Präoperative Erwartungsoptimierung : Die Relevanz individueller Faktoren
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Philipps-Universität Marburg
Abstract
Cardiovascular diseases, such as coronary artery disease and heart valve diseases, are widespread worldwide and are one of the leading causes of death. Affected individuals are impaired due to the disease and report a reduced quality of life. Severe forms of the diseases are often treated surgically, which can relieve symptoms and increase patients' survival chances. Nevertheless, a significant proportion of patients still feel impaired despite successful surgery. This underscores the need to further improve recovery processes and treatment outcomes.
In addition to specific factors, such as the surgeries themselves, expectations play a crucial role in recovery processes and treatment outcomes. However, there are often unrealistic expectations about the disease and its management before heart surgery. Developing positive-realistic and reducing maladaptive expectations seems promising for optimizing treatment success. Some studies have developed preoperative interventions to optimize expectations, but the body of research is small and heterogeneous.
Within the PSY-HEART study, promising results were found for patients with coronary artery bypass surgery regarding disease-related disabiltiy, quality of life, and hospital stay after participating in the expectation-focused EXPECT intervention compared to standard medical care.
Individual factors (e.g., depressiveness) and prior information (e.g., preoperative information) play a role in expectation formation according to Bingel’s model of treatment expectations.
However, it is still unclear which mechanisms are responsible for the effects of expectations on recovery processes and treatment outcomes. Therefore, systematic use of personalized expectation optimization is not yet possible. A more detailed investigation of the individually influencing factors would provide the opportunity to systematically maximize placebo effects and minimize nocebo effects. Thus, this dissertation investigated which individual factors influence the effectiveness of preoperative psychological interventions and how expectation-optimizing interventions can be further developed.
The first study explored moderating effects of depressive and anxiety symptoms, as well as illness beliefs, in the context of the PSY-HEART-I study, to determine which patients benefit the most from the preoperative psychological EXPECT intervention. Moderating effects of baseline depressive symptoms, personal control, and concern as illness beliefs on the effectiveness of the intervention with respect to these symptoms and illness beliefs were found.
The second study conceptualized the PSY-HEART-II study, which will investigate the generalizability of the results from the PSY-HEART-I study in a multicenter trial.
The third and fourth studies focused on the conceptualization and evaluation of a potential adaptation of the EXPECT intervention for heart valve disease patients. The EXPECT intervention was also shortened to allow better integration into clinical practice and to increase patient participation. No direct effects of the shortened EXPECT intervention for heart valve patients were observed. However, regarding individual factors, moderation effects were found in relation to need for information. Patients with a high need for information felt less anxious before the surgery and reported less restrictions in their quality of life four to six days after surgery when participating in the EXPECT intervention compared to the standard medical treatment. Additionally, there were indications of sex as another potential moderator.
The fifth study investigated general preoperative information needs regardless of the type of surgery. There was a generally high level of interest in information before surgery. Women and individuals with anticipated realistic expectations seem to be more interested in information regarding surgery than men or individuals with anticipated optimistic expectations.
Overall, this dissertation expanded knowledge about the effectiveness of preoperative psychological interventions aimed at optimizing expectations before heart surgery. The results indicate that such interventions positively affect recovery and treatment outcomes and may potentially reduce healthcare costs. However, not all patients benefit equally from the interventions. Individual factors that moderate the effectiveness of interventions have been identified (e.g., depression, illness beliefs, information needs, and sex). The development, investigation, and implementation of personalized approaches that consider these factors seem promising for improving healthcare.