Presurgical Distress Research Articles

Presurgical distress about bodily sensations predicts chronic postsurgical pain intensity and disability 6 months after cardiothoracic surgery.

Chronic postsurgical pain (CPSP) and disability after cardiothoracic surgery are highly prevalent and difficult to treat. Researchers have explored a variety of presurgical risk factors for CPSP and disability after cardiothoracic surgery, including one study that examined distress from bodily sensations. The current prospective, longitudinal study sought to extend previous research by investigating presurgical distress about bodily sensations as a risk factor for CPSP and disability after cardiothoracic surgery while controlling for several other potential psychosocial predictors. Participants included 543 adults undergoing nonemergency cardiac or thoracic surgery who were followed over 6 months postsurgically. Before surgery, participants completed demographic, clinical, and psychological questionnaires. Six months after surgery, participants reported the intensity of CPSP on a 0 to 10 numeric rating scale and pain disability, measured by the Pain Disability Index. Multinomial logistic regression analyses were conducted to evaluate the degree to which presurgical measures predicted pain outcomes 6 months after surgery. The results showed that CPSP intensity was significantly predicted by age and presurgical scores on the Symptom Checklist-90-Revised Somatization subscale (Nagelkerke R2 = 0.27, P < 0.001), whereas chronic pain disability was only predicted by presurgical Symptom Checklist-90-Revised Somatization scores (Nagelkerke R2 = 0.29, P < 0.001). These findings demonstrate that presurgical distress over bodily sensations predicts greater chronic pain intensity and disability 6 months after cardiothoracic surgery and suggest that presurgical treatment to diminish such distress may prevent or minimize CPSP intensity and disability.

The role of religion and spirituality in psychological distress prior to surgery for urologic cancer.

The present study examined the associations between religion and spirituality (R/S), presurgical distress, and other psychosocial factors such as engagement coping, avoidant coping, and social support. Participants were 115 men scheduled for surgery for urologic cancer. Before surgery, participants completed scales measuring intrinsic religiosity, organized religious activity, and nonorganized religious activity (IR, ORA, NORA); social support (Medical Outcomes Study Social Support Survey); and distress (Impact of Event Scale [IES], Perceived Stress Scale [PSS], Brief Symptom Inventory-18 [BSI-18], and Profile of Mood States [POMS]). R/S was positively associated with engagement coping. Social support was positively associated with engagement coping and inversely associated with POMS and PSS scores. Engagement coping was positively associated with IES and BSI scores, and avoidant coping was positively associated with all distress measures. R/S moderated the association between engagement coping and IES scores, such that the association between engagement coping and IES was not significant for men with high R/S scores (greater religious belief). R/S moderated the association between social support and distress; the inverse association between social support and PSS and POMS scores was only significant for men who scored high on R/S. This study replicated findings from previous studies suggesting that engagement and avoidant types of coping can lead to increased distress prior to surgery. Although R/S was associated with engagement coping, it was not associated with any of the distress measures. The finding that R/S moderated the associations between engagement coping and distress and social support and distress suggests that the association between R/S, coping style, social support, and adjustment to stressful life situations is not simplistic, and indirect associations should be explored.

Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: Response expectancies and emotional distress.

The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years; 63% White, 15% Hispanic, 13% African American, and 9% other) were randomized to a hypnosis or to an attention control group. Prior to surgery, patients completed assessments of hypothesized mediators (response expectancies and emotional distress), and following surgery, patients completed assessments of outcome variables (pain, nausea, and fatigue). Structural equation modeling revealed the following: (a) Hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p < .0001) but not by distress (p = .12); (b) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p = .02) but not by nausea expectancy (p = .10); and (c) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p = .0001) and presurgical distress (p = .02). The results demonstrate the mediational roles of response expectancies and emotional distress in clinical benefits associated with a hypnotic intervention for breast cancer surgical patients. More broadly, the results improve understanding of the underlying mechanisms responsible for hypnotic phenomena and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery.

