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| Name | Class |
|---|---|
| Kingston Health Sciences Centre | OTHER |
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Coronary artery bypass graft (CABG) surgery is performed more frequently on individuals who are older and sicker than in previous years. Increased patient acuity and reduced hospital length of stays leave individuals ill prepared for their recovery following discharge. Individuals experience pain, functional impairment and depressive symptoms following discharge, which persist for 8 weeks in 50% of individuals. Unrelieved pain, functional decline and depressive symptoms predispose individuals to adverse events, impaired health-related quality of life (HRQOL), and increased morbidity and mortality.
Existing supports; including printed education materials, community care resources, cardiac rehabilitation programs and nurse-initiated telephone follow-up, fail to address concerns of individuals in this early period following hospital discharge.
Despite the positive health outcomes in other patient populations, valid studies examining the impact of telephone-based peer support to men and women after hospital discharge from CABG surgery were not found. It is anticipated that a home-based peer support program, delivered by telephone, will improve recovery and enhance HRQOL for individuals in the early weeks post hospital discharge from CABG surgery.
Coronary artery bypass graft (CABG) surgery is performed more frequently on individuals who are older and sicker than in previous years. This, combined with reduced hospital length of stays, leaves individuals ill prepared for their recovery after discharge. Individuals experience pain, functional impairment and depressive symptoms; which predispose them to adverse events and impaired health-related quality of life (HRQOL). A home-based peer support program may improve recovery outcomes for individuals following CABG surgery.
The objectives of this pilot trial were to test the feasibility of all procedures, specifically to determine: 1) an estimate of patient and peer recruitment rates, 2) peer compliance and dose of the intervention, 3) peer satisfaction with orientation, 4) peer support activities offered to patients, and 5) patients' satisfaction with peer support. Additionally, exploratory research questions were used to determine indicators of the effects of peer support on HRQOL, pain, pain-related interference with activities, function, depressive symptoms, and enrolment in cardiac rehabilitation. An 8-week pre-post test RCT design enrolled men and women undergoing CABG surgery at a single site in Southeastern Ontario. Patients were randomized to either a usual care or an intervention group. Patients allocated to usual care received preoperative/postoperative education sessions, a preoperative video/information booklet, and preoperative/postoperative visits from in-hospital peer volunteers. In addition to usual care, patients in the intervention group received individualized education and support via telephone for 8 weeks following hospital discharge from trained peer volunteers.
Peer volunteers participated in a 4-hour orientation session. Ninety-three percent of the peers felt adequately prepared for their peer volunteer role and 98% of them initiated calls within 72 hours of the patient's discharge. Peers made an average of 12 calls, less than 30 minutes in duration, to each patient over the 8-week period. Most common support activities provided by the peers included listening to patient concerns, promoting activities, reinforcing rest periods and encouraging achievements. Patients were satisfied with their peer support experience. The intervention group reported improved physical function, role function, less pain and improved cardiac rehabilitation enrolment.
The evidence obtained from this pilot trial suggests that a home-based peer support intervention is feasible following CABG surgery. The information will be used to plan a larger multi-centre trial.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Peer Support | Other |
| Measure | Description | Time Frame |
|---|---|---|
| Health-related Quality of Life (SF-36v2-acute Form) | The SF-36v2 yields a score for each domain of health. All domains are scored on a scale from 0 (negative health) to 100 (positive health), with 100 representing the best possible health state. | 9 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Pain (McGill Pain Questionnaire-Short Form) | 9 weeks | |
| Interference With Activities (Brief Pain Inventory-Interference Subscale) | 9 weeks | |
| Function (Human Activity Profile) |
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Inclusion Criteria (patients): Men and women who
Inclusion Criteria (peers): Men and women who
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| Name | Affiliation | Role |
|---|---|---|
| Monica J. Parry, PhD | Faculty of Nursing, University of Toronto | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Toronto | Toronto | Ontario | M5T 1P8 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21719124 | Derived | Parry M, Arthur H, Brooks D, Groll D, Pavlov A. Measuring function in older adults with co-morbid illnesses who are undergoing coronary artery bypass graft (CABG) surgery. Arch Gerontol Geriatr. 2012 May-Jun;54(3):477-83. doi: 10.1016/j.archger.2011.04.013. Epub 2011 Jun 29. | |
| 19960132 | Derived | Parry MJ, Watt-Watson J, Hodnett E, Tranmer J, Dennis CL, Brooks D. Cardiac Home Education and Support Trial (CHEST): a pilot study. Can J Cardiol. 2009 Dec;25(12):e393-8. doi: 10.1016/s0828-282x(09)70531-8. |
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One hundred and one patients were randomized at hospital discharge to either usual care or peer support. Five patients who were recruited preoperatively did not meet the eligibility criteria postoperatively for randomization. Of the 20 peers recruited, 6 were unable to participate in one of the training sessions offered in April 2006.
Patients (n=106) were recruited between April-February 2007. Patients having elective coronary artery bypass graft surgery were recruited at the outpatient preadmission class; those having urgent/semi-urgent surgery were recruited in hospital. Peers (n=20) were recruited from the region of Southeastern Ontario during February-March 2006.
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| ID | Title | Description |
|---|---|---|
| FG000 | Usual Care | Patients allocated to usual care received the standard education/support offered to patients post coronary artery bypass graft surgery: preoperative/postoperative group education, preoperative video, general information booklet and preoperative/postoperative visits from in-hospital peer volunteers. |
| FG001 | Peer Support | In addition to usual care, patients randomly assigned to peer support received individualized pain management and exercise education via home-based peer support delivered by telephone. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Usual Care | Patients allocated to usual care received the standard education/support offered to patients post coronary artery bypass graft surgery: preoperative/postoperative group education, preoperative video, general information booklet and preoperative/postoperative visits from in-hospital peer volunteers. |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Health-related Quality of Life (SF-36v2-acute Form) | The SF-36v2 yields a score for each domain of health. All domains are scored on a scale from 0 (negative health) to 100 (positive health), with 100 representing the best possible health state. | Posted | Mean | Standard Deviation | units on a scale | 9 weeks |
|
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Monica Parry, RN, PhD, CCN(C) | University of Toronto | parrym@kgh.kari.net |
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| ID | Term |
|---|---|
| D003324 | Coronary Artery Disease |
| D010146 | Pain |
| D003863 | Depression |
| D003289 | Convalescence |
| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| 9 weeks |
| Depressive Symptoms (Center for Epidemiologic Studies Depression Scale) | 9 weeks |
| Peer Support |
In addition to usual care, patients randomly assigned to peer support received individualized pain management and exercise education via home-based peer support delivered by telephone. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Left Ventricular Function | Number | Participants |
|
| Marital Status | Number | participants |
|
| Health-Related Quality of Life (SF-36v2-Acute Form) | The SF-36v2 yields a score for each domain of health. All domains are scored on a scale from 0 (negative health) to 100 (positive health), with 100 representing the best possible health state. | Mean | Standard Deviation | units on a scale |
|
|
|
|
| Secondary | Pain (McGill Pain Questionnaire-Short Form) | Not Posted | Sep 2009 | Number | Participants | 9 weeks |
| Secondary | Interference With Activities (Brief Pain Inventory-Interference Subscale) | Not Posted | Sep 2009 | Number | participants | 9 weeks |
| Secondary | Function (Human Activity Profile) | Not Posted | Sep 2009 | Mean | Standard Deviation | participants | 9 weeks |
| Secondary | Depressive Symptoms (Center for Epidemiologic Studies Depression Scale) | Not Posted | Sep 2009 | Number | participants | 9 weeks |
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| D001161 |
| Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |