Waiting for coronary artery bypass surgery: a qualitative analysis

Waiting lists for coronary artery bypass surgery (CABS) are common in many developed countries. Yet, there is limited information available regarding patients' health care needs at this time. This paper reports on a prospecti ve study which aimed to investigate the experience of waiting for CABS from a qualitative perspective. An inductive research approach was used to cond uct interviews with 70 randomly selected patients at three intervals over t he first year on the waiting list - referral for surgery, again after waiti ng 6 months (n = 49), and finally after waiting for 1 year (n = 28). Attrit ion was mainly caused by surgery having been performed (n = 36), although d eath (n = 4) and refusal to participate (n = 2) also contributed. Domicilli ary interviews were taped and transcribed verbatim. Thematic content analys is identified three central themes in this experience - uncertainty, chest pain and anxiety; with six secondary themes - powerless, dissatisfaction wi th treatment, anger/frustration, physical incapacity, reduced self-esteem, and altered family and social relationships. The nature and meaning inheren t in each theme is described using interview quotations, and a model is pro posed which summarizes this data and the relationship between themes. From this analysis, uncertainty, chest pain and anxiety emerge as important indi cators of a negative outcome for these patients. This report strongly sugge sts that patients awaiting bypass surgery require more information regardin g the waiting time for such a surgery. Nurses should also offer advice rega rding pain management to help improve patients' skills and decrease the fea r associated with angina. Nursing intervention and support should also be d irected at reducing patients' anxiety levels. This is the first known quali tative study which specifically examines patients' perception of the waitin g period prior to bypass surgery. It may therefore provide new evidence on which to base practice for nurses in both hospital and community, and may a lso stimulate further research in this area.