Multidimensional symptom clusters: an exploratory factor analysis in advanced chronic kidney disease

Almutary, Hayfa; Douglas, Clint; Bonner, Ann

doi:10.1111/jan.12997

Cited by 49 publications

(96 citation statements)

References 41 publications

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“…sleep disturbance, poor appetite and depression), which may collectively cause impairments in the physical and social functioning of individuals with CKD (Almutary et al . ).…”

Section: Discussionmentioning

confidence: 97%

The Relationship Between Chronic Kidney Disease, Symptoms and Health‐Related Quality of Life: A Systematic Review

Yapa

Purtell

Chambers

et al. 2019

Journal of Renal Care

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A. (2020). The relationship between chronic kidney disease, symptoms and healthrelated quality of life: a systematic review. Journal of Renal Care 46(2), 74-84. S U M M A R YBackground: People with chronic kidney disease (CKD) experience a wide range of symptoms due to reduced kidney function. As the disease progresses these symptoms become more burdensome and often negatively affect a person's health-related quality of life (HRQoL). Objective: To examine the evidence of symptoms and HRQoL in CKD stages 1-5 and the relationships between these. Methods: Studies published in English from January 2008 to July 2018 using six databases (PubMed, MEDLINE, CINAHL, PsycINFO, Cochrane Library and JBI Library) were searched. Results: Thirteen studies were included in this review although only three had interventional designs. By considering symptom experience and HRQoL together, four studies found that HRQoL decreased when symptoms increased. Feeling washed out, fatigue and drowsiness were found to be the most common symptoms reported. Only two studies reported follow-up measurements although six studied how symptoms change over time. None of the studies examined the change of symptoms over time across the different CKD stages. The majority of studies showed a decline in physical HRQoL and improvement in mental HRQoL over time. Nutritional and exercise interventions showed some improvements in symptom experience and HRQoL. Conclusions: Only four studies were found that reported the relationship between symptoms and HRQoL of those with CKD. Of these, in view of symptom experience and HRQoL together, HRQoL decreased when symptoms increased. However, more research is warranted to establish a clear understanding of the relationship between symptoms and HRQoL in CKD to enable the design of appropriate interventions.

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“…sleep disturbance, poor appetite and depression), which may collectively cause impairments in the physical and social functioning of individuals with CKD (Almutary et al . ).…”

Section: Discussionmentioning

confidence: 97%

The Relationship Between Chronic Kidney Disease, Symptoms and Health‐Related Quality of Life: A Systematic Review

Yapa

Purtell

Chambers

et al. 2019

Journal of Renal Care

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“…These findings substantiate the work of Almutary et al . (), where, rather than existing in isolation, symptoms were found to occur in clusters. The multiplicity of symptoms reported by participants emphasises the systemic nature of renal disease, a finding consistent with Thomas et al .…”

Section: Discussionmentioning

confidence: 99%

Symptom experience in non‐dialysis‐dependent chronic kidney disease: A qualitative descriptive study

Pugh-Clarke

Read

Sim

2017

Journal of Renal Care

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SUMMARY Background Studies indicate that symptoms attributable to impaired kidney function are important determinants of quality of life and functional status in patients with chronic kidney disease (CKD). Accordingly, symptom assessment and subsequent control are prerequisites of high‐quality care in this patient population. Whilst symptom burden in patients with advanced CKD managed without dialysis has been likened to that of palliative care cancer populations, there is little information about the nature and range of symptoms in earlier stages of the CKD trajectory. This paper reports the findings of the preliminary phase of a study aimed at exploring the symptom experience in patients with CKD stages 4 and 5. Methods Eighteen semi‐structured patient interviews were conducted, using an interview schedule developed specifically to guide discussion. Data were analysed using thematic analysis to identify symptom categories and thematic patterns across the patient experiences. Results Patients reported a wide range of symptoms, with over 50 different categories and sub‐categories emerging from the interview data. Symptom categories could be broadly classified into physical symptoms, such as ‘Altered taste perception’, ‘Sleep disturbance’ and ‘Fatigue’, and psychological symptoms, such as ‘Forgetfulness’, ‘Poor concentration’ and ‘A sensation of gradually slowing down’. Of note, when questioned further, patients indicated that they would not usually report their symptoms to clinicians. Conclusions This study suggests that patients with CKD stages 4 and 5 may have a high symptom burden. The finding that patients did not routinely report their symptoms emphasises a need for clinicians to incorporate symptom assessment into routine clinical consultations.

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“…Other individual symptoms included pain (e.g., Matthie & McMillan, 2014), constipation (McMillan, Tofthagen, Small, Karver, & Craig, 2013) and chronic cough (French, Crawford, Bova, & Irwin, 2017). Just over half of the investigators included more than one symptom, ranging from two or three symptoms to more than 30 symptoms (e.g., Almutary, Douglas, & Bonner, 2016). However, there was often little attention given to all four symptom dimensions included in the TOUS: timing, distress, intensity and quality.…”

Section: Symptomsmentioning

confidence: 99%

An integrative review of the theory of unpleasant symptoms

Blakeman

2019

Journal of Advanced Nursing

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Aims The aim of this study was to explore how the theory of unpleasant symptoms (TOUS) has been used in the methodological design and analysis of symptom research. Design An integrative review, using Whittemore and Knafl's approach. Data Sources Searches were conducted between 26 January–10 February 2018. Databases included CINAHL Complete, PubMed, Proquest Nursing and Allied Health Source, Health Source: Nursing/Academic Edition, Academic Search Complete and Google Scholar. Review Methods A systematic approach to searching, screening and analysing the literature was applied. The matrix method, content analysis, constant comparison, counting and clustering were used. Results Sixty‐four records were included. Most studies were quantitative, cross‐sectional, instrument‐based and conducted in the USA. Various symptoms and patient populations were represented and each of the TOUS concepts were explored. Conclusion Although the theory has a role to play in furthering symptom science, attention should be paid to the areas of the model and of symptom research that have received less attention. More complex statistical approaches and big data will help to illuminate symptom experiences. Additional focus on intervention studies and all symptom dimensions will help to advance symptom science research. Impact This review is the first to provide a comprehensive, systematic summary of the uses of the TOUS across the research literature to date. This theory is a diverse, holistic middle‐range theory capable of being applied to multiple symptoms and populations. Researchers should consider using the theory as a conceptual framework for studies to advance symptom science and explore symptoms holistically.

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Multidimensional symptom clusters: an exploratory factor analysis in advanced chronic kidney disease

Cited by 49 publications

References 41 publications

The Relationship Between Chronic Kidney Disease, Symptoms and Health‐Related Quality of Life: A Systematic Review

The Relationship Between Chronic Kidney Disease, Symptoms and Health‐Related Quality of Life: A Systematic Review

Symptom experience in non‐dialysis‐dependent chronic kidney disease: A qualitative descriptive study

An integrative review of the theory of unpleasant symptoms

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