| Objectives(1)The Symptom clusters type of patients with lung cancer radiotherapywas identified by Exploratory Factor Analysis analysis(EFA).(2)To explore the influencing factors of Symptom clusters.(3)To explore the role model of Symptom clusters,self-perception burden and quality of life.To provide theoretical support for the management of symptoms and Symptom clusters of patients with lung cancer.MethodsFrom May 2017 to November 2017,250 patients with lung cancer radiotherapy were investigated by convenient sampling method in the five third-grade hospitals in Beijing and Jinan,Shandong Province.Instruments include general Characteristics questionnaire,M.D.Anderson Symptom Inventory Chinese(MDASI-C),lung cancer-specific symptom module,self-perceived burden scale(SPBS-CP),FACT Generic scale(FACT-G).Epidata3.1 was used to input data,SPSS21.0 and AMOS 21.0 were used to analyze data,including descriptive statistics analysis,inde-pendent sample T test,one-way analysis of variance(ANOVA),multiple linear regression analysis,exploratory factor analysis(EFA),Pearson correlation analysis,structural equation model(SEM)analysis.Results1.The incidence of lung cancer radiotherapy in patients with symptoms ranked in the top four(91.2%),in turn,is fatigue,poor appetite(84.1%),pain(83.3%),shortness of breath(80.2%),the last four of the list were hemoptysis(26%),weight loss(54.6%),constipation(58.1%),numbness(60.4%).The symptom severity scores ranged from 1.94-5.17 points with an average of 3.60±2.519,which ranked in the top four in turn(5.17±2.611)were fatigue(5.17±2.611),distress(4.50±2.788)and a poor appetite(4.45±2.794),cough(4.16±2.619),those in the bottom three were hemoptysis(1.94±1.981),losingweight(2.01±2.160),forgetfulness(3.01±2.256),numbness,(3.10±2.509).2.Pearson correlation analysis was performed between different symptoms of lung cancer patients.The results showed a positive correlation between the symptoms(P<0.05).The highest correlation coefficient ranked in the top five were vomiting and nausea(r=0.784),cough and expectoration(r=0.762),distress and sadness(r=.0.738),shortness of breathand chest tightness(r=0.694),cough and chest tightness(r=0.606).3.The incidence rate and severityof symptoms distressamong patients with lung cancer radiotherapy,the first one wasthe work(including housework),Up to 90.7%(average score4.89±3.425),and the last one was the relationship with others,with incidence of 64.85%.4.EFA was used toanalyze the types of symptom clusters.Finally,four symptom clusterswere identified,the cumulative variance contribution rate was 68.216%.5.Thetotalmean(SD)scoreof symptomclusters was(3.60±1.77),the highest score was the pain-fatigue symptoms clusterwiththemean(SD)of(3.91 ±1.805)points,thelowestscore was Lung dysfunction symptoms clusterwiththemean(SD)of(2.99±1.692).Thetotalmean(SD)scoreof self-perceived burden was(3.01 ±0.797)points,the highest score was the economy/family burdenwiththemean(SD)of(3.71 ±0.923)points,thelowestscore was treatmentburden withthemean(SD)of(2.37±0.905).Thet-otalmean(SD)scoreof the quality of life scale was(2.52±0.526)points,the highest score was the social/family condition(3.10±0.543),and the lowest score was the physical condition(2.13 ±0.742).6.Results of the univariateanalysis showed that age,place of residence,level of education,economic pressure,health of caregivers,ECOG-PS of symptom score weresignificantdifference(P<0.05).There were significant differences in the scores of the symptom clusters(P<0.05)among the patients aged>60 years and those aged<45,45 to 60.There was a significant difference between living in rural areas and living in towns and cities(P<0.05);There were significant differences between primary and middle schools,high schools and universities in terms of education.The economic pressure between relatively lighter and very heaviest has significant difference(P<0.05);There was a significant difference between the better health of the caregivers and the worse(P<0.05).There were significant differences in ECOG-PS scores of 3 and 0,1 and 2(P<0.05).Multivariate linear regression analysis,the age,education degree,and primary caregivers of the patients were entered into the regression equation,the treatment burden of theself-perceivedburden enters the regression equation,all of these can explain 22%of variance.Among them,the treatment burden was the first to enter the regression model,which had a great effect on the Symptom clusters.The treatment burden could explain the variation of 14.1%of the Symptom clusters alone(β=0.321,R2=0.141).7.Pearson correlation analysis showed that symptom clustersand quality of life were significantly negative correlation(r=0.608,P<0.01),the Symptom clusters and self-perceived burden has significant positive correlation(r=0.314,P<0.01),the self-perceivedburden and quality of life were significantly negative correlation(r=0.493,P<0.01).8.Results of structural equation model showed that self-perceived burden played a partly mediated role of between the Symptom clusters and quality of life,with the mediated effect accounting for 16.3%of the total effect.Conclusions1.Patients with lung cancer radiotherapy will be accompanied by multiple disease symptoms during the course of disease treatment.Among them,the highest incidence of fatigue.The burden of self-perception and the quality of life were at a moderate level.2.Symptoms between the two related,you can extract four Symptom clusters.Pain-fatigue related symptoms cluster performance is the most prominent,so medical and nursing staff should focus on this symptom cluster in clinical care to reduce its impact on patients.3.The factors affecting the Symptom clusters are "differential in the same situation",which is mainly related to the education degree,age,and the physical condition of the main caregiver.4.Self-perception burden partlymediatedthe symptom clusters and quality of life.lt is suggested that the medical staff can influence the patient’s symptom experience by reducing the patient’s self-perception burden,thereby indirectly improving the quality of life of the patients. |
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