| Summary: | 博士 === 國立臺北護理健康大學 === 護理研究所 === 104 === Background: Chronic obstructive pulmonary disease is a disease associated with irreversible airway obstruction that cannot be cured with medical treatments. As the disease progresses, lung function is impaired and acute exacerbation is increasing. Not only the symptom of dyspnea, most patients with COPD also suffer one or more symptoms associated with respiratory tract such as cough, phlegm and wheezing. These symptoms may interact with the others and form a “symptom cluster” then result in defect of functional status and health related quality of life (HRQOL). Patients with COPD suffer distress and burden from symptoms similar as patients with cancer; but patients with COPD tend to live longer. Symptoms experienced by patients are the indicators of change in normal function and they are the danger signals of threats to health.
Aim: To explore the symptom clusters and the related factor in patients with COPD.
Method: A cross-sectional & descriptive-correlation design was used to examine patients’ symptom experiences with the related factor, and collect the data from the medical center in central Taiwan. The patients received specific questionnaires including the Memorial Symptom Assessment Scale (MSAS), modified Medical Outcomes Study Social Support Survey (mMOS-SS), Clinical COPD Questionnaire (CCQ), and Short Form-12 health survey (SF-12).
Results: A total of 139 subjects were recruited in this study. The subjects were predominantly men (95.7 %), with a mean age of 71.79 ± 10.23 years. In average, patients with COPD experienced many symptoms (6.71 ± 4.79). The most prevalent physical symptoms were cough (90.65 %), lack of energy (61.15 %), dyspnea (58.99 %), dry mouth (38.13 %), and pain (36.69 %). The most prevalent psychological symptoms were difficulty sleeping (32.37 %) and feeling sad (23.74 %). Hierarchial cluster analysis (HCA) revealed symptoms grouped into 4 distinct clusters: respiratory symptoms with fatigue, symptoms related to sensory discomfort and feeling drowsy, symptoms related to excretory system and appetite, and symptoms related to nutrition. In addition, HCA was used to derive a 3-cluster solution based on the 18 physical symptoms. Multivariate analysis of variance (MANOVA) revealed that significant mean differences (Wilks' Lambda = 0.493, F = 18.94, p < 0.001) in disease severity, psychological distress scores, and social support scores between 3 subgroups. Psychological distress is a critical predictor of symptom cluster in discriminant analysis. Using the psychological distress, social support and health-related quality of life (HRQOL) scores (total scores of CCQ and SF-12) to predict the subgroups of symptom cluster, there were 77.0 % (107/139) of original grouped cases correctly classified into the subgroups of symptom cluster. Furthermore, there were significant mean difference (Wilks' Lambda = 0.270，F = 10.606，p < 0.001) in both HRQOL scores — CCQ and SF-12 of 3 subgroups. Linear regression also revealed that the moderate physical symptom subgroup was significantly lower in the CCQ scores (β = -0.367, t = -4.077, p < 0.001) and significantly higher in the SF-12 scores (β = 0.355, t = 4.315, p < 0.001) which compared with the high physical symptom subgroup. Also, low physical symptom subgroup was significantly lower in the CCQ scores (β = -0.837, t = -9.310, p < 0.001) and significantly higher in the SF-12 scores (β = 0.909, t = 11.057, p < 0.001) which compared with the high physical symptom subgroup. The symptom cluster was able to explain 41.5 % of variance in the total scores of CCQ (R2 = 0.415, F= 48.279, p < 0.001) and 51.1 % of variance in the total scores of SF-12 (R2 = 0.511, F = 71.054, p < 0.001), indicating higher physical symptom cluster has worse HRQOL.
Conclusions: Experiences of symptom in patients with COPD are complex. They suffer distress from more than one symptom simultaneously. Severity of disease, psychological distress, and social support are the influential factors of the physical symptoms. The impact of symptoms like a vicious cycle that affects every aspect of patients, and results in impairing the overall health status and HRQOL. For the patients with COPD, the symptom assessment should be multidimensional based on the concept of symptom cluster. It has to assess the symptoms that are in the same cluster, and also assess the influential factors. The findings of this study provide a foundation for symptoms management and nursing interventions to improve health status and HRQOL of patients with COPD. We hope the findings of this study can offer a reference to clinical staffs in symptoms management in patients with COPD.
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