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This randomized controlled trial will evaluate the effectiveness of artificial intelligence-supported individualized discharge education for patients undergoing coronary artery bypass graft (CABG) surgery. Participants will be assigned to either the intervention group, which will receive personalized AI-generated discharge education delivered through a nurse-avatar video in addition to standard verbal education, or the control group, which will receive standard discharge education only. The study will compare postoperative pain, anxiety, physiological stress response, recovery, and satisfaction with discharge education between the two groups. Outcomes will be measured during hospitalization and at the routine postoperative follow-up visit. The findings may help improve patient education methods and postoperative recovery in cardiac surgery patients.
Coronary artery bypass graft (CABG) surgery is a major cardiac procedure that requires structured discharge education to support patients' physical, psychological, and behavioral recovery after hospitalization. Traditional discharge teaching provided by nurses is often limited by time constraints, varying patient needs, and inconsistent information delivery. Recent advances in artificial intelligence (AI) offer new opportunities to provide individualized, understandable, and repetitive patient education that may enhance postoperative recovery.
This randomized controlled trial aims to evaluate the effectiveness of AI-supported individualized discharge education for patients undergoing CABG surgery. The intervention consists of a personalized discharge education script generated by an advanced large-language-model system (ChatGPT), structured according to 6 main topics and 24 sub-domains, and then converted into a nurse-avatar video. Patients in the intervention group will receive this AI-supported education in addition to the standard verbal discharge education provided by cardiovascular surgery nurses. Patients in the control group will receive only the standard discharge education based on current hospital protocols.
The study will assess multiple postoperative outcomes, including pain intensity, anxiety levels, physiological stress response (cortisol, adrenaline, noradrenaline, ACTH, glucose, and insulin), recovery after discharge using a validated surgical recovery scale, and satisfaction with discharge education. Measurements will be collected at four time points: the day before discharge, the morning of discharge before education, immediately after the completion of discharge education, and at the routine postoperative follow-up visit.
A total of 128 participants will be randomized into two groups using block randomization stratified by sex. All data will be collected using validated scales and standardized laboratory procedures. This study is expected to provide evidence on whether AI-supported discharge education can improve postoperative recovery, reduce stress and anxiety, and increase satisfaction among CABG patients. The results may contribute to the development of innovative, technology-enhanced education models for surgical patients and support the integration of AI tools into nursing practice.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| AI-Supported Discharge Education | Experimental | Participants in this arm will receive individualized discharge education generated by an artificial intelligence system (ChatGPT) and delivered through a nurse-avatar video. This education covers 6 main topics and 24 subcomponents tailored to the patient's clinical, social, and psychosocial characteristics. Participants will also receive the standard verbal discharge education routinely provided by cardiovascular surgery nurses. |
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| Standard Discharge Education | Active Comparator | Participants in this arm will receive only the standard verbal discharge education routinely provided by cardiovascular surgery nurses, based on hospital discharge protocols. No AI-generated or video-based educational materials will be used in this group. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| AI-Supported Individualized Discharge Education | Behavioral | This intervention consists of personalized discharge education generated by an advanced artificial intelligence system (ChatGPT) based on the patient's clinical, social, and psychosocial characteristics. The content is structured into 6 main topics and 24 sub-sections. The script is converted into a nurse-avatar video and delivered to the patient via a mobile device. This intervention is provided in addition to the standard verbal discharge education routinely given by cardiovascular surgery nurses. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Intensity | Anxiety will be measured using a 10-cm Visual Analog Scale (VAS). Participants will indicate their perceived level of anxiety on a horizontal line ranging from 0 to 10, where 0 represents "no anxiety" and 10 represents "the highest possible level of anxiety." The score is obtained by measuring the distance in centimeters from the left end of the scale to the participant's mark, producing a continuous value between 0 and 10. Higher scores indicate higher levels of anxiety. This measure allows for sensitive detection of changes in anxiety over time. No threshold or categorical classification is used; all results are reported as continuous VAS scores. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
