg.de/diss/z2014/0248/pdf/djl.pdf
doi_str_mv http://dx.doi.org/10.17192/z2014.0248
edition http://dx.doi.org/10.17192/z2014.0248
publishDate 2014
era_facet 2014
contents Patients‘ expectations have been identified as a major psychological predictor of course and outcome following cardiac surgery procedures. In addition, patients’ expectations have been shown to be modifiable through psychological interventions. However, few studies have tried to specifically change different aspects of patients’ expectations prior to cardiac surgery. This dissertation had two main purposes. First, a brief psychological intervention was developed in order to optimize different aspects of preoperative expectations in cardiac surgery patients (study I). The effect of the intervention on change in expectations was compared to a standard medical care condition and an active control condition in N = 90 patients undergoing coronary artery bypass graft surgery (study III). The brief psychological intervention was able to optimize patients’ preoperative expectations. Patients developed higher expectations of personal control, more realistic expectations of disease duration and partially lower disability expectations. The beneficial effect of the intervention was predominant in patients with low to moderate disability. Second, the associations of different aspects of patients’ expectations among each other as well as the associations of patients’ expectations with other preoperative characteristics were investigated in N = 63 patients before coronary artery bypass graft surgery (study II). Interestingly, patients’ disability expectations were unrelated to patients’ actual surgery related risk factors. Patients’ disability expectations were associated with patients’ expectations of treatment control and patients’ self rated disability. Expectations about personal control, however, were not associated with patients’ disability expectations. In conclusion, this dissertation provides first evidence that a brief psychological intervention can optimize patients’ expectations prior to cardiac surgery. Further, it identifies factors possibly influencing preoperative expectations in cardiac surgery patients. Whether the optimized expectations will lead to benefits in terms of patients health has to be answered after collecting the follow up data of the ongoing trial.
language German
publisher Philipps-Universität Marburg
last_indexed 2014-05-28T23:59:59Z
license_str http://archiv.ub.uni-marburg.de/adm/urhg.html
dewey-raw 150
dewey-search 150
genre Psychology
genre_facet Psychology
topic_facet Psychologie
author Laferton, Johannes Andreas Christoph
first_indexed 2014-05-28T00:00:00Z
institution Psychologie
building Fachbereich Psychologie
thumbnail http://archiv.ub.uni-marburg.de/diss/z2014/0248/cover.png
spelling diss/z2014/0248 Präoperative Erwartungen stellen einen wichtigen psychologischen Prädiktor der Genesung und des Behandlungsergebnises bei Patienten nach der Herzoperation dar. Weiterhin konnte bereits bei anderen Behandlungsformen gezeigt werden, dass sich die Erwartungen der Patienten mittels psychologischer Interventionen beeinflussen lassen. Im Bereich der Herzchirurgie gibt es jedoch bisher noch kaum Studien, die sich spezifisch mit der Optimierung verschiedener Aspekte präoperativer Erwartungen bei Patienten vor der Herzoperation befasst haben. Die vorliegende Dissertation verfolgte daher zwei Ziele. Erstens wurde eine kurze psycho-edukative Intervention zur Optimierung der präoperativen Erwartungen bei herzchirurgischen Patienten entwickelt (Studie I) und diese im Vergleich zur medizinischen Standardbehandlung und zu einer Aufmerksamkeits-Kontrollgruppe anhand von N = 90 Patienten vor dem aortokoronaren Bypass evaluiert (Studie III). Durch die kurze psychologische Intervention war es möglich die Erwartungen der Patienten vor der Operation zu optimieren. Die Patienten entwickelten höhere persönliche Kontrollerwartungen, eine realistischere Erwartung der Krankheitsdauer und zum Teil positivere Beeinträchtigungserwartungen. Dabei profitierten vor allem Patienten mit niedriger bis mittlerer aktueller krankheitsbedingter Beeinträchtigung von der Intervention. Zweitens wurden Zusammenhänge verschiedener Aspekte von Erwartungen untereinander sowie Zusammenhänge von Erwartungen mit weiteren Charakteristika bei N = 83 Patienten vor dem aortokoronaren Bypass untersucht (Studie II). Dabei zeigte sich, dass die Beeinträchtigungserwartungen der Patienten in keinem Zusammenhang mit der tatsächlichen Ausprägung herzchirurgie-bezogener Risikofaktoren standen. Vielmehr stand das Ausmaß der Beeinträchtigungserwartung mit Behandlungskontrollerwartungen und dem selbst eingeschätzten Ausmaß der aktuellen krankheitsbedingten Beeinträchtigung im Zusammenhang, nicht aber mit den persönlichen Kontrollerwartungen. Die vorliegende Arbeit konnte erste Belege für die Wirksamkeit einer psychologischen Intervention auf die Veränderung der präoperativen Erwartungen herzchirurgischer Patienten liefern. Weiterhin gibt sie erste Anhaltspunkte für mögliche Einflussfaktoren auf die Erwartungen von Patienten vor der Herzoperation. Ob die optimierten Erwartungen zu einem verbesserten Operationsergebnis führen, kann jedoch erst mit der Erhebung der Katamnese-Daten beantwortet werden. Optimizing heart surgery patients´ expectations: a randomized controlled trial evaluating the effect of a preoperative psychological intervention on heart surgery patients´ expectations Erwartungs-Optimierung bei Patienten vor der Herzoperation: Eine randomisiert-kontrollierte Studie zur Wirksamkeit einer präoperativen psychologischen Intervention auf die Erwartungen herzchirurgischer Patienten Hirani, S. P., Patterson, D. L. H., & Newman, S. P. (2008). What do coronary artery disease patients think about their treatments? An assessment of patients " treatment representations. Journal of Health Psychology, 13, 311–322. 