| Objectives1.To explore the symptom clusters morphology of patients with gastric cancer at different time points in perioperative period(the first day after admission,2-4 days after surgery,and 1month after surgery).2.The predictive effect of baseline correlation factors(general data)on the track category of perioperative symptom clusters in patients with gastric cancer was investigated by fitting the track category of the symptom clusters.3.To explore the dynamic relationship between the track category of perioperative symptom clusters and its unmet needs in patients with gastric cancer,so as to provide reference for accurately improving patient needs.MethodsA longitudinal research design was adopted to select 353 gastric cancer patients who were expected to undergo surgical treatment in the gastrointestinal surgery and general surgery wards of 5 Grade A tertiary hospitals in Jiangsu Province from September 2021 to September 2022 by convenient sampling method.The general data questionnaire(only T1 was collected,and information related to disease treatment,such as surgical methods and tumor sites,was filled in at T2),the the short-form survivor unmet needs survey and M.D.Anderson Symptom Inventory-Gastrointestinal Cancer and,were used to follow the patients at 1 day after admission(T1),2 to 4days after surgery(T2),and 1 month after surgery(T3).SPSS26.0 and Mplus8.3 software were used for statistical description and analysis.Frequency and component ratio were used to describe the count data,and mean±standard deviation was used to describe the measurement data.EFA was used to extract SC.ANOVA of repeated measurements was used to analyze the longitudinal trend of unmet needs in patients.Latent Class Growth Model(LCGM)was used to fit the latent class track of perioperative symptom clusters in patients.X~2 test were used to compare the baseline characteristics of gastric cancer patients with various symptom clusters.Multinomial Logistic regression analysis was used to determine the predictive effect of baseline related the class of perioperative symptom clusters trajectory in patients.ANOVA was used to explore the dynamic relationship between the class symptom clusters locus and unmet needs at three time points in patients.Results1.Sample collection status:A total of 393 gastric cancer patients were included in the baseline investigation of this study.After 1-month follow-up investigation,40 cases were lost to follow-up,among which 10 cases stopped the investigation due to severe postoperative discomfort,2 cases were seriously ill,18 cases refused to continue to participate for some reason,and 10 cases were lost to follow-up,with a cumulative loss of follow-up rate of 10.18%.Finally,353 gastric cancer patients completed 3 surveys.2.Occurrence of symptoms at three time points in perioperative period in patients with gastric cancer:The patient had 18 symptoms at three time points T1,T2 and T3.T1 including shortness of breath,forgetfulness,vomiting,numbness,diarrhea,and dysphagia.Among the other symptoms,the incidence of distress(99.7%),sadness(98.6%),decreased appetite(94.9%)and sleep disturbance(90.4%)ranked the top four,the top four symptoms were distress(3.90±1.64),sadness(3.59±1.52),restless sleep(3.33±1.60)and decreased appetite(3.19±1.28).2 to 4 days after surgery(T2),the incidence of shortness of breath,forgetfulness and numbness was less than20%,and the top four of other symptoms were distress(100.0%),pain(99.7%),sadness(99.4%)and dry mouth(98.6%),respectively.The top four symptom severity scores were fatigue(4.32±1.63),pain(3.62±1.71),sleep disturbance(3.12±1.37)and distress(3.12±1.34).One month after surgery(T3),the incidence of shortness of breath,forgetfulness,vomiting,numbness and dysphagia was less than 20%,and the incidence of distress(88.7%),fatigue(78.8%),sadness(66.0%)and sleep disturbance(65.4%)were the top four among the remaining symptoms.Distress(3.16±1.39),fatigue(2.92±1.72),sleep disturbance(2.08±1.55)and sadness(1.87±1.40)were the top four symptoms.3.Symptom clusters composition of patients with gastric cancer at different time points during perioperative period:In patients with gastric cancer,there were three symptom clusters:energy deficit symptom cluster,emotional and psychological symptom cluster and digestive tract symptom cluster in both T1 and T3.On the basis of the three symptom clusters,surgery-related symptom cluster was added in T2,totaling 4 symptom clusters.4.Change of symptom clusters severity and unmet needs at different time points in patients during perioperative period:The severity scores of each symptom cluster and total symptom clusters(except surgery-related symptom cluster)were significantly different at different time points(P<0.05).The severity of emotional and psychological symptom cluster showed a linear trend from high to low,and the severity of energy deficit symptom cluster,digestive tract symptom cluster and the three symptom cluster all showed a trend from low to high and then decreased.The scores of two dimensions of unmet need dimension of information,unmet need dimension of sharing and unmet need dimension of emotion at three time points in the perioperative period of gastric cancer patients and the total score of unmet need showed a trend from low to high and then decreased,the scores of unmet needs of work economy and unmet needs of care access and extended care showed a trend of increasing from high to low.Three time points of each dimension score and total score did not meet the demand difference had statistical significance(P<0.05).5.Development trajectory of perioperative symptom clusters and predictive factors in patients with gastric cancer:The change characteristics of perioperative symptom clusters in patients with gastric cancer showed population heterogeneity,presenting three latent classes,which were respectively named as moderate level stable remission class(C1,56.7%),low level rapid decline class(C2,26.6%)and high level slow decline class(C3,16.7%)according to the characteristics of their initial level and development trajectory.Multiple Logistic regression analysis showed that compared with the moderate level of stable response class,gastric cancer patients with college education and ERAS were more likely to enter the low level of rapid decline class,and compared with the moderate level of stable response class,patients with stage III clinical stage,total gastrectomy and more than 3 chronic diseases were more likely to enter the high level of slow decline class.6.Dynamic relationship between developmental trajectory of perioperative symptom groups and unmet needs in patients with gastric cancer:There were statistically significant differences in the scores of unmet needs for care access and extended care among the three classes at time points T1 and T2(P<0.05),and the highest scores at the two time points were in the high level slowly declining class.There were statistically significant differences among the three classes in the dimensions of unmet needs for sharing and emotion and the total scores of unmet needs at T1 and T3 time points(P<0.05),among which the highest scores at the two time points were in the high level slowly declining class;there was no statistical significance in the scores of unmet demand for information and unmet work economy among the three groups at each time(P>0.05).Conclusion1.Patients with gastric cancer experience multiple physical and mental symptoms at various time points during perioperative period.Symptom clusters at various time points are stable,while their severity,intra-group symptom composition and duration are dynamically changing.Medical staff should take preventive and targeted intervention measures according to the characteristics of symptom clusters at different stages of patients.2.The perioperative symptom clusters of patients with gastric cancer were characterized by three heterogeneous tracks,which were divided into moderate stable remission class(C1,56.7%),low level rapid decline class(C2,26.6%)and high level slow decline class(C3,16.7%).Medical staff should conduct individualized targeted symptom management according to their class characteristics and predictors.3.There is a dynamic relationship between the track category of perioperative symptom clusters of patients with gastric cancer and their unmet needs.The unmet needs score at each time point is the highest in the group with high C3 level slowly declining,suggesting that medical staff should formulate targeted intervention measures for different groups of patients to accurately meet the individual needs of patients,so as to alleviate their symptoms and improve their health outcomes. |
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