Development and Initial Testing of a Brief Mindfulness Meditation Training Intervention for Preoperative Patients: An Application of the ORBIT Model
Over 1,500,000 surgical procedures occur in Canada every year. Although medical and technological advances have greatly improved outcomes, surgery is not risk free: for instance, 3-16% of patients receiving general anesthesia will experience a perioperative complication; and approximately 30% of arthroplasty patients report an adverse event. Biomedical, social, and psychological factors have all been associated with poor surgical outcomes and perioperative complications. One such factor is preoperative distress, an acute stress reaction experienced by a patient in response to impending surgery. Individuals with higher preoperative distress experience more adverse events, like delayed wound healing and mortality. The psychological technique of mindfulness meditation is associated with improved health and well-being, and is suggested as a potential tool for mitigating preoperative distress. Informed by the mindfulness mediation literature, Social Cognitive Theory, and the ORBIT Model of Developing Behavioural Treatments for Chronic Disease, this dissertation aimed to develop and test a mindfulness meditation protocol for patients undergoing elective surgery. Research took place in three parts, corresponding with Phases IA, IB, and IIA of the ORBIT Model. Study One utilized a theory-guided, mixed-methods design, in which surgical wait-list patients (N = 31) and health care providers (N = 20) provided feedback regarding their perceptions of and preferences concerning preoperative mindfulness meditation. In Study Two, Study One findings were integrated with the results of a literature review to develop a theory-grounded and evidence-based mindfulness meditation intervention. The intervention was reviewed by both health professionals (N = 16) and surgical wait-list patients (N = 14), who reported that it was both acceptable and beneficial. Lastly, Study Three was a proof-of-concept study in which the mindfulness meditation intervention was tested via randomized controlled trial. Surgical wait-list patients (N = 66) received either standard care or standard care plus mindfulness meditation. Results indicated small but consistent pre-post meditation improvements in health/wellness perceptions, suggestive that a brief, online meditation bestows an acute benefit. Between-group differences in perioperative health, mental health, and functioning variables were primarily non-significant and small. Together, the three studies suggest that a brief, online mindfulness meditation program is feasible and may produce acute changes in patient health. However, many questions remain regarding the role of mindfulness meditation during the perioperative window. Namely: Is there something unique within the perioperative environment that renders (brief, online) mindfulness meditation non-effective? Do patients require a greater “dose” of mindfulness meditation to see an effect? (And, if so, are these higher-dose interventions feasible?) What surgical- or patient-level factors might moderate effects?
URI for this recordhttp://hdl.handle.net/1974/28750
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