Patient perspective: coping with preoperative anxiety in patients scheduled for coronary artery by-pass surgery. A mixed-methods study.

Background: Despite substantial literature that addresses preoperative anxiety, identifying effective anxiety-management interventions is still recommended. Identifying factors related to preoperative anxiety is essential for intervention planning. Aim: To explore patient-reported factors contributing to decreased anxiety among patients scheduled for coronary artery by-pass grafting (CABG). Methods: This mixed-methods observational study involved 75 patients aged 40-83 (70.7% men; mean age 65.4±9.41). Qualitative analysis involved 25 randomly selected patients (focus group) and asked to specify factors they believed were helpful in reducing their anxiety. Visual Analogue Scale (VAS-Anxiety) was used at the moment of diagnosis and decision making (Time1, retrospectively), and on the day preceding CABG (Time2). Focus group responses were explored with the use of Interpretative Phenomenological Analysis (IPA). The Pearson’s chi - squared and the Mann-Whitney-U tests were calculated to explore differences between the study groups. Significance level α≤0.05 was used in all analyses. Results: VAS-Anxiety scores reduced from 5 points at Time1 to 3 points at Time 2 (p<0.01). Fifty patients (66.7%) reported decreased anxiety between Time1 and Time2, 21 (28%) reported a stable level and 4 (5.3%) reported an increase. Employment status was the only significant factor differentiating “relief’ and “no relief” groups among socio-demographic and clinical variables. IPA yielded five main themes: conversations with health care providers, perceived inevitability of surgery, family support, other patients’ experience, and religion/faith. Conclusions: Individual patient-centered interview in conjunction with emotional support are vital for managing preoperative anxiety. Providing contact with family members and paying attention to spiritual needs are also important.