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.