Effect of Peer Support Intervention on Early Recovery Outcomes Post Coronary Artery Bypass Graft Surgery

The Effect of a Professionally-guided Telephone Peer Support Intervention on

Recovery from coronary artery bypass graft (CABG) surgery is a complex process involving physical recuperation and psychological adjustment. The high prevalence of postoperative depression in this population may threaten optimal recovery. Peer support over the recovery period has promise to mitigate this threat. The purpose of this study was to examine the effect of a professionally-guided telephone peer support intervention on recovery outcomes including depression, social support and health care resource utilization.

In a randomized controlled trial, 185 male CABG surgery patients randomly assigned to an intervention (n=61) or usual care (n=124) group. Participants in the intervention group received weekly telephone calls from a peer volunteer over 6 weeks post discharge. At hospital discharge and at 6 and 12 weeks follow up, depression was measured using the Beck Depression Scale-II, social support was measured using the Shortened Social Support Scale and health care resource utilization was measured using items in the Postoperative Self Report of Recovery Questionnaire. Participants in the intervention group were also asked questions about their perceptions regarding peer support using the Peer Support Evaluation Inventory.

Study Overview

• Status: Completed
• Conditions: Cardiovascular Disease
• Intervention / Treatment: Behavioral: Peer Support

• Study Type: Interventional
• Enrollment (Actual): 185
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Newmarket, Ontario, Canada, N2C6J5
      • Southlake Regional Health Centre
    • Sudbury, Ontario, Canada, P3E2C6
      • Sudbury Regional Hospital
    • Toronto, Ontario, Canada, M4G 1R7
      • Sunnybrook Health Sciences Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 36 years to 87 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• English speaking
• > 35 years of age
• undergoing first-time traditional (sternotomy approach) CABG surgery
• an uncomplicated postoperative course
• standard length of hospital stay (four to eight days)
• had a telephone in the home
• able to hear telephone conversation.

Exclusion Criteria:

• had cardiac surgery procedures other than CABG surgery
• resided in a nursing home or long term care facility
• had any neurological or psychiatric disorder that may have impeded ability to self reflect or communicate
• had emergent cardiac surgery
• had sustained in-hospital post surgical complications of major significance (i.e., stroke, GI bleed, cardiac tamponade, renal failure, cardiac arrest, major sepsis of any origin, deep sternal wound infection, myocardial infarction with significant hemodynamic compromise)

Study Plan

How is the study designed?

Design Details

• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Regular follow up care; No intervention group - received routine follow up care following discharge from hospital after cardiac surgery (no peer support intervention).
Active Comparator: Peer Support intervention; Support (informational, emotional and appraisal) in the form of like persons (i.e. age, gender) who have undergone CABG surgery with successful outcomes (post-recovery at least one year); peer support was provided by telephone for 6 weeks post cardiac surgery recovery.	Behavioral: Peer Support; Support (informational, emotional and appraisal) in the form of like persons (i.e. age, gender) who have undergone CABG surgery with successful outcomes (post-recovery at least one year); peer support was provided by telephone for 6 weeks post cardiac surgery recovery.; Other Names: Social Support

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post operative depression	A disorder of mood characterized by sadness and loss of interest in usually satisfying activities, a negative view of the self and hopelessness, passivity, indecisiveness, suicidal ideations, loss of appetite, weight loss, sleep disturbances, and other physical symptoms. Some or all of these symptoms may be present, and depression can be categorized as mild, moderate, or severe/major according to scores measured on the Beck Depression Inventory II (BDI-II) (Diagnostic and Statistical Manual of Mental Health Disorders - Fourth Edition) (DSM-IV criteria).	6 weeks
Post operative depression	A disorder of mood characterized by sadness and loss of interest in usually satisfying activities, a negative view of the self and hopelessness, passivity, indecisiveness, suicidal ideations, loss of appetite, weight loss, sleep disturbances, and other physical symptoms. Some or all of these symptoms may be present, and depression can be categorized as mild, moderate, or severe/major according to scores measured on the Beck Depression Inventory II (BDI-II) (Diagnostic and Statistical Manual of Mental Health Disorders - Fourth Edition) (DSM-IV criteria).	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceptions of recovery	Includes biophysical recovery, return to activity, and return to social roles; perceptions focused on the absence or resolution of physiological and/or psychosocial clinical symptoms. (Perceptions of recovery were measured by the Postoperative Self-Report of Recovery Questionnaire (PSRRQ) over 12-weeks post-discharge.	6 and 12 weeks
Perceptions of social support	Resources provided by others that can take the form of emotional support, instrumental aid, information, and positive feedback as to one's importance, capabilities or self worth. Social support was measured using the Shortened Social Support Scale (SSSS).	6 and 12 weeks
Health services utilization	The consumption of health services (emergency room visits, regularly scheduled and unscheduled family physician visits and readmission to hospital) to meet health care needs as defined by the patient or the health care professional. This was measured by the number of health care visits/readmissions to hospital over 12-weeks post-discharge using the Postoperative Self Report of Recovery (PSRRQ).	6 and 12 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceptions of peer support	Evaluation of the different aspects of peer support received (supportive interactions, relationship qualities, perceived benefits, satisfactions with support received) as measured by the Peer Support Evaluation Inventory (PSEI).	12 weeks

Collaborators and Investigators

• Sponsor: University of Calgary
• Collaborators: Heart and Stroke Foundation of Canada; Canadian Council of Cardiovascular Nurses
• Investigators: Principal Investigator: Kathryn King, PhD, University of Calgary

Publications and helpful links

General Publications

• Colella TJ, King KM. Peer support. An under-recognized resource in cardiac recovery. Eur J Cardiovasc Nurs. 2004 Sep;3(3):211-7. doi: 10.1016/j.ejcnurse.2004.04.001.

Study record dates

Study Major Dates

• Study Start: November 1, 2006
• Primary Completion (Actual): November 1, 2008
• Study Completion (Actual): November 1, 2009

Study Registration Dates

• First Submitted: December 29, 2012
• First Submitted That Met QC Criteria: January 23, 2013
• First Posted (Estimate): January 24, 2013

Study Record Updates

• Last Update Posted (Estimate): January 24, 2013
• Last Update Submitted That Met QC Criteria: January 23, 2013
• Last Verified: January 1, 2013

More Information

Terms related to this study

• Keywords: Depression, peer support, recovery, health services
• Additional Relevant MeSH Terms: Cardiovascular Diseases
• Other Study ID Numbers: 17897; UofC 17897 (Other Identifier: University of Calgary)