Before ever stepping into the operating room, patients who were encouraged to imagine a better life after surgery -- while keeping their expectations realistic -- enjoyed better outcomes, researchers found.
The PSY-HEART trial randomized one of three groups to a presurgical psychological intervention as a form of placebo treatment in which patients were encouraged to develop ideas and images about their future after coronary artery bypass graft (CABG) surgery, including activities they will be able to resume over time (such as gardening). Therapists also discussed ways in which patients could positively influence their symptoms.
Over 6-month follow-up, this group showed the largest improvement in disability (-12.6 points on a modified version of the Pain Disability Index), compared to their peers who were randomized to a general psychological intervention or standard of care. In fact, a psychological intervention with no focus on post-surgery activities was as ineffective as no intervention at all, according to Winfried Rief, PhD, of Germany's University of Marburg, and colleagues in BMC Medicine.
After adjusting for baseline characteristics, a nonsignificant trend signaled less disability for the group receiving the intervention on managing expectations (P=0.09). These patients also enjoyed a better mental quality of life (P<0.001) and more hours of working ability (P=0.041).
"Optimizing patients' expectations pre-surgery helps to improve outcome 6 months after treatment. This implies that making use of placebo mechanisms has the potential to improve long-term outcome of highly invasive medical interventions," Rief's group suggested.
The expectations-focused intervention was “highly cost-effective,” and likely to work across various fields, Rief told MedPage Today.
“The role of expectations in determining treatment success has been shown in fields such as orthopedic surgeries, dermatological interventions, [and] interventions in cardiology,” Rief noted. “Moreover, patient’s expectations also determine adherence to drug treatments and development of side effects (e.g. in cancer treatments), hereby contributing additionally to treatment success.”
PSY-HEART was a three-pronged trial that included 124 patients undergoing elective on-pump CABG or CABG combined with valve surgery.
Compared with standard care, both surgery interventions were associated with less increase in pro-inflammatory cytokine concentrations after surgery.
Rief declared receiving honoraria from Heel, Berlin Chemie, and Bayer.
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