2008 What do coronary artery disease patients think about their treatments? An assessment of patients " treatment representations Petrie, K. J., Cameron, L. D., Ellis, C. J., Buick, D., & Weinman, J. (2002). Changing illness perceptions after myocardial infarction: An early intervention randomized controlled trial. Psychosomatic Medicine, 64, 580–586. 2002 Changing illness perceptions after myocardial infarction: An early intervention randomized controlled trial Scheier, M. F., Matthews, K. A., Owens, J. F., Schulz, R., Bridges, M. W., Magovern, G. J., & Carver, C. S. (1999). Optimism and rehospitalization after coronary artery bypass graft surgery. Archives of Internal Medicine, 159, 829–35. 1999 Optimism and rehospitalization after coronary artery bypass graft surgery Habibovic, M., Pedersen, S. S., van den Broek, K. C., & Denollet, J. (2014). Monitoring treatment expectations in patients with an implantable cardioverter-defibrillator using the EXPECT- ICD scale. Europace. Advance online publication. doi:10.1093/europace/euu006 2014 Monitoring treatment expectations in patients with an implantable cardioverter-defibrillator using the EXPECT- ICD scale. Europace. Advance online publication Markowitz, J. C., Kocsis, J. H., Fishman, B., Spielman, L. A., Jacobsberg, L. B., Frances, A. 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Process and outcome in cardiac rehabilitation: an examination of cross-lagged effects. Journal of Consulting and Clinical Psychology, 72, 605–616. 2004 Process and outcome in cardiac rehabilitation: an examination of cross-lagged effects Ware Jr, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220– 33. 1996 A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity Tindle, H. A., Belnap, B. H., Houck, P. R., Mazumdar, S., Scheier, M. F., Matthews, K. A., … Rollman, B. L. (2012). Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery. Psychosomatic Medicine, 74, 200–207. 2012 Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery Petrie, K. J., Weinman, J., Sharpe, N., & Buckley, J. (1996). Role of patients " view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study. British Medical Jounral, 312, 1191–1194. 1996 Role of patients " view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study Furze, G., Dumville, J. C., Miles, J. N. V, Irvine, K., Thompson, D. R., & Lewin, R. J. P. (2009). " Prehabilitation " prior to CABG surgery improves physical functioning and depression. International Journal of Cardiology Cardiol, 132, 51–58. 2009 Prehabilitation " prior to CABG surgery improves physical functioning and depression Barefoot, J. C., Brummett, B. H., Williams, R. B., Siegler, I. C., Helms, M. J., Boyle, S. H., … Mark, D. B. (2011). Recovery expectations and long-term prognosis of patients with coronary heart disease. Archives of Internal Medicine, 171, 929–935. 2011 Recovery expectations and long-term prognosis of patients with coronary heart disease Lau-Walker, M. (2004). Relationship between illness representation and self-efficacy. Journal of Advanced Nursing, 48, 216–25. 2004 Relationship between illness representation and self-efficacy Cameron, L., Petrie, K. J., Ellis, C., Buick, D., & Weinman, J. (2005). Trait negative affectivity and responses to a health education intervention for myocardial infarction patients. Psychology & Health, 20, 1–18. 2005 Trait negative affectivity and responses to a health education intervention for myocardial infarction patients http://dx.doi.org/10.17192/z2014.0248 2014 Patients‘ expectations have been identified as a major psychological predictor of course and outcome following cardiac surgery procedures. In addition, patients’ expectations have been shown to be modifiable through psychological interventions. However, few studies have tried to specifically change different aspects of patients’ expectations prior to cardiac surgery. This dissertation had two main purposes. First, a brief psychological intervention was developed in order to optimize different aspects of preoperative expectations in cardiac surgery patients (study I). The effect of the intervention on change in expectations was compared to a standard medical care condition and an active control condition in N = 90 patients undergoing coronary artery bypass graft surgery (study III). The brief psychological intervention was able to optimize patients’ preoperative expectations. Patients developed higher expectations of personal control, more realistic expectations of disease duration and partially lower disability expectations. The beneficial effect of the intervention was predominant in patients with low to moderate disability. Second, the associations of different aspects of patients’ expectations among each other as well as the associations of patients’ expectations with other preoperative characteristics were investigated in N = 63 patients before coronary artery bypass graft surgery (study II). Interestingly, patients’ disability expectations were unrelated to patients’ actual surgery related risk factors. Patients’ disability expectations were associated with patients’ expectations of treatment control and patients’ self rated disability. Expectations about personal control, however, were not associated with patients’ disability expectations. In conclusion, this dissertation provides first evidence that a brief psychological intervention can optimize patients’ expectations prior to cardiac surgery. Further, it identifies factors possibly influencing preoperative expectations in cardiac surgery patients. Whether the optimized expectations will lead to benefits in terms of patients health has to be answered after collecting the follow up data of the ongoing trial. urn:nbn:de:hebis:04-z2014-02489 opus:5550 2014-05-28 2014-05-19 2014-05-28 ths Prof. Dr. Rief Winfried Rief, Winfried (Prof. Dr.) Philipps-Universität Marburg Laferton, Johannes Andreas Christoph Laferton Johannes Andreas Christoph
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