The objective of this review was to summarise the best available research evidence related to the effectiveness of pre-intervention educational methods for adult patients undergoing a cardiac intervention. The review will focus on educational methods aimed at reducing pain, anxiety, length of stay and improving knowledge retention.
Type of participants
Adult hospital patients who were scheduled to undergo a cardiac intervention.
Type of interventions
Educational methods provided to patients prior to the cardiac intervention. Education methods included:
- Audio-visual (video)
- Information pamphlets
- Telephone intervention
- Pre-admission teaching session
- Verbal education by a nurse post admission
- Combination of methods and
- Timing of education delivery - pre or post admission
Type of outcomes measures included
Anxiety, pain, length of stay and/or knowledge retention.
Type of studies
Randomised controlled trials (RCT).
Where RCTs could not be identified the results of uncontrolled clinical trials and descriptive studies were incorporated into the results in a narrative form. Studies were excluded from the review if they were of poor methodological quality or the description of the participants, intervention, outcome measure or the research methods were inadequately reported.
The search sought to identify published and unpublished studies. The databases searched included MEDLINE, CINAHL, The York Database of Abstracts of Reviews of Effectiveness (DARE), The Cochrane Library, Current Contents, Centre for Reviews and Dissemination (CRD), Health Star, Expanded Academic Index and EMBASE. Databases searched for unpublished studies included Dissertation Abstracts International Database and Proceedings First Database. Key journals and cardiac conference proceedings were also searched by hand. The reference lists and/or bibliographies of all retrieved articles were checked for additional studies.
Assessment of quality
All identified studies that met the inclusion criteria were evaluated for methodological quality prior to inclusion in the review using a ‘data collection tool’ developed by the author based on tools of The Joanna Briggs Institute.
Data was extracted from study reports using a ‘data collection tool’ developed by the author based on tools of The Joanna Briggs Institute.
Studies were summarised using both tabular and narrative summaries. Due to the lack of homogeneity between the study outcomes no meta-analysis could be completed. When appropriate, the findings from individual studies were detailed in graph format. For continuous data that used the same scale, weighted mean difference (WMD) and 95% confidence interval (CI) was used as a summary measure.2
The literature search identified 29 articles that appeared to meet the initial inclusion criteria. However, only 5 studies met the review inclusion criteria. The included studies comprised of two RCTs and three randomised quasi-experimental studies. The included studies addressed comparisons in relation to different educational delivery methods and/or the timing of the educational delivery (pre-admission teaching times versus post-admission teaching times). Studies were then examined according to specific outcome measures: post intervention pain, anxiety, length of stay and/or knowledge retention.
- Study one by Mott demonstrated there was no statistically significant difference in pre-cardiac catheterisation mean anxiety levels when a comparison of verbal education, video or a combination of video and verbal was made.1
- Study two by Lamarche, Taddeo & Pepler initially identified a statistically significant difference in anxiety level on admission (p=0.02) in those patients who had received an educational telephone call in addition to a pre-admission teaching session when compared to those who had not. However, once data was entered as covariates by the authors (anxiety level at teaching time and length of waiting time before admission) in MANOVA statistical significance was not demonstrated (p = 0.14).2 There was no statistical significance in mean discharge anxiety scores between groups.
- Study two also demonstrated a statistically significant increased perceived knowledge level on admission in the group who had not received the telephone call when compared to the group that had (p = 0.002).2 There was no statistically significant difference in perceived knowledge between groups at discharge.
- Study three by Christopherson & Pfeiffer identified that there was no statistically significant difference in pre coronary artery vein graft (CAVG) mean anxiety levels with the provision of information pamphlets (3–35 days prior to CAVG) when compared to a group who were yet to receive the information pamphlet.3 Seven to ten days post CAVG all patients had received the information pamphlet and again there was no statistically significant difference between the groups.
- Study three also identified that there was no statistically significant difference in knowledge level in either groups when tested at 7–10 days post CAVG.3
- Study four by Cupples identified that there was a statistically significant lower mean anxiety score prior to CAVG when the timing of the educational delivery was provided prior to admission (5–14 days) when compared to the post-admission control group.4 However, the control group's anxiety level was measured closer to the cardiac intervention. There was no statistically significance difference in mean anxiety scores between groups day 4 post CAVG.4
- Study four also found a statistically significant (p<0.001) difference in knowledge scores (higher) in the experimental group ie: those patients who received specifically designed education (5–14 days) pre-admission compared to the routine general post-admission pre-CAVG education.4 The knowledge levels were also not measured at the same time in relation to the cardiac intervention.
- Study five by Rice, Mullin & Jarosz identified that there was no statistically significant difference in the quantity of analgesia administered immediately post CAVG and until day 3 between the group who received pre-admission education compared to the group who received post admission education.5
- Study five also recognised that there was no statistically significant reduction in length of stay between groups.5
Two RCTs and three randomised quasi-experimental studies were identified that evaluated the impact of education methods for patients prior to cardiac interventions. The study by Mott (1999) compared the use of verbal education, video and a combination of both.1 The second study by Lamarche et al compared the provision of a pre-admission teaching session with an additional telephone call prior to the cardiac intervention.2 Neither study demonstrated a statistically significant impact on anxiety levels. In the Lamarche et al study however, a statistically significant difference in perceived knowledge was demonstrated between groups.2 The group who did not receive a telephone call prior to admission had higher perceived knowledge scores. The participants who received the telephone intervention prior to admission did not demonstrate any statistically significant reduction in anxiety levels when tested on admission and again at discharge.
When the timing of the educational delivery was compared (pre-admission versus post-admission) the research by Cupples (1991) identified a statistically significant difference in state anxiety scores (p=0.02), however it must be noted that proximity to the time of the intervention may have had an impact.4 This study also showed a statistically significant difference in knowledge scores for a group that received pre-admission education compared to those receiving education on admission. No included studies had demonstrated improved outcomes for the patient post cardiac intervention when post-intervention pain or length of stay was considered.
The main outcomes of this review are the recognition that there are very few studies specific to this area of practice. The only studies identified must be viewed with caution, as the participant numbers are small.
Although many education methods are being used only a small number are being studied.