Study On The Characteristics Of Core Symptom Cluster And Its Effect On Quality Of Life In Patients With Chronic Obstructive Pulmonary Disease

ObjectiveBased on core symptom score of the chronic obstructive pulmonary disease,the study aims to explore the internal characteristic of core symptom cluster by cluster analysis;identify distinct subgroups who are experiencing four core symptoms with chronic obstructive pulmonary disease;distinguish and analyze risk predication index of high burden of symptoms;and find out the effect of symptom cluster on the life quality of patients in order to provide scientific basis for accurate nursing and efficient management.MethodsBy using convenience sampling method,we choosen 196 patients with chronic obstructive pulmonary disease in the department of respiratory medicine of a tertiary hospital between August 2019 and October 2020 in Shandong Province.The general data of the patients,the scores of symptom in the core symptom cluster(dyspnea-fatigue-anxiety-depression)and the scores of the patients’ life quality were collected.After data collection,SPSS 25.0 software package was used for data analysis.If the measurement data conformed to the positive distribution,it would be described by mean ± standard deviation;if not,it would be described by median and interquaternary interval.Categorical variables were presented by percentage and frequency.An agglomerative hierarchical cluster analysis was performed with squared Euclidean distances used in the proximities matrix and weighted average linkage used as the clustering method.Based on the scores of symptom within the core symptom cluster,the internal characteristics of the symptom cluster were discussed and the symptom subgroup was identified.Nonparametric test,chi-square test and Fisher’s exact probability test were applied to analyze the symptom on different level,differences on life quality and demographic data among different groups.By binary Logistic regression,the factors that affected the subgroup of symptom cluster was explored to determine the distinguishing indexes between groups.At last,stratified regression analysis was used to make sure degree of influence of subgroup on patients’ life quality.Results1.The dyspnea scores of 196 patients with COPD were(2.35±1.25),of which6.63% were mild,22.45% were moderate,and 70.92% were severe;92.9% of the patients had fatigue symptoms,the total score of fatigue was(7.47±4.05);31.63% of the patients were preliminarily screened as having anxiety symptoms with different degrees,and the anxiety total score was(6.06±5.06);36.22% of the patients were screened to have different degrees of depression symptoms,their total score was(6.53±4.20).The quality of life scores were(11.11±4.57),11.73% of COPD patients had good quality of life(0～5 points);33.67% had average quality of life(6～10 points);37.76% had poor quality of life(11～15 points);and 16.84% had very poor quality of life(16～20 points).2.According to agglomerative hierarchical cluster analysis,the core symptom cluster was divided into two subgroups: “All low” subgroup and “All high” subgroup.The two subgroups accounted for 66.33% and 33.67% respectively.The scores of symptoms and quality of life in the “All high” subgroup were higher,and the difference was statistically significant(P<0.05).3.Unifactor analysis showed that there were differences between the two subgroups in age,primary caregiver,residential area,occupation,daily exercise time,home oxygen therapy or not,medication compliance,BMI grade,number of acute exacerbations within one year,Charlson complication index,diagnosis years,pulmonary function grade(P<0.1).Binary Logistic regression analysis showed that between the ages of 40 and 59,inactivity,more than 2 times of acute exacerbations within a year,and higher lung function grade were risk factors of the “All high” subgroup(P < 0.05).4.The hierarchical regression analysis with life quality scores as the dependent variable showed that,compared with a single symptom,symptom clusters subgroups had a more significant impact on life quality,which could independently explain 7.2%variation degree of life quality.Conclusions1.For chronic obstructive pulmonary disease patients,there is a high incidence rate of dyspnea,fatigue,anxiety,depression,among which dyspnea is the most serious.The life quality of the patients is in a poor level.Medical staff should pay attention to the comprehensive evaluation of patients’ symptoms and life quality.2.The symptom cluster including four core symptoms are classified into two subgroups: “All low” subgroup and “All high” subgroup.It could confirm that there are differences between the subgroups when the core symptoms of COPD patients are used as the subgroup heterogeneity index,which may indicate the heterogeneity of the symptom cluster of patients.Thereinto,“All high” subgroup has more severe symptoms and worse life quality.Therefore,health care personnel should focus on evaluating this group,and give them the higher-dose and more targeted intervention programs based on evidence.3.Age,time of daily exercise,number of acute exacerbations within a year,and lung function grade could be used as predictors of the risk in the “All high” subgroup.Medical staff should identify patients at risk in advance and intervene as soon as possible,and give a personalized care plan,for the aim of reducing the burden of patients’ symptoms and the risk of aggravating.4.Symptom cluster is better predictors of changes in quality of life than single symptom.In clinical practice,symptom evaluation and management should be carried out according to the target of symptom cluster and correlations and synergies between symptoms should be emphasized,then we could make targeted interventions to reduce patients’ overall symptomatic experience,for the aim of improving the life quality of patients to a greater extent.