A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: A randomized controlled trial

Background
Patients awaiting cardiac surgery typically experience significant physical and psychological stress. However, although there is evidence that preoperative education interventions can lead to positive postoperative outcomes for surgical patients in general, less is known about the effectiveness among patients undergoing cardiac surgery, especially Chinese cardiac patients.

Objectives
To determine whether a preoperative education intervention designed for Chinese cardiac patients can reduce anxiety and improve recovery.

Design
Randomized controlled trial.

Settings
Cardiac surgical wards of two public hospitals in Luoyang, China.

Methods
153 adult patients undergoing cardiac surgery were randomized into the trial, 77 to a usual care control group and 76 to preoperative education group comprising usual care plus an information leaflet and verbal advice. Measurement was conducted before randomization and at seven days following surgery. The primary outcome was change in anxiety measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes were change in depression (HADS), change in pain as measured by subscales of the Brief Pain Inventory-short form (BPI-sf), length of Intensive Care Unit stay and postoperative hospital stay.

Results
Of 153 participants randomized, 135 (88.2%) completed the trial. Participants who received preoperative education experienced a greater decrease in anxiety score (mean difference -3.6 points, 95% confidence interval -4.62 to -2.57; P < 0.001) and a greater decrease in depression score (mean difference -2.1 points, 95% CI -3.19 to -0.92; P < 0.001) compared with those who did not. There was no difference between groups in average pain, current pain, and interference in general activity, mood and walking ability. Patients randomized to the preoperative education group reported less interference from pain in sleeping (mean difference -0.9 points, 95% CI -1.63 to -0.16; P = 0.02). There was some evidence to suggest a reduced number of hours spent in the Intensive Care Unit among preoperative education patients (P = 0.05) but no difference in length of postoperative hospital stay (P = 0.17).

Conclusions
This form of preoperative education is effective in reducing anxiety and depression among Chinese cardiac surgery patients. Based upon existing evidence and international practice, preoperative education should be incorporated into routine practice to prepare Chinese cardiac patients for surgery.