Abstract
Purpose
Some variability in recovery and outcomes after cardiac surgery may be influenced by psychosocial aspects not routinely captured. Preliminary evidence suggests patient expectations impact health status, but there is no specific measure of expectations for cardiac surgery. The purpose of this study was to adapt an expectations scale to cardiac surgery and assess the psychometric properties of the scale.
Methods
Before surgery, 93 patients awaiting non-emergent cardiac surgery completed questionnaires, including the adapted Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ). At 1 year after surgery, 68 patients completed questionnaires.
Results
Mean C-SPEQ score was 39.4 ± 9.02, and scores were normally distributed (Cronbach’s alpha = 0.86). Higher score indicated negative expectations. Higher presurgery C-SPEQ score was correlated with greater depression (r = 0.32, p = 0.01) and perceived stress (r = 0.36, p = 0.003), but not state anxiety (r = 0.18, p = 0.14), at one-year post-surgery. Higher C-SPEQ was associated with longer recovery time (B = 0.14, p = 0.006) and lower physical HRQL after surgery (B = −0.31, p = 0.005). Higher C-SPEQ was not related to greater odds for perioperative complications (OR 1.01, p = 0.68) or readmissions <30 days (OR 1.05, p = 0.31). C-SPEQ score was not related to survival.
Conclusions
Adaptation of an expectations questionnaire to cardiac surgery patients was successful with acceptable reliability and validity. Negative expectations had a detrimental impact on recovery and HRQL following cardiac surgery but were not related to clinical outcomes. Although focus is mainly on improving clinical outcomes, there are opportunities to improve non-clinical aspects of the patient experience. Presurgical education might better prepare patients, reduce negative expectations, and improve psychosocial outcomes after cardiac surgery.
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Funding
The work presented in the following manuscript was supported in part by an Inova Health System Research Seed Grant (#150680) received by Dr. Holmes.
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Conflicts of interest
Dr. Sari D. Holmes, Dr. Lisa M. Fornaresio, Ms. Casey E. Miller, and Ms. Deborah J. Shuman have no conflicts of interest to declare. Dr. Niv Ad is a consultant for Medtronic, Inc., on the speaker's bureau for LivaNova and AtriCure, a proctor for LivaNova, on the advisory board for Nido Surgical, and co-owner for Left Atrial Appendage Occlusion, LLC.
Ethical standards
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki 1975, as revised in 2000. Informed consent was obtained from all individual participants included in the study.
Appendix 1: Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ)
Appendix 1: Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ)
Please indicate the extent to which you agree or disagree with each of the following statements. The direction of the statements may differ, so please take a moment to consider your answer. There are no right or wrong answers. Please be as accurate and honest with your answers as you can.
Strongly agree | Agree | Undecided | Disagree | Strongly disagree | |
|---|---|---|---|---|---|
1. It is going to be difficult for me to make any changes that are necessary to adjust after my heart surgery… | 5 | 4 | 3 | 2 | 1 |
2. I expect that I may have more heart problems in the future… | 5 | 4 | 3 | 2 | 1 |
3. Although this illness has slowed me down, I will be able to return to work and/or most of my usual activities… | 5 | 4 | 3 | 2 | 1 |
4. I expect that my heart surgery experience will go according to what my doctor told me… | 5 | 4 | 3 | 2 | 1 |
5. I expect that I will have to avoid large groups of people and stimulating situations in the future… | 5 | 4 | 3 | 2 | 1 |
6. I expect that my lifestyle will suffer because of my heart surgery… | 5 | 4 | 3 | 2 | 1 |
7. I doubt that I will ever fully recover from my heart surgery… | 5 | 4 | 3 | 2 | 1 |
8. After my heart surgery, I will be healthy enough for sex… | 5 | 4 | 3 | 2 | 1 |
9. In the long run, there is nothing I can do to affect the outcome after my heart surgery… | 5 | 4 | 3 | 2 | 1 |
10. I expect that in 6 months to a year, my life will be back to normal… | 5 | 4 | 3 | 2 | 1 |
11. I will not have enough support from others for my recovery… | 5 | 4 | 3 | 2 | 1 |
12. I am concerned that my heart surgery will have an impact on my finances… | 5 | 4 | 3 | 2 | 1 |
13. I expect to experience a good deal of pain while I recover from my surgery… | 5 | 4 | 3 | 2 | 1 |
14. My heart surgery and recovery will have few complications… | 5 | 4 | 3 | 2 | 1 |
15. I think that it is likely that I will have to give up working around the house in the long term because of my heart surgery… | 5 | 4 | 3 | 2 | 1 |
16. I can still live a long and healthy life… | 5 | 4 | 3 | 2 | 1 |
17. In the long term, I will have to give up a lot of the things that I enjoy most because of my heart surgery… | 5 | 4 | 3 | 2 | 1 |
18. My sleep will not suffer because of my heart surgery… | 5 | 4 | 3 | 2 | 1 |
19. My heart surgery will have a negative effect on my family… | 5 | 4 | 3 | 2 | 1 |
20. I am optimistic about my future and returning to a normal lifestyle… | 5 | 4 | 3 | 2 | 1 |
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Holmes, S.D., Fornaresio, L.M., Miller, C.E. et al. Development of the Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ). Qual Life Res 25, 2077–2086 (2016). https://doi.org/10.1007/s11136-016-1243-4
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DOI: https://doi.org/10.1007/s11136-016-1243-4