Unmet information and communication needs in the intermediate recovery from coronary artery bypass surgery

Abstract

Coronary artery bypass graft (CABG) is a common surgical procedure for CHD (1). Compared to less invasive treatments, such as lifestyle modifications, or percutaneous transluminal coronary angioplasty (PTCA), undergoing CABG is a more challenging experience (2) that influences well-being before and after surgery (3). CABG convalescents are expected to incorporate sophisticated regiments into their daily lives as they manage their own recovery. During preparation for surgery and the few days of hospitalization after surgery, the convalescent receives large quantities of information: verbal and written. This includes information about the procedure, the wounds on the sternum and legs, the sternum incision, and specifically, temporary activity restrictions during the immediate recovery period. During the immediate recovery, the convalescent’s capacity to comprehend, process, and incorporate new information is most likely constrained, and their attention is not paid towards learning and information processing (4). The amount and timing of given information are significant, and capacity to comprehend can influence the ‘sense of coherence’ (5). Much of the pre- and post-surgery information explains the procedure, specifically self-monitoring in the immediate recovery and recommended lifestyle changes, such as smoking cessation, ‘healthy eating’ and ‘regular exercise’ (6). Lifestyle changes are usually required to fully benefit from CABG and to reduce symptoms that may require additional treatment. Convalescents may experience anxiety and symptoms of depression in this early recovery period (1,7). In addition, ‘the heart’ carries a significant, existentially oriented meaning to many of us. The capacity to comprehend; process the relevance of or evaluate the usefulness of provided information can be inhibited (1,4,7). Hence, convalescents can report information dearth and a lack of information following CABG (8). During the recovery from CABG, convalescents monitor their own healing and are encouraged to adopt sophisticated regiments for secondary prevention as part of their daily routines. Recovery experiences alter during recovery (3,9). Women report setbacks from unexpected muscular pain in the chest and problems with maintaining recommended activity levels after surgery (10,11,12). Men can experience the recovery process more smoothly than women, and they attribute this to family support, especially from a wife, partner or significant other (10). According to Antonovsky’s salutogenic model (5,13), the individual’s experience of comprehensibility, manageability and meaningfulness is a core premise to handling every day situations. A convalescent’s ‘sense of coherence’ is likely to influence his ability to engage in recovery management on a daily basis, as he incorporates recommendations for secondary prevention of CHD. Acknowledging that CABG recovery may be challenging, this study was theoretically inspired by attention, patient education (4) and ‘sense of coherence’ (5). We have only identified previous studies setting out to measure SOC as an aspect of assessment of quality of life studies following heart surgery. To the best of our knowledge, there are no previous studies applying this construct to elaborate challenges the convalescents are facing in the intermediate recovery period. To better understand recovery challenges and information needs during CABG recovery, we need to elicit the CABG convalescents’ information and communication needs in the intermediate recovery period.