Changes in patients’ illness representations before and after elective percutaneous transluminal coronary angioplasty

Background
Elective percutaneous transluminal coronary angioplasty (PTCA) is an increasingly popular treatment for coronary heart disease, but little is known about individuals’ cognitive responses to this intervention. As part of adapting to living with chronic disease, individuals develop unique models, or illness representations, which enable them to “make sense” of their predicament. Inaccurate illness representations have a negative affect on patient behaviors and outcomes.
Objective
This purpose of this study was to examine changes in patients’ self-reported illness representations before and after first-time elective PTCA.
Methods
In this descriptive, repeated-measures design, illness representations were evaluated in 117 consecutive patients attending a pre-PTCA clinic using the Illness Perceptions Questionnaire. Data were collected pre- and 6 to 8 months post-elective PTCA.
Results
A typical participant was male (75%), of European ethnicity (90%), and aged 62 years (±10.7). Six to 8 months post-PTCA self-reported symptom frequency (Z = 8.034, N-ties, P = .000) and duration decreased significantly (Z = 8.361, N-ties 20, P = .000) compared with pre-PTCA levels. Timeline scores increased significantly (Z = 3.46, N-ties 10, P = .001) indicating a shift in patients’ representations of their disease from an acute to a chronic model. Cure/control and consequence scores decreased significantly, indicating that representations regarding personal control over their illness weakened (Z = 3.251, N-ties 18, P = .001), as did their representation of their illness as having serious consequences (Z = 5.250, N-ties 0, P = .00).
Conclusion
Some inaccuracies in illness representations were evident, some of which evolved to more realistic representations, whereas others did not. In the era of promoting effective self-management among those living with chronic diseases a clear understanding of illness representation in the context of coronary heart disease is valuable, particularly as inaccuracies are associated with negative outcomes.
Elective percutaneous transluminal coronary angioplasty (PTCA) is an increasingly popular treatment choice for coronary heart disease (CHD). In 2002, an estimated 657,000 procedures were performed.1 This represents a staggering 324% increase in comparable figures for 1982.1 Despite this, little is known about how individuals undergoing this procedure “make sense” of their illness, and the elucidation of such information is not a routine part of nursing practice.
As part of adapting to living with chronic disease, individuals develop unique models, or illness representations (IRs), which enable them to “make sense” of their predicament.2 IRs are consistent across a variety of chronic disease states and form part of the self-regulation model formulated by Leventhal et al.2 The IR component of this model consists of five individual components. These are disease identity (symptom frequency and duration), timeline, consequences, cure/control, and causal attribution.2 IRs are significant because they have been shown to influence a range of health behaviors and outcomes such as adherence to recommended treatment regimens and patients’ disease-management behaviors,3, 4, 5 and 6 self-diagnosis and help-seeking behavior,7 attendance at cardiac rehabilitation,8 time taken to return to employment,9 and adverse events after acute myocardial infarction (AMI).10
Factors influencing health behavior change during recovery from PTCA are particularly important as they form the cornerstone of secondary prevention efforts to reduce coronary risk. The Illness Perception Questionnaire (IPQ) was developed as an instrument to evaluate IR11 and is used in this study to assess IR before and after elective PTCA. Four components of IR (disease identity, timeline, consequences, cure/control) will now be described. Causal attribution is the fifth component of IR but has been omitted from this article to maintain brevity. Findings for this component are published elsewhere.1