Using information to improve recovery

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DOCTOR–PATIENT COMMUNICATION
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THE WIDER ROLE OF INFORMATION IN ILLNESS
Information and recovery from surgery
Information may also be related to recovery and outcome following illness and surgery.
On the basis that the stress caused by surgery may be related to later recovery,
Janis (1958) interviewed patients before and after surgery to examine the effects of
pre-operative fear on post-operative recovery. Janis examined the differences between preoperative extreme fear, moderate fear and little or no fear on outcome. Extreme fear was
reflected in patients’ constant concern, anxiety and reports of vulnerability, moderate
fear was reflected in reality orientation with the individual seeking out information,
and little or no fear was reflected by a state of denial. The results were that moderate
pre-operative fear (i.e. a reality orientation and information seeking) was related to a
decrease in post-operative distress. Janis suggested that moderate fear results in the
individual developing a defence mechanism, developing coping strategies, seeking out
relevant information, and rehearsing the outcome of the surgery. This approach
may lead to increased confidence in the outcome, which is reflected in the decreased
post-operative distress. However, there is conflicting evidence regarding this ‘U’ shaped
relationship between anxiety and outcome (see Johnston and Vogele 1993).
Using information to improve recovery
If stress is related to recovery from surgery, then obviously information could be an
important way of reducing this stress. There are different types of information that could
be used to effect the outcome of recovery from a medical intervention. These have been
described as (1) sensory information, which can be used to help individuals deal with their
feelings or to reflect on these feelings; (2) procedural information, which enables individuals to learn how the process or the intervention will actually be done; (3) coping skills
information, which can educate the individual about possible coping strategies; and (4)
behavioural instructions, which teach the individual how to behave in terms of factors
such as coughing and relaxing.
Researchers have evaluated the relative roles of these different types of information
in promoting recovery and reducing distress. Johnson and Leventhal (1974) gave
sensory information (i.e. information about feelings) to patients before an endoscopic
examination and noted a reduction in the level of distress experienced by these patients.
Egbert et al. (1964) gave sensory information (i.e. about feelings), and coping skills
information (i.e. about what coping skills could be used), to patients in hospital undergoing abdominal surgery. They reported that sensory and coping information reduced the
need for pain killers and in addition reduced the hospital stay by three days. Young and
Humphrey (1985) gave information to patients going into hospital, and found that
information specific to how they could survive hospital reduced the distress and their
length of stay in the hospital. Research has also specifically examined the role of preoperative information. Johnston (1980) found that pre-operative information can influence recovery and reduce anxiety, pain rating, length of hospitalization and analgesic
intake. Further, in a detailed meta-analysis of the published and unpublished literature
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