The effects of surgery type on pretreatment distress and negative expectations in women scheduled for gynecologic surgery

e20562 Background: Most women with gynecologic cancer must undergo surgery as part of their treatment. Research suggests that laparoscopic surgery may lead to fewer side effects and faster recovery than laparotomy. Clinically, however, it is unclear if these benefits have led to decreased levels of emotional distress in patients prior to the procedure and/or to reduced expectations of negative side effects. The purpose of the present study was to assess and compare levels of emotional distress and expectations for postoperative discomfort and pain in women scheduled for either laparoscopic gynecological procedures, or laparotomy. Methods: Fifty-nine women scheduled for gynecologic surgery (mean age = 52.0 years) were recruited to this study. The dependent variables, pretreatment emotional distress and expectations of postoperative pain and discomfort, were assessed in the clinic with a numeric rating scales (0–10) prior to surgery. The independent variable, surgery type, was categorized into: minor laparoscopic, major laparoscopic, and laparotomy. Results: Univariate analyses revealed that mean distress levels between minor laparoscopic (x = 3.4), major laparoscopic (x = 4.2) and laparotomy (x = 3.8) did not differ (p&gt;.1), nor did expectations of pain or discomfort (p's&gt;.1). Demographic variables (age, race, education, marital status) did not show bivariate relationships with pre-surgical distress or expectations and therefore were not controlled for in the models. Conclusions: Based on the present results, the benefits of laparoscopic gynecologic surgery do not appear to affect patients’ levels of pretreatment distress or expectations of negative outcomes. The results suggest that women undergoing even minor gynecologic surgery may benefit from interventions to reduce preoperative distress, which has been shown to be a risk factor for increased postoperative side effects. No significant financial relationships to disclose.

Psychosocial factors in heart surgery: Presurgical vulnerability and postsurgical recovery.

Distress and low perceived social support were examined as indicators of psychosocial vulnerability in patients about to undergo heart surgery. A total of 550 study patients underwent heart surgeries, including bypass grafting and valve procedures. Psychosocial interviews were conducted about five days before surgery, and biomedical data were obtained from hospital records. Sociodemographic, personality, religious, and biomedical factors were evaluated as predictors of psychosocial vulnerability, and all five sets of variables were evaluated as contributors to hospital length of stay (LOS). Patients scoring higher on one or more indicator of presurgical psychosocial vulnerability were younger, more likely to be female, less likely to be married, less well educated, lower in dispositional optimism, higher in trait anger, and lower in religiousness. Older age, depression, low support, and low trait anger each showed an independent, prospective association with greater LOS, and several other predictors had prospective relationships with LOS that were statistically mediated by depression or perceived support. Evidence that multiple psychosocial factors may influence adaptation to heart surgery has implications for understanding and ameliorating presurgical distress and for improving postsurgical recovery.

Hypnosis Decreases Presurgical Distress in Excisional Breast Biopsy Patients

Excisional breast biopsy is associated with presurgical psychological distress. Such distress is emotionally taxing, and may have negative implications for postsurgical side effects and satisfaction with anesthesia. We investigated the ability of a brief hypnosis session to reduce presurgical psychological distress in excisional breast biopsy patients. Ninety patients presenting for excisional breast biopsy were randomly assigned to receive either a 15-minute presurgery hypnosis session (n = 49, mean age: 46.4 (95% CI: 42.3-50.4)) or a 15-minute presurgery attention control session (n = 41, mean age: 45.0 (95% CI: 40.8-49.2)). The hypnosis session involved suggestions for increased relaxation and decreased distress. The attention control session involved nondirective empathic listening. Presurgery distress was measured using visual analog scales (VAS) and the short version of the Profile of Mood States (SV-POMS). Data were analyzed using analysis of variance and chi2 procedures. Groups did not differ in terms of the following: demographics (age, education, ethnicity, marital status, all P's > 0.28); medical variables (presurgery diagnosis, previous excisional biopsy, previous breast cancer, all P's > 0.11); or preintervention distress (SV-POMS P > 0.74) assessed on the day of surgery. Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS emotional upset (16.5 vs 38.2, P < 0.0001, d = .85), VAS depressed mood (6.6 vs 19.9, P < 0.02, d = .67), and SV-POMS anxiety (10.0 vs 5.0, P < 0.0001, d = 0.85); and significantly higher levels for VAS relaxation (75.7 vs 54.2, P < 0.001, d = -0.76) than attention controls. The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical distress in women awaiting diagnostic breast cancer surgery.

