Longitudinal Study Of The Symptom Clusters In Colostomy Patients

Objective: To develop the Symptom Assessment Scale for Chinese colostomy patients,and contribute tools to similar research. Analysis the symptom clusters change process incolostomy patients at different period (two weeks after surgery, a month after surgery,3months after surgery), lay the foundation for the medical staff to take prospectiveintervention measures, and improve the quality of survival.Methods: Through the literature review and group discussions, the items pool ofsymptom assessment scale for colostomy patients was developed. Then, the items pool wasscreened by Delphi method,292colostomy patients were recruited by convenient samplingin this study, with internal consistency Cronbach’s α coefficient between dimensions,correlation coefficient R and factor analysis method verify the reliability and validity of thescale, Finally the colostomy patients’ symptom assessment scale was formed.103colostomy patients were recruited by convenient sampling in this study, by thequestionnaire method, using the percentage demographic characteristics, describe clinicalcharacteristics, symptoms and the quantitative data the frequency, by describe symptomseverity and qualitative material, analysis the change of the symptom cluster at differentperiod (two weeks after surgery, a month after surgery,3months after surgery) by thelongitudinal survey method.Results:1, Building the Symptom Assessment Scale for colostomy patients, whichcontains46items, the principal component analysis and the maximum variance method forrotating exploratory factor analysis results extraction to8factors and3separate items, andthe cumulative contributed up to71.8%, and the Cronbach’s α is0.910, the individualCronbach’s α coefficient between0.731to0.937, with good content consistency, accordingto the requirement of psychometric.2, Four symptom clusters were found at three time points: psychological symptomcluster, lack of energy symptom cluster, appetite drops-excrete symptom cluster and painsymptom cluster. The kind and severity of symptoms in symptom clusters are different ateach time point.Four symptom clusters were found at2weeks after surgery:(1) psychological symptom cluster, including12symptoms. The symptoms occur infrequency from high to low in turn for: decreased sense of well-being (2.24±0.785), down(2.18±0.764), social disorder (2.01±0.834), grief (1.95±0.821), excessive attention focused on stoma (1.91±0.786), insomnia (1.83±0.792), anxiety (1.97±0.845), inferiority(1.82±0.764), charm decrease (1.91±0.887), stress (1.81±0.793), loneliness (1.61±0.854)and irritable (1.50±0.862), its occurrence frequency respectively is:87.4%,84.5%,74.8%,69.0%,69.0%,69.0%,68.93%,67%,65.05%,63.10%,42.72%,31.07%.(2)lack of energy symptom cluster, including five symptoms. The symptoms occur infrequency from high to low in turn for: weight loss (1.79±0.750), fatigue (1.72±0.692),dry mouth (1.34±0.587), sweating (1.34±0.587) and fever (1.29±0.571), its occurrencefrequency respectively is:61.17%,58.25%,28.16%,28.16%,25.24%.(3) appetite drops-excrete symptom cluster, including four symptoms. The symptomsoccur in frequency from high to low in turn for: dysuria (1.51±0.655), decreased appetite(1.51±0.670), feces with mucous in colostomy bag (1.42±0.552) and the mucous fromoriginal anus (1.42±0.552), its occurrence frequency respectively is:43.69%,41.75%,38.83%,38.83%.(4) pain symptom cluster, including three symptoms. The symptoms occur infrequency from high to low in turn for: hip, rectal or rectum pain