Waiting For Heart Surgery

Detta är en avhandling från Department of Cardiothoracic Surgery, Lund University, Lund, Sweden

Sammanfattning: Patients waiting for cardiac surgery often consider the period from the decision for surgery to the time for the operation as long, heavy and dreary. Therefore, it is important that patients are supplied with structured oral and written information regarding their disease and its treatment, so that they are able to understand and discuss the forthcoming operation, the risk of complications and the possibility that surgery may be delayed. Next of kin play a crucial role for patients waiting for cardiac surgery and are often forgotten by health care personnel. The overall aims of this thesis were to describe experiences of support while waiting for heart surgery, from the perspective of patients and their next of kin, and to describe the patients? experiences of information received about the risks of complications in relation to the surgery. A further aim was to investigate the frequency of postponements and cancellations and to study how these affected the patients. A total of 531 patients admitted to bypass surgery or valve replacement and 23 next of kin were included in these five studies. Data were collected through questionnaires and semi-structured interviews using the critical incident technique (CIT). Degree of anxiety and depression was measured using the HADS, and distress was measured using the IES. Both patients and next of kin described experiences as positive when they received attention and information and felt involved in the care, and negative when they were dissatisfied with the health care organization and lacked a supportive social network (Study I and II). Patients who received written extended information about the risk of complications in connection with cardiac surgery were satisfied with the information without being more affected by anxiety, depression or distress than patients who received traditional written information (Study III). Patients reacted negatively to postponement of surgery, especially if due to organizational reasons, which were also the most common reasons for postponements. Some patients experienced physical or psychosomatic symptoms and some feared cardiovascular problems after postponement or cancellation of their operation. Women in the cancellation group had a significantly higher degree of depression than men in the same group, and than both men and women in the control group (Studies IV and V). Patients and next of kin were generally satisfied with the reception from the health care professionals (Studies I-V). Implications of these studies are that organizational and medical problems must be identified in time to avoid postponements, and that patients and their next of kin must be allowed to participate in the care and must receive attention from health care professionals. If patients and their next of kin are carefully and thoroughly informed, they are more satisfied and probably better prepared if complications occur.

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