Prospects of Heart Surgery: Psychological Adjustment to Coronary Bypass Grafting

251 Pages·1988·7.72 MB·English

by  Alan Radley (auth.)

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Prospects of Heart Surgery: Psychological Adjustments
to Coronary Bypass Grafting
A/an Rad/ey
Alan Radley
Prospects of Heart Surgery
Psychological Adjustment to Coronary
Bypass Grafting
Springer-Verlag
New York Berlin Heidelberg
London Paris Tokyo
Alan Radley
Department of Social Sciences
University of Technology
Loughborough, Leicestershire
England
Advisor
J. Richard Eiser
Department of Psychology
University of Exeter
Exeter EX4 4Q,C
England
Library of Congress Cataloging-in-Publication Data
Radley, Alan.
Prospects of heart surgery.
(Contributions to psychology and medicine)
Bibliography: p.
Includes index.
I. Aortocoronary bypass-Psychological aspects.
2. Aortocoronary bypass-Social aspects. 1. Tide.
II. Series. [DNLM: 1. Aortocoronary Bypass-psychology.
2. Attitude to Health. 3. Coronary Disease-surgery.
we 169 R129p]
RD598.R34 1988 617'.412'0019 88-4911
© 1988 by Springer-Verlag New York Inc.
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To My Parents
Preface
Every time medical technology reaches deeper into the body, it turns our at
tention to new features of the social world. The surgical treatment for cor
onary artery disease is no exception, for it raises all kinds of questions about
when the operation should be offered, to which patients, and with what
promise of life-quality in the years afterwards. At first sight these might ap
pear to be issues calling for decisions based upon biomedical information
only. However, if one looks closer at what is involved, it becomes clear that
questions about the quality oflife of patients undergoing coronary graft sur
gery depend crucWly upon people's beliefs about what it is to be ill or
healthy in the modem world.
While the considerable amount of research carried out by social scientists
into people's health beliefs and practices has touched many parts of the
medical field, little has so far been written about the personal situation of the
patient awaiting (and receiving) coronary graft surgery. This might be due
partly to the fact that, once drawn into the very center of medical treatment
(surgery), the person's illness appears to have become so palpably a matter
concerning the physical body. This situation contrasts markedly with the
considerable-and still growing-literature on the sociological and psy
chological aspects of coronary disease; social scientists are understandably
drawn to the task of helping to discover the source of this stream of affiiction.
To continue this metaphor, this book follows the flow in the opposite direc
tion. By pursuing the diversity of experience of patients where surgery is suc
cessful, or where it fails to relieve symptoms, it is possiple to study how in
dividuals variously adjust to the demands of an ailing body as well as to the
expectations of others in the home or at the workplace.
This shift of attention towards the ways in which individuals cope with
angina, and later with the "good" or "poor" outcome of coronary graft sur-
viii Preface
gery, brings into focus their relationships with important people in their
lives-their spouses in particular. When one listens to what heart patients
say about their symptoms, it is clear that what so often makes things matter
about their bodies are things concerning other people. As a guiding princi
ple, it has always been common knowledge that "matters of the heart" ex
tend beyond the territory of the body. For this reason, the project reported
in this book took as its focus the patient-spouse relationship rather than the
patient as an isolated individual.
People with symptomatic heart disease, like those with other chronic ill
nesses, are faced with the issue of how to live a life of unhealth, a moral re
quirement of our time. This concern poses questions of how people literally
live their illness through their bodily conduct. Here we find the meeting
ground of research into health beliefs and studies of the ailing physical
body. This calls for an approach that can be called "social-psychological,"
though I would not wish to quibble about labels. By calling it a meeting
ground, I am not suggesting a so-called integration of sociological and
biomedical concepts. Instead, attention is being drawn to the way in which
something is worked out in people's conduct with others concerning the
place of symptoms in their daily lives.
This suggestion calls for theory development; that is why this book offers
both a conceptual framework and a methodology for putting it into practice.
As a result, the report frequently moves between data and theory, on the
grounds that one must sometimes develop concepts as one goes along.
Regarding the form of data, the work takes its stand in qualitative inves
tigations. This does not mean an avoidance of numerical analysis, but in
stead a commitment to examining the meaning of what the patients and
their spouses ~old us. As a consequence, because the project was more about
sick people than about disease, the practical implications of the work may
not easily be drawn within the context of the medical consultation. This re
striction, I am led to believe, applies more to the British than to, say, the
American health-service context. Nevertheless, the approach offered here
does speak to practitioners, of whatever field, who are concerned not only
with what care is provided to coronary patients, but with how it is given (and
received), with what justification, and with what understanding.
The book is organized into three parts. In Part I the first chapter provides
a brief overview of improvement in life-quality as a criterion for judging the
success of coromuy grafting. Cl1apter 2 establishes a social-scientific per
spective and, with Chapter 3, outlines a new methodology for putting some
of tllese icieas into practice. Chapter 3 also describes the form of the research
project. Part II contains the body of the project findings. Chapters 4, 5, 6,
and 7 describe patients and their spouses at angiography, prior to admission
for surgery, in the early weeks, and at 1 year after the operation. Part III
sets out (in Chapter 8) a theoretical development which extends some of the
concepts to illness in general, while the final chapter discusses the practical
and, indeed, the moral implications of'the work reported.
Alan Radley
Acknowledgments
The research on which this book is based was made possible by grants from
The British Heart Foundation, to whom I wish to express my gratitude.
Thanks are also due to the medical staff at Groby Road Hospital, Leicester,
who provided me with valuable assistance with the arrangements for con
ducting the work. I am, of course, indebted to the patients and to the wives
who agreed to be interviewed during what was, for them, a critical and at
times a stressful period of their lives. Their belief that by doing this they
might help others in a similar situation will, I hope, turn out to be true, even
if only in some sm;iII measure.
I have been especially fortunate in having, as my colleagues, two diligent
yet critical co-workers. In the early stages of the research Ruth Green was in
strumental in helping to develop the methodology and the conceptual
framework which guided the work, and I am pleased to acknowledge her
signifi<:ant contribution here. Later on in the project, Margaret Radley was
able to provide valuable clinical insights when analyzing the interview
transcripts, on which ideas several of the interpretations offered in this book
depend. To them both, as the "eyes and ears" of the project, I am
deeply grateful.
The transcription of the interview tapes was carried out by Sue Spencer
with care and remarkable speed. The preparation of the manuscript was in
the hands of Cathie Ward whose professionalism, interest, and cheerfulness
smoothed the transition from first draft to final copy; for this she has my sin
cere thanks.
I can now repay, in small measure, a debt of gratitude which lowe to Peter
Nixon of Charing Cross Hospital, whose encouragement when I first
became interested in these problems made the initial steps possible.
Finally, I want to thank my wife Margaret, not only for a happy and pro
ductive working partnership, but for the sustained and informed support
that I count myself lucky to receive.
Contents
Preface Vll
Acknowledgments ix
Part I
Chapter 1 Surgery and Social Science: Improving the Quality
of Life 3
Chapter 2 Symptoms and Society: Ill-Health as Adjustment 21
Chapter 3 The Project: Context, Aim, and Method 42
Part II
Chapter 4 Living with Coronary Disease 61
Chapter 5 The Anticipation of Surgery 93
Chapter 6 After Surgery-Relief and Recovery 123
Chapter 7 One Year Later-Restoring Health and Social Life 151
Part III
Chapter 8 Development of Theory 183
Chapter 9 Implications and Applications 200
xii Contents
References 216
Appendices 225
Author Index 239
Subject Index 243