| ObjectivesThis study aims to:(1)know the experiences of symptom clusters among young adults patients with hematologic malignancies;(2)explore the influencing factors of symptoms clusters;(3)construct the effect model of symptom clusters on health-related quality of life,and explore the mediation effect of loss of dignity and the moderating effect of self-efficacy.MethodsA total of 315 young adults patients with hematologic malignancies were recruited through convenience sampling in two three-grade hospitals in Jinan,from September 2020 to August 2021.What used for assessment were general information questionnaire designed by the researcher,M.D.Anderson Symptom Inventory,Patient Dignity Inventory,General Self-Efficacy Scale and the MOS item short from health survey.SPSS 21.0 and Mplus 8.3 were used for analyses.Data were analyzed through descriptive analysis,independent sample t test,one-way analysis of variance(ANOVA),multiple linear regression analysis,exploratory factor analysis(EFA),Pearson correlation analysis,and structural equation modeling(SEM).Factors were selected according to factor loading and significance.Internal consistency tests were used to analyze the stability of symptom clusters.Model fitness was evaluated according to the fit index and path coefficients.Results(1)Fatigue(81.6%),poor appetite(74.9%),distress(73.7%),dry mouth(73.7%),and restless sleep(70.5%)were the top five symptoms in young adult patients with hematological malignancies.The last three symptoms were numbness(52.4%),shortness of breath(54.0%)and vomiting(54.9%).The top five symptoms in severity were fatigue(3.22±2.472),distress(2.95±2.75),poor appetite(2.82±2.67),restless sleep(2.78±2.71),and pain(2.52±2.64).The symptoms of the last three were numbness(1.62±2.21),shortness of breath(1.62±2.03),and forgetfulness(1.81±2.16).For the items affected by symptoms,the highest incidence was mood(71.4%),and the lowest was walking(51.1%).Work(including housework)was the most affected item(2.98±3.21),while walking was the least affected item,with an average score of 1.83±2.54.(2)There was a significant positive correlation between all symptoms(P<0.05).Among them,nausea and vomiting(r=0.754),poor appetite and vomiting(R=0.669),lethargy and dry mouth(r=0.637),distress and sadness(r=0.627),and lethargy and fatigue(r=0.606)were the top five most correlated.(3)Exploratory factor analysis identified five symptom clusters.namely pain and fatigue symptom cluster;Neurorelated symptoms cluster:forgetfulness,lethargy;Symptom interference items:general activity,mood,work,relationship with others,walking,life pleasure;Digestive symptom cluster:nausea,poor appetite,vomiting,numbness;Psycho-psychological symptom cluster:disturbed sleep,distress.(4)Single factor analysis of social demographic and general clinical variables of patients with symptom clusters as dependent variable showed that gender,marital status,personal monthly income,cancer type and other variables had statistically significant differences in the distribution of symptom clusters(P<0.05).Symptom cluster were taken as the dependent variable,and variables mentioned above were included in the regression model as independent variables.According to the step-up method,monthly income was first included in the regression model,and the results showed that monthly income could explain 19.1%of the variation of symptom clusters(β=-0.175.R2=0.191).followed by gender(β=-0.133,R2=0.239)and cancer type(β=-0.117,R2=0.266).(5)Correlation analysis showed that symptom cluster was significantly positively correlated with loss of dignity(r=0.658),and significantly negatively correlated with self-efficacy and health-related quality of life(r=-0.323:r=0.563).The negative correlation between loss of dignity and self-efficacy and health-related quality of life was significant(r=-0.311;r=0.659);Self-efficacy was positively correlated with health-related quality of life(r=0.328).(6)Structural equation modeling showed that the mediating effect of loss of dignity between symptom clusters and health-related quality of life was significant(β=-0.014,P<0.001),accounting for 29.2%of the total effect of symptom clusters on health-related quality of life.Self-efficacy significantly moderated the three mediating pathways of the mediating model.When loss of dignity was taken as the dependent variable,self-efficacy negatively moderated the effect of symptom clusters on loss of dignity(β=-0.213,P<0.001):When health-related quality of life was used as the dependent variable,the moderating effect of self-efficacy on symptom clusters to health-related quality of life was weak and negative(β=-0.008,P=0.031),and the moderating effect of loss of dignity on health-related quality of life was positive(β=0.186,P<0.001).Conclusions(1)Young adult patients with hematological malignancies had multiple symptoms during the treatment,among which fatigue(fatigue)was the highest and most serious,and emotional symptoms of patients were also more prominent,which should be highly valued.(2)There was correlation between single symptoms,and five symptom clusters were extracted by factor analysis.The average score of pain-fatigue symptom cluster was the highest,suggesting that clinical medical staff should give priority to the intervention of the prominent symptom cluster.(3)The influencing factors of symptom clusters included gender,marital status,personal monthly income and cancer type.Further model analysis showed that gender still had a significant effect on symptom cluster.Therefore,future studies should provide more theoretical guidance for symptom management strategies of patients from the perspective of gender control.(4)In the symptoms cluster model among young adult patients with hematological malignancies,the loss of dignity mediated the effect of symptoms clusters on health-related quality of life,and self-efficacy played a moderating role on the paths of symptom clusters on health-related quality of life,suggesting that clinical medical staff should pay attention to the psychological condition of patients,enhance the adaptability and improve their quality of life. |
PDF Full Text Request