Psychological experiences and needs of cardiac patients: Systematic review of angioplasty patients and qualitative study of practitioners understanding in cardiac rehabilitation.

Abstract

Paper One, presents a synthesis of the literature on patients psychological experiences following primary or coronary angioplasty. A mixed-method convergent design was utilised. 14 qualitative and 14 quantitative studies were included. Thematic synthesis of the qualitative studies identified five main analytical themes: (1) surprise at the sudden effects of treatment (2) repetitive negative thinking, (3) uncertainty and lack of understanding, (4) coping strategies, and (5) re-appraisal of life. Patients experiences comprised of persistent and difficult to control negative thinking, uncertainty and use of coping strategies that could be interpreted as maladaptive. The quantitative narrative synthesis indicated that patients experience anxiety and depression after angioplasty. These findings were explained from the perspective of the Metacognitive Model (Wells & Matthews, 1994, 1996; Wells, 2009; 2019). The value of applying psychological theory to develop understanding in this area was discussed, as well as clinical implications. Paper Two presents an empirical study of CR practitioners views on CR patients psychological needs, which consists of two interrelated qualitative interview studies. Study One included pre-collected interviews from six CR practitioners. Four main themes were developed through thematic analysis: (1) staffs awareness of mental health problems faced, (2) CR patients needs, (3) staffs self-efficacy to support patients psychological needs and (4) current psychological provision in CR. For Study Two, eleven CR practitioners were interviewed using member checking principles. The findings indicated the themes, and most subthemes, from Study One were transferable to a wider range of CR practitioners. Practitioners described patients experience a range of psychological concerns, including cardiac and non-cardiac worries. Although most practitioners delivered relaxation and stress management techniques, some practitioners felt the techniques were not effective in addressing patients concerns. Practitioners had varying confidence levels when discussing and supporting patients psychological needs but felt psychological support would be well placed in CR and expressed a need for training. As evidence-based psychological interventions that target a range of psychological concerns are not routinely available in CR, practitioners may benefit from being trained in a transdiagnostic process-focused therapy, such as Metacognitive Therapy, to support patients in addressing psychological concerns. Paper Three critically evaluates Papers One and Two and provides further detail regarding key decisions, the strengths and limitations of the research, ethical considerations, and clinical implications, as well as the researchers personal reflections.

Date of Award	17 Oct 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Adrian Wells (Main Supervisor) & Lora Capobianco (Co Supervisor)