Symptom Distress And Symptom Management Behavior In Bladder Cancer Patients Three Months After Radical Cystectomy

Objective:To identify symptom distresses,symptom clusters,self-management behaviors and the related factors in patients with bladder cancer three months after radical cystectomy.Methods:The combined methods of qualitative and quantitative researches are used,the objects were patients with bladder cancer three months after radical cystectomy.1.A cross sectional design was used to investigate 99 patients of bladder cancer three months after radical cystectomy.Data were collected by demographic and disease characteristic questionnaires,the symptom experience scale of the MD Anderson symptom inventory,two additional symptoms specific to radical cystectomy,and the functional assessment of cancer therapy questionnaire-G.Factor analysis,stepwise regression,and correlation analysis were applied.2.The phenomenological methodology was used.The semi structured interviews were conducted in 10 patients selected from the quantitative research before,and then Nvivo 11 software was used for content analysis to extract the themes.Results:1.The most severe symptom of patient was distress,followed by fatigue and urinary function.There are 56.6% patients presented with more than four concurrent symptoms at moderate and severe levels.Three symptom clusters were identified: fatigue-malaise,nausea-vomiting,and psycho-urinary.Age,complication degree,albumin post-surgery(negative),orthotropic neobladder,adjuvant chemotherapy and American Society of Anesthesiologists(ASA)scores were significant predictors of fatigue-malaise.Adjuvant chemotherapy,orthotropic neobladder,female gender,ASA scores and albumin(negative)were significant predictors of nausea-vomiting symptoms.Not being married,higher educational level and complication degree were significant predictors of psycho-urinary symptoms.The correlations between clusters and each cluster with quality of life are significant,and the maximum correlation was between the psycho-urinary cluster and quality of life(r=0.685).2.The theoretical model of symptom management behavior was established.The core themes is unmet need.Two themes was included: one is the symptom management style,three vice themes included: active response,negative response and potential risky response;the other is the influence factors,three vice themes included too: symptom experience,self-efficiency,and social support.Conclusions:1.Bladder cancer patients experience concurrent symptoms that appear to cluster and are significantly correlated with quality of life.Moreover,symptom clusters could be predicted by certain demographic and clinical characteristics.2.The symptom management behavior is not good.To meet the need of symptom management of patient,the socialsupport,symptom experience and self-efficacy should be considered in an integrated manner.