The effects of preoperative preparation on postoperative outcomes: the moderating role of control appraisals.

OBJECTIVE: To test the proposal that external health locus of control and self-efficacy would moderate the effects of a psychological preparation for surgery on outcomes for surgical heart patients. MAIN OUTCOME MEASURES: Psychological distress, pain, serum cortisol, and tumor necrosis factor alpha. DESIGN: A total of 80 coronary artery bypass graft patients were given standard care plus a psychological preparation or standard care alone using a single-blind methodology with random assignment. Data on psychological and biological functioning were collected at admission (baseline) and discharge. RESULTS: As predicted, external health locus of control and self-efficacy moderated the effect of the preparation on all outcomes. Results indicated that for high external health locus of control, the preparation was related to lower distress for people with high self-efficacy compared with those with low self-efficacy. When external health locus of control was low, the preparation was related to lower distress for those with lower self-efficacy. CONCLUSION: These findings caution against the use of preparations and education for surgical patients without accounting for control appraisals.