An anxious wait: a combined qualitative and quantitative study of anxiety on the waiting list for coronary artery bypass surgery

Heart disease is one of the biggest sources of mortality and morbidity in the developed world to-day. Coronary artery bypass surgery (CABS) is the gold-standard treatment. However, due to finite resources, demand has out-stripped capacity in many countries and long queues are common. Waiting lists for CABS have been associated with many problems, including pain, unemployment, uncertainty and death (McHugh et al 2001). However, one of the most salient features of this experience is undoubtedly the anxiety experienced by patients who face a lifethreatening diagnosis but indeterminate wait for treatment (Fitzsimons et al 2003). The aim of this paper was to describe the nature and intensity of anxiety experienced by patients awaiting CABS. Therefore a combined qualitative and quantitative approach was appropriate. Data were collected using semi-structured interview and the State Trait Anxiety Inventory (STAI) (Spielberger et al 1983), at three intervals over participants’ first year on the waiting list. The randomised sample comprised 70 patients recruited within 4 weeks of surgical referral. Interviews were recorded, transcribed verbatim and analysed using Colaizzi’s approach. Quantitative data were entered onto SPSS and analysed using standard non-parametric statistics and t-tests. Participants cited 5 main sources of anxiety:- chest pain, uncertainty, fear of operation, physical incapacity,and dissatisfaction. The STAI scores were significantly higher than other comparable groups at all stages of data collection and there was a statistically significant relationship between STAI scores and angina levels (p=<0.05). We have identified the sources and severity of the anxiety experienced by patients awaiting CABS. Thus, our findings may facilitate greater understanding of the needs of these patients and assist in the development of specific nursing interventions to help alleviate their specific problems. The combination of qualitative and quantitative methods generated a much more complete description of this construct than may have been achieved by either method in isolation.