Symptoms and Symptom Clusters in End Stage Chronic Disease

慢性病末期的症状和症状群

• 批准号: 7456223
• 负责人: LOIS L MILLER
• 金额: $ 23.1万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-09 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7456223
• 关键词: Address; Age; All Sites; Biological Process; Blood Pressure; Cancer Etiology; Case Management; Cause of Death; Cessation of life; Chronic; Chronic Disease; Clinic; Cluster Analysis; Complex; Condition; Consensus; Data; Data Collection; Death Certificates; Dementia; Disease; Distress; Elderly; Family; Foundations; Frequencies; Future; Gender; Goals; Heart Diseases; Heart failure; Home environment; Hospice Care; Incidence; Individual; Interview; Liver diseases; Longitudinal Studies; Lung diseases; Malignant Cerebral Neoplasm; Malignant Neoplasms; Medical; Medical Care Costs; Methodology; Modeling; Morbidity - disease rate; Multivariate Analysis; Numbers; Outcome; Pain; Palliative Care; Participant; Patients; Pattern; Personal Satisfaction; Physical Function; Prevalence; Procedures; Public Health; Rate; Recruitment Activity; Renal function; Research; Sampling; Score; Severities; Social Functioning; Staging; Sudden Death; Symptoms; Techniques; Thinking; Time; Vascular Diseases; base; design; end of life; end of life care; experience; follow-up; hospice environment; innovation; mortality; programs; psychologic; psychological distress; social

DESCRIPTION (provided by applicant): Patients in the advanced stage of several chronic eventually-fatal diseases, including heart disease, obstructive lung disease, cancer, cerebral vascular disease, chronic liver disease and dementia may experience multiple concurrent symptoms caused by the disease, disease treatment, or their combination. Yet, the complex relationships between and among symptoms in these major chronic diseases have not been well described and the impact of multiple symptoms on important outcomes have not been evaluated. This pilot exploratory study focuses on symptoms experienced by older adults in the advanced stage of one chronic eventually-fatal disease, heart failure (HF), using the innovative approach of symptom clusters analysis. Symptom cluster analysis is a multivariate statistical technique, which will identify clusters of individuals with similar patterns across symptoms based on their ratings of symptom distress. A longitudinal descriptive design will be used. A sample of 120 patients with end-stage HF will be recruited from three settings: a hospice and palliative program, a heart failure case management program, and a heart failure treatment clinic. Data will be collected once in participants' homes using an interview format. Patient variables include symptoms (including frequency, severity and distress), all sites of pain, physical, social, and psychological functioning, and co-morbidities. Longitudinal follow-up will occur in 6 months with an analysis of death certificates to determine who in the sample has died. By identifying participants who die, we will be able to determine whether symptom clusters differ for those who do and do not die, and among those who die, whether symptoms clusters vary as a function of the number of months prior to death. Analyses include correlation of individual symptoms and symptom clusters to selected variables, and multivariate analysis to determine symptom cluster predictors of time before death. The results of this study will provide the foundation for future longitudinal studies of symptoms in patients with end-stage HF and in patients with other chronic eventually-fatal conditions. Study results may suggest potential direction for identifying underlying causative mechanisms. Information on symptoms and their patterns in the months preceding death will be essential for developing the much-needed palliative strategies for HF. PUBLIC HEALTH RELEVANCE: As one of the leading causes of death in the U.S. and the only heart disease whose incidence, prevalence, and mortality are increasing, HF is a growing public health concern. Symptom burden is high in end-stage HF and adds to the suffering of patients and families and to the cost of medical care.

描述（由申请人提供）：处于几种慢性最终致死性疾病晚期的患者，包括心脏病、阻塞性肺病、癌症、脑血管疾病、慢性肝病和痴呆，可能会出现由疾病、疾病治疗或其组合引起的多种并发症状。然而，这些主要慢性疾病的症状之间的复杂关系尚未得到很好的描述，多种症状对重要结果的影响尚未得到评估。这项试点探索性研究的重点是老年人在一种慢性最终致命疾病心力衰竭（HF）的晚期阶段所经历的症状，使用症状聚类分析的创新方法。症状聚类分析是一种多变量统计技术，它将根据症状痛苦的评级来识别具有相似症状模式的个体集群。将采用纵向描述性设计。120例终末期HF患者的样本将从三个环境中招募：临终关怀和姑息治疗计划，心力衰竭病例管理计划和心力衰竭治疗诊所。数据将在参与者家中使用访谈格式收集一次。患者变量包括症状（包括频率，严重程度和痛苦），疼痛的所有部位，身体，社会和心理功能以及合并症。纵向随访将在6个月内进行，分析死亡证明，以确定样本中的死亡人员。通过识别死亡的参与者，我们将能够确定死亡和未死亡的参与者的症状群是否不同，以及在死亡的参与者中，症状群是否随死亡前的月数而变化。分析包括个体症状和症状群与选定变量的相关性，以及确定死亡前时间的症状群预测因子的多变量分析。本研究的结果将为将来对终末期HF患者和其他慢性最终致死性疾病患者的症状进行纵向研究提供基础。研究结果可能为确定潜在的致病机制提供潜在的方向。死亡前几个月的症状及其模式信息对于制定急需的心力衰竭姑息治疗策略至关重要。公共卫生关系：作为美国的主要死亡原因之一，也是唯一一种发病率、患病率和死亡率不断增加的心脏病，HF是一个日益增长的公共卫生问题。终末期HF的症状负担很高，增加了患者和家庭的痛苦以及医疗费用。