Researchers have long suggested that a surgical patient's expectations play an important part in recovery. Consistent with this view, several studies have suggested that preparing patients for surgery by providing them with more information about the sensations they can expect after surgery can facilitate recovery. Unfortunately, the current staff shortages that most hospitals are experiencing makes it difficult to provide patients with anything more than the most cursory preparatory information. The proposed project represents an effort to develop a preoperative intervention for coronary artery bypass graft (CABG) surgery that requires very little staff time, and yet effectively reduces patient distress and facilitates recovery. The proposed study involves the development of three brief videotapes designed to provide accurate information regarding the various procedures and sensations typically experienced by CABG patients prior to and for several days following surgery. Two of the tapes will depict actual CABG patients the evening prior to surgery and at several points following surgery as they describe their feelings, the sensations they are experiencing, etc. One of these tapes will focus exclusively on the positive aspects of recovery, and will depict only patients having a relatively easy time and no coping difficulties. The second tape will depict some patients having a relatively easy time and others experiencing but then overcoming some moderate fear and coping problems. The third tape will depict a nurse providing similar procedural and sensory information as that provided in the other two tapes. Following development of the tapes, 200 preoperative CABG patients will be randomly assigned to view one of the three videotapes the day prior to surgery or to receive only standard preparatory care. Measures of patients' preoperative anxiety, postoperative analgesic use, postoperative psychological upset, postoperative ambulation, and speed of recovery then will be collected. Data analyses will include planned orthogonal comparisons contrasting: a) the three videotape groups with the (non-videotape) standard care group to determine whether instructional videotape preparation has benefits over standard care; b) the two patient videotape groups with the nurse videotape group to determine whether information provided by fellow patients is more effective than that provided by a medical expert; and c) the coping tape group with the mastery tape group to determine whether a more complete picture of possible recovery scenarios is more effective than an optimistically slanted portrayal.
