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Title: Complex factors that influence patient and partner and dyad outcome 4 months after coronary artery bypass surgery
Author: Thomson, Patricia
ISNI:       0000 0004 2684 3946
Awarding Body: University of Stirling
Current Institution: University of Stirling
Date of Award: 2008
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Background: Coronary heart disease (CHD) remains a major cause of death and ill-health in Scotland. Coronary artery bypass grafting (CABG) aims to relieve CHD symptoms, improve quality of life and increase life expectancy in high-risk groups. Partners may positively or negatively influence patient outcome, and they too may be adversely affected by the experience of CABG. Health care is currently organised around the patient. The partner's is seen as merely assisting patient recovery. Their health and well-being is neglected despite them being at an increased risk of CHD. Research has been limited in the partner variables that have been examined. Their health needs and concerns and the influence of the patient on partner outcome have seldom been examined and the effects of CABG on the dyad. The dyad has not previously been examined as an outcome variable of interest. Aim: To explore the complex factors that influence patient and partner and dyad outcome 4 months after CABG surgery. Design and methods: A multifactorial exploratory, prospective study was carried out. A consecutive sample of 80 patient-partner/family pairs were recruited and data were collected on a number of physical and psychosocial variables 2-3 months prior to elective CABG and 4 months after surgery. The outcome measures were perceived health status, quality of life and CHD risk factors. Findings: The patients' CHD risk factors and physical and mental health (SF-12) improved significantly from pre- to post-operatively, but there was no corresponding improvement in the partners. Most patients were free from angina following CABG. Though the partners' quality of life improved it remained sub-optimum post-operatively. The patients' self efficacy beliefs and partners' efficacy judgements about the patient's cardiac capabilities improved significantly at 4 months; treatment beliefs were unchanged. The patients' perceived social support improved post-operatively, but not the partners. Patients' and partners' total number of important need met increased significantly post-operatively, and the number of important needs unmet decreased. There were significant differences between the patient and partner groups over the two time periods (pre- and post-operatively) for CHD risk factors, physical health (SF-12), self-efficacy for maintaining function, affectionate support, positive social interaction and important needs met and unmet. Overall, the recovery patterns indicated a move towards concordance. The patients' poorer pre-operative physical and mental health (SF-12) significantly predicted their poorer post-operative physical health, and lower pre-operative importance need met predicted poorer mental health. Greater pre-operative CHD risk factors and being female predicted higher post-operative risk factors. Partners' poorer pre-operative physical and mental health (SF-12) significantly predicted their poorer post-operative physical and mental health; low pre-operative affectionate support predicted poorer physical and social health (QL-SP); and a greater number of pre-operative CHD risk factors predicted higher post-operative risk factors. The patients' pre-operative beliefs about CABG - mortality risk reduction predicted the partners' poorer post-operative physical health (SF-12) and emotional health (QL-SP); and patients' poorer pre-operative mental health (SF-12) and greater physical limitation (SAQ) predicted the partners' poorer physical and social health (QL-SP). Only the partners' poorer pre-operative physical health predicted patients' poorer post-operative physical health (SF-12). This unidirectional relationship in which the patients' pre-operative factors predominantly influenced partner outcome(s) was also evident when the physical and mental health and CHD risk factors of the dyad (outcomes) were examined. Results highlight the potential that pre-operative rehabilitation and use of interventions, which target the dyad have for the primary and secondary prevention of CHD. Nurses are heavily involved in the pre-operative preparation for CABG and in the post-operative care of patients and could contribute further to improving the outcomes of surgery for patients and partners.
Supervisor: Niven, Catherine ; Peck, David F. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: CABG ; Surgery ; Patients ; Partners ; Dyads ; Outcomes ; Cardiology ; Coronary heart disease ; Heart Surgery