Predictors of expectancies for post-surgical pain and fatigue in breast cancer surgical patients

Expectancies for post-surgical pain and fatigue have previously been found to predict pain and fatigue among breast cancer surgery patients. However, the study of predictors of these expectancies has been neglected. The present study was designed to investigate predictors of expectancies for post-surgical pain and fatigue among breast cancer surgery patients. Four hundred and eighteen women ( M = 48.3 years, SD = 13.66 years) scheduled to undergo excisional breast biopsy or lumpectomy completed questionnaires assessing demographics/medical history, pre-surgical distress, stable personality characteristics, pre-surgical pain and fatigue, and expectancies for post-surgical pain and fatigue. Path analysis revealed: expectancies for post-surgical pain were significantly predicted by trait anxiety, acute pre-surgical distress, and age; and expectancies for post-surgical fatigue were significantly predicted by acute pre-surgical distress, acute pre-surgical fatigue, previous experience with the same surgical procedure, and education (all ps < .05). Examination of an alternative model revealed that the effects of the aforementioned predictors on expectancies were not mediated by acute pre-surgical distress, clarifying the directionality of the distress–expectancy relationship. Expectancies for post-surgical pain and fatigue are influenced by distress, treatment history, stable personality characteristics, extant symptoms, and demographic factors. These variables should be considered in designing clinical interventions to manipulate expectancies for patient benefit.

Sources of anticipatory distress among breast surgery patients.

Surgical consultation concerning the possibility of breast cancer is a distressing experience, and having to take the next step of breast surgery even more so for many women. However, the sources of variability in such presurgical distress are not well understood. Sixty-one women (mean age = 51) were recruited immediately following surgical consultation in which a recommendation of breast surgery (excisional biopsy/lumpectomy) was made. Patients completed measures of distress, worry about cancer and surgery, trait anxiety, optimism and pessimism prior to surgery. Surprisingly, results revealed no effect of surgeon-provided information concerning preliminary diagnosis on patient distress. Rather, worry about what the surgeon might find concerning the breast mass during surgery, worry about having to go through the operative procedures, and patient optimism were the only factors that uniquely contributed to patient distress (p's < 0.05). This study provides a foundation for future clinical interventions to reduce presurgery distress.

A prospective study of psychological predictors of lumbar surgery outcome.

Prospective design in which 102 patients were evaluated with a battery of psychological assessment tests 1-2 weeks before surgery, and outcome was assessed 6 months and 1 year after surgery. The study examined whether three aspects of psychological distress (depression, anxiety, and hostility) predict several surgical outcomes (employment status, subjective pain change ratings, and changes in functional abilities). Surgery for back pain has been shown to yield poor results in 15-45% of patients. Tools are needed to identify those "at risk" for poor outcome. Aspects of emotional distress, including anxiety, depression, and hostility, have been found to be relevant to various illness outcomes (e.g., cancer, heart disease), but their influence has not been prospectively evaluated for back pain surgical outcome. Study patients completed measures of distress before surgery, including the Spielberger Trait Anxiety Inventory, Zung Depression Scale, Modified Somatic Perception Questionnaire, and Cook-Medley Hostility Scale. At 1-year follow-up, patients completed pain change ratings, functional abilities measure (Dallas Pain Questionnaire), and questions about employment status. Multivariate regression analyses, controlling for significant demographic variables, found that failure to return to work was predicted by presurgical anxiety (P < 0.001) and depression (P < 0. 01); failure to report improvement in pain was predicted by presurgical somatic anxiety (P < 0.01) and depression (P < 0.058); and failure to report improved functional abilities was predicted by presurgical somatic anxiety (P < 0.01) and depression (P < 0.05). Hostility did not predict any outcome. Regression analyses found a strong predictor to be a combination of the Zung Depression Scale and Modified Somatic Perception Questionnaire, known as the Distress and Risk Assessment Method (DRAM). These results indicate that screening for presurgical distress is likely to identify those patients at risk for poor outcome. Studies to evaluate whether presurgical psychological treatment improves outcome are warranted.