The effectiveness of different approaches to pre-intervention education for adult cardiac patients: A Systematic Review

Abstract

Objective The objective of this review was to summarise the best available research evidence related to the effectiveness of pre-intervention educational methods for adult patients undergoing a cardiac intervention. The review will focus on educational methods aimed at reducing pain, anxiety, length of stay and improving knowledge retention. Inclusion criteria Type of participants Adult hospital patients who were scheduled to undergo a cardiac intervention. Type of interventions Educational methods provided to patients prior to the cardiac intervention. Education methods included: - Audio-visual (video) - Information pamphlets - Telephone intervention - Pre-admission teaching session - Verbal education by a nurse post admission - Combination of methods and - Timing of education delivery - pre or post admission Type of outcomes measures included Anxiety, pain, length of stay and/or knowledge retention. Type of studies Randomised controlled trials (RCT). Where RCTs could not be identified the results of uncontrolled clinical trials and descriptive studies were incorporated into the results in a narrative form. Studies were excluded from the review if they were of poor methodological quality or the description of the participants, intervention, outcome measure or the research methods were inadequately reported. Search strategy The search sought to identify published and unpublished studies. The databases searched included MEDLINE, CINAHL, The York Database of Abstracts of Reviews of Effectiveness (DARE), The Cochrane Library, Current Contents, Centre for Reviews and Dissemination (CRD), Health Star, Expanded Academic Index and EMBASE. Databases searched for unpublished studies included Dissertation Abstracts International Database and Proceedings First Database. Key journals and cardiac conference proceedings were also searched by hand. The reference lists and/or bibliographies of all retrieved articles were checked for additional studies. Assessment of quality All identified studies that met the inclusion criteria were evaluated for methodological quality prior to inclusion in the review using a 'data collection tool' developed by the author based on tools of The Joanna Briggs Institute. Data extraction Data was extracted from study reports using a 'data collection tool' developed by the author based on tools of The Joanna Briggs Institute. Data synthesis Studies were summarised using both tabular and narrative summaries. Due to the lack of homogeneity between the study outcomes no meta-analysis could be completed. When appropriate, the findings from individual studies were detailed in graph format. For continuous data that used the same scale, weighted mean difference (WMD) and 95% confidence interval (CI) was used as a summary measure. Results The literature search identified 29 articles that appeared to meet the initial inclusion criteria. However, only 5 studies met the review inclusion criteria. The included studies comprised of two RCTs and three randomised quasi-experimental studies. The included studies addressed comparisons in relation to different educational delivery methods and/or the timing of the educational delivery (pre-admission teaching times versus post-admission teaching times). Studies were then examined according to specific outcome measures: post intervention pain, anxiety, length of stay and/or knowledge retention. - Study one by Mott demonstrated there was no statistically significant difference in precardiac catheterisation mean anxiety levels when a comparison of verbal education, video or a combination of video and verbal was made. - Study two by Lamarche, Taddeo & Pepler initially identified a statistically significant difference in anxiety level on admission (p=0.02) in those patients who had received an educational telephone call in addition to a pre-admission teaching session when compared to those who had not. However, once data was entered as covariates by the authors (anxiety level at teaching time and length of waiting time before admission) in MANOVA statistical significance was not demonstrated (p = 0.14).2 There was no TRUNCATED AT 600 WORDS