A thesis submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in fulfilment of the requirements for the
degree of
Doctor of Philosophy
Johannesburg, 1998 / Coronary heart disease (CHD) is the most common cause of death in the
western world (Roberts, 1992). A high incidence of CHD is also reported for
the White and the Asian population of South Africa (Wyndham, 1979).
Coronary artery bypass graft (CABG) SL ~..;ry continues to be a proven,
effective therapy to relieve symptoms of angina, to improve the patient's
quality of life and to prolong life in selected patients (Connolly and Guyton,
1992). This intervention is costly and the operative success of coronary
revascularization is limited unless the patient understands and will adhere to
the prescribed medical regimen, diet and exercise after surgery (Marshall et
al, 1986). The problem is compounded as post-operatively, the symptoms of
coronary artery disease are ameliorated and the patient may be unaware of
the persistence of the disease process. In additlon, the World Health
Organisation's definition of cardiac rehabilitation, puts (olward the concept
that the patient must accept responsibility for his or her own recovery
(Oldridge, 1986). The role that the patient plays post-operatively must
therefore become important in the final outcome. In 1977 Ginzberg wrote: "No
improvement in the health care system will be efficacious unless the citizen
assumes responsibility k~ his/her own well-being", This statement implies
that people must take charge of their own health and not abrogate this
responsibility to the experts.
This study was designed to determine whether the acceptance of selfresponsibility
is all important determinant of the successful outcome of
corollary artery bypass graft (CABG) surgery. The final study was preceded
by five pilot studies to assist in formulating and identifying the concept of selfresponsibility.
Questionnaires were designed to determine aspects of
improved quality of life and self-responsibility. For the final study. 75 patients
who had undergone CABG surgery, were selected from surgical patients in
the private as well as the public sector. In order to assess the acceptance of
self-responsibility, the spouses/care-givers of the patients were included in
this study. Patients were interviewed 4 to 6 days after the operation, and
again six months and 12 months later. Successful outcome was measured in
terms of improved quality of life using the criteria suggested by the Coronary
Artery Surgery Study (Coronary Artery Surgical Study Principal Investigators,
1983). Tine acceptance of self-responsibility was then investigated as a
possible factor influencing the improvement of the quality of life of these
patients ..
It was found that the acceptance of self-responsibility for the successful
outcome of CABG surgery was a significant factor in the group of patients
with an improved quality of life (p<0.01). From the results of this study, a
profile of South African patients with improved quality of life was identified.
They are: Men, married, annual income> R50 000 (US $8 000), who had a
normal sex-life prior to the operation. They differ significantly from the group
without an improved quality of life in the following aspects: they had spent
more hours participatinp in sport at school (p=0.04), had stopped their
sporting activities for a shorter period of time prior to the operation (p<0.01)
and were taller (p<O.01). They were not depressed 12 months after the
operation (p<0.01).
Patients who accept self-responsibility for their recovery after CABG surgery
have the following characteristics: married (p<0.01), have a level of
education> grade 12 (p=O.01), have an annual income: R50 000 (p=O.05).
They differ from the group who are not responsible in that they and their
spouses/care-givers have more knowledge about the disease and the risk
factor modification (p=O.01; p<O.01), and twelve months after the operation
the patients are satisfied with the outcome of the operation (p<0.01).
A stepwise logistic regression established that the acceptance of selfresponsibility
was the strongest predictive fsctor for an improved quality of
life after CABG surqe.,: Patients who did not accept responsibility would not
have an improved quality of life irrespective of the impact of all other
parameters.
Patients' satisfaction with the outcome of the operative procedure is an
important predictor of the acceptance of self-responsibility. Realistic
expectations of the outcome of CABG surgery will improve pati-mts'
satisfaction with the outcome ..The knowledge of the spouse is a significant
factor in the patients' acceptance of self-responsibility. The spouse of a
patient is frequently neglected by health- care workers and yet this person is
very important for the patient's successful lifestyle change. Knowledge of the
chronic nature of their disease as well as risk factor modification and realistic
expectations of the outcome of CABG surgery influences patients'
acceptance of self-responsibility. Every effort should be made to assist
patients in accepting the responsibility for their own recovery so that the
outcome of CABG will be successful. / MT2017
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/22169 |
| Date | January 1998 |
| Creators | Eales, Cecelia Johanna |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | Online resource (334 leaves), application/pdf, application/pdf |
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