Symptom Prioritization among Adults Receiving In-Center Hemodialysis: A Mixed Methods Study
Symptom Prioritization among Adults Receiving In-Center Hemodialysis: A Mixed Methods Study
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DOI：
10.2215/cjn.10850917
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发表时间：
2018-05-07
影响因子：
9.8
通讯作者：
Mehrotra, Rajnish
中科院分区：
文献类型：
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作者：
Flythe, Jennifer E.;Hilliard, Tandrea;Mehrotra, Rajnish
背景和目的：接受中心血液透析的个体经历了高的症状负担，这在精神上影响了他们的生活质量。在这一人群中，几乎没有基于证据的症状缓解干预措施。为了刺激症状管理的创新，需要患者症状优先级和治疗偏好的数据。我们进行了这项研究，以（1）确定患者优先症状的症状缓解疗法的发展和（2）引起个人之间接受hemodialys.Design，设置，参与者和测量的治疗偏好。我们进行了一项混合方法的研究，包括焦点小组在卡尔伯勒，北卡罗来纳州，亚利桑那州图森市和华盛顿西雅图和全国分布的在线调查。焦点小组的成绩单进行了分析的模式，并确定最高优先级的症状的基础上的频率和报告的严重程度。我们使用焦点小组的调查结果为调查项目提供信息。焦点小组和调查结果进行了交叉验证和综合的最终症状prioritization.Results Therewere 32名参与者在三个焦点小组和87名调查受访者来自27个州在美国。所有焦点小组的参与者都报告了失眠、疲劳、肌肉痉挛和恶心/呕吐的身体症状以及焦虑和抑郁情绪的情绪症状。在受访者中，疲劳（94%），抽筋（79%）和身体疼痛（76%）是最常见的身体症状，而感到沮丧（66%），担心（64%）和沮丧（63%）是最常见的情绪症状。最优先的症状在焦点小组和调查参与者中是一致的，包括身体症状失眠，疲劳和痉挛以及情绪症状焦虑，抑郁和沮丧。参与者表示，症状的频率，持续时间，不可预测性，社会和经济影响的因素最严重的症状prioritization.Conclusions患者优先考虑的身体症状失眠，疲劳，痉挛和情绪症状的焦虑，抑郁和沮丧的顶级症状，以寻找新的治疗方法。
Background and objectives Individuals receiving in-center hemodialysis experience a high symptom burden that detrimentally affects their quality of life. There are few evidence-based interventions for symptom relief in this population. To stimulate innovation in symptom management, data on patient symptom prioritization and treatment preferences are needed. We undertook this study to (1) identify patient-prioritized symptoms for the development of symptom relief therapies and (2) elicit preferences for treatments among individuals receiving hemodialysis.Design, setting, participants,& measurements We conducted a mixedmethods study that included focus groups in Carrboro, North Carolina; Tucson, Arizona; and Seattle, Washington and a nationally distributed online survey. Focus group transcripts were analyzed for patterns, and the highest priority symptoms were determined on the basis of frequency and report severity. We used focus group findings to inform survey items. Focus group and survey results were crossvalidated and synthesized for final symptom prioritization.Results Therewere 32 participants across three focus groups and 87 survey respondents from 27 states in the United States. The physical symptoms of insomnia, fatigue, muscle cramping, and nausea/vomiting and the mood symptoms of anxiety and depressed mood were reported by participants in all focus groups. Among survey respondents, fatigue (94%), cramping (79%), and body aches (76%) were the most common physical symptoms, and feeling depressed (66%), worried (64%), and frustrated (63%) were the most common mood symptoms. The top-prioritized symptoms were consistent across focus group and survey participants and included the physical symptoms insomnia, fatigue, and cramping and the mood symptoms anxiety, depression, and frustration. Participants indicated that symptom frequency, duration, unpredictability, and social and financial effects factored most heavily into symptom prioritization.Conclusions Patients prioritized the physical symptoms of insomnia, fatigue, and cramping and the mood symptoms of anxiety, depression, and frustration as the top symptoms for which to find new therapies.