Female bypass patients experience fewer complications when spouses know what to expect

December 12, 2002

Female coronary bypass surgery patients whose husbands viewed an optimistic informational videotape prior to their surgery experienced fewer complications than did women whose husbands received only the standard hospital preparation.

The study, published recently in Health Psychology, was completed by University of California, San Diego psychologists Heike Mahler and James Kulik. The study evaluated the progress of 226 male and 70 female patients for six months after their first coronary artery bypass graft (CABG) surgery. Prior to the patients' discharge from the hospital, the spouses of the patients viewed one of two videotapes--one more optimistic, than the other-- informing them of what to expect during the recovery period.

"Our results are noteworthy because they suggest that instilling more positive expectations about the recovery process in spouse caregivers may contribute significantly to the recovery of cardiac patients, especially female patients," said Mahler.

While CABG surgery is considered safe and effective treatment for relieving the symptoms of ischemic heart disease, a patient's quality of life is often worse for several months after surgery than it was prior to the operation, according to Mahler, the principal researcher in the study. Many of these potential difficulties affect the patient's family, particularly the spouse. It has been well documented that the families of heart patients find the pre-operative, peri-operative, and post-operative (recovery) periods to be quite stressful.

A major contributing factor to the distress felt by spouses of heart surgery patients, who typically experience stress at levels higher than the actual patient, may be the lack of preparatory information prior to surgery and discharge, said Mahler.

"Better preparation of the spouses of the CABG patients might also lead to better patient outcomes," hypothesizes Mahler. "A well-prepared spouse might benefit from the emotional well-being of the patient simply by virtue of appearing knowledgeable about recovery. Preparation would presumably also enable the spouse to know better which recommended recovery behaviors to encourage in the patient."

The participants in the study, conducted at Scripps Memorial Hospital and the San Diego Veterans Affairs Medical Center, both in La Jolla, CA and Tri-City Medical Center in Oceanside, CA, viewed one of the two videotapes prior to their spouse's discharge after CABG surgery. While both videotapes showed patients who discussed their experiences in recovering from CABG surgery, one tape, which Mahler refers to as the "mastery" tape, portrays patients discussing only their progress after surgery, while the second, the "coping" tape, also portrayed the problems and challenges that patients frequently face after surgery.

The study found that females, both as patients and spouse caregivers, had higher levels of emotional distress and negative outcomes. However, female patients whose male spouses watched the optimistic "mastery" tape were protected from higher rates of complications and were 25 percent less likely to need rehospitalization over the six month period following surgery than women whose husbands received only the standard hospital preparation.

The videotapes, produced by Mahler and Kulik, are both about 35 minutes long and provide accurate information to spouses regarding exercise, diet, incision care, and resumption of normal activities, as well as pain, fatigue, emotions, sleep, and appetite. Both of the films feature four actual CABG patients describing their experiences after surgery.

"Future research will be needed to determine exactly how and why the viewing of the 'mastery' tape by male spouses led to smoother recoveries among female patients," said Mahler. "However, our results suggest an additional reason women cardiac patients tend to have more difficult recoveries than men. Women patients generally have male rather than female spouse caregivers, and we suspect that male caregiving may generally be less effective. However, when our male spouses received a realistic but optimistically-slanted depiction of the recovery period, their wives experienced fewer complications during the recovery process. Given the considerable economic and psychological costs of rehospitalization, targeting male spouses for 'mastery' preparation may be particularly cost effective. Viewed optimistically, female patients do not necessarily have to have more difficult recoveries from cardiac surgery."

University of California - San Diego

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