| Anxiety Level | Anxiety will be assessed using the Visual Analog Scale (VAS). The scale ranges from 0 to 10, where higher scores indicate greater anxiety levels. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
| Serum Cortisol Level | Physiological stress will be evaluated by measuring serum cortisol levels obtained from venous blood samples. Higher cortisol levels indicate increased physiological stress response. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
| Postoperative Recovery | Postoperative recovery will be evaluated using a validated postoperative recovery scale assessing physical, emotional, and functional recovery. Higher scores indicate better postoperative recovery. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
| Satisfaction with Discharge Education |
| Measure | Description | Time Frame |
|---|---|---|
| Heart Rate | Heart rate will be measured using a clinical monitor and recorded in beats per minute (bpm). Higher values indicate increased cardiac activity. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Uğur Akman, RN, MSc | Contact | +905428155049 | ugurkman@gmail.com |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Ronaldson S., et al. (2022). Patient-centered education in postoperative cardiac care: A systematic review. Heart & Lung, 55, 54-62. | ||
| Background | Akbari M., Çelik S. (2015). Effects of nurse-led discharge training on anxiety and recovery in surgical patients. Journal of Perioperative Nursing, 28(4), 215-223. | ||
| Background | Minami K., et al. (2020). Effects of discharge education on postoperative recovery in cardiac surgery patients. European Journal of Cardiovascular Nursing, 19(7), 660-668. | ||
| Background | Hwang B., et al. (2023). Artificial intelligence in patient education: A scoping review. Patient Education and Counseling, 112, 107-115. | ||
| 20435785 |
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| ID | Term |
|---|---|
| D003324 | Coronary Artery Disease |
| D001008 | Anxiety Disorders |
| D010146 | Pain |
| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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Participants will be randomly assigned to one of two parallel groups. The intervention group will receive AI-supported individualized discharge education delivered through a nurse-avatar video in addition to standard verbal education. The control group will receive standard discharge education only. Each participant will remain in the group to which they were originally assigned throughout the study.
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No masking was used. This is an open-label trial, and no parties were blinded to group assignment.
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| Standard Discharge Education | Behavioral | This intervention consists of routine verbal discharge education provided by cardiovascular surgery nurses according to standard hospital protocols. It includes essential postoperative instructions, medication guidance, wound care instructions, activity recommendations, and follow-up information. No AI-generated or video-based educational materials are provided in this intervention. |
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Satisfaction with discharge education will be measured using a validated satisfaction scale assessing patients' satisfaction with the information received before discharge. Higher scores indicate greater satisfaction.
| Pre-discharge (within 24 hours before discharge) and 4 weeks (±3 days) post-discharge |
| Blood Pressure - Systolic | Systolic blood pressure will be measured using a calibrated clinical blood pressure monitor and recorded in mmHg. Higher values indicate higher arterial pressure during cardiac contraction. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
| Blood Pressure - Diastolic | Diastolic blood pressure will be measured using a calibrated clinical blood pressure monitor and recorded in mmHg. Higher values indicate arterial pressure during cardiac relaxation. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
| Respiratory Rate | Respiratory rate will be measured by counting the number of chest rises over one minute and recorded as breaths per minute (breaths/min). Higher values indicate increased respiratory effort or possible respiratory distress. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
| Oxygen Saturation (SpO₂) | Oxygen saturation will be measured using pulse oximetry and recorded as the percentage of oxygen-saturated hemoglobin in arterial blood. Lower values indicate impaired oxygenation. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
| Body Temperature | Body temperature will be measured using a digital thermometer and recorded in degrees Celsius (°C). Deviations from normal temperature may indicate infection or inflammatory response. | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge |
| Background |
| Fredericks S, Guruge S, Sidani S, Wan T. Postoperative patient education: a systematic review. Clin Nurs Res. 2010 May;19(2):144-64. doi: 10.1177/1054773810365994. |
| D001161 |
| Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
| D001523 | Mental Disorders |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |