Patients' pre- and postoperative expectations as predictors of clinical outcomes six months after cardiac surgery.

The aim of this study was to investigate not only preoperative expectations (as shown previously), but also postoperative expectations of patients predict clinical outcomes six months after cardiac surgery. Furthermore, the study sought to examine illness behavior as a possible pathway through which expectations may affect postoperative well-being. Seventy patients scheduled for cardiac surgery were examined one day before surgery, ~7-10 days after surgery, and six months after surgery. Regression analyses indicated that disability at follow-up (primary outcome) was significantly predicted by postoperative (ß = -.342, p = .008), but not by preoperative expectations (ß = -.213, p = .069). Similar results were found for the secondary outcomes, i.e. quality of life and depressive symptoms. A bootstrapped mediation analysis showed that although both postoperative expectations and illness behavior had significant unique effects on disability, there was no significant mediation effect. While previous studies have mainly focused on patients' preoperative expectations, the present is the first to emphasize the predictive value of patients' expectations a few days after surgery, pointing to the potential of interventions targeting postoperative expectations. However, given the non-significant results of the mediation analysis, it remains unclear how exactly patients' expectations affect clinical outcomes in cardiac surgery.

Hope in Medicine: Applying Multidisciplinary Insights.

Hope is a crucial aspect of human life and has been a topic of interest in many scholarly disciplines. The medical literature, however, has-with a few exceptions-failed to take account of conceptions of hope across other scholarly disciplines. Before exploring what makes hope a distinctive and important phenomenon in medical contexts, this article reviews prominent views on hope from philosophy, anthropology, theology, and psychology. To synthesize these different conceptions, the authors propose an integrative approach aimed at improving the understanding of hope in medicine. The authors use a modes-of-hoping framework to explain different phenomena related to hope in medicine, such as hope in the face of a dismal prognosis, in the disclosure of diagnostic information, and in the initiation of new treatments. Based on this tentative framework, possible directions for future empirical research are discussed. Beside further qualitative research into the patients' and physicians' understanding and experiences of hope, the authors urge a quantitative examination of the impact of hope (while recognizing that a quantitative approach might not able to capture hope's many intricacies). Finally, they discuss clinical and ethical implications with respect to a balance between physicians being honest and acknowledging patients' hope.

Using Different Expectation Mechanisms to Optimize Treatment of Patients With Medical Conditions: A Systematic Review.

OBJECTIVE: Patients' expectations have been shown to predict the course and treatment success of a variety of medical conditions. Therefore, expectation-focused psychological interventions (EFPIs) have been developed to use these expectation effects clinically. Importantly, EFPI differ with regard to the particular expectation mechanism being addressed, i.e., expectation optimization or expectation violation. The aims of this systematic review were to give an overview of the application of these expectation interventions and to evaluate their effectiveness. METHODS: Several databases were searched to identify clinical trials or experimental studies that conducted EFPI among participants with various medical conditions. Risk of bias was evaluated using the Cochrane Risk of Bias tool. RESULTS: Eleven studies (N = 944) investigating different medical conditions (coronary heart disease, cancer, chronic pain) were included. Qualitative synthesis revealed positive effects of EFPI on clinical outcome variables in all studies. Expectation optimization approaches yielded particularly promising results. Because of the large heterogeneity of outcome measures, quantitative synthesis was not possible. CONCLUSION: This review highlights the potential of EFPI for optimizing treatment of patients with medical conditions. However, it seems that different expectation mechanisms might have different application possibilities. Therefore, we provide suggestions for further developing EFPI to tailor treatment and develop personalized psychological interventions. We argue that for this purpose, it is important to consider both disease-specific aspects and patients' personality traits. In addition, we discuss future challenges such as implementing EFPI into routine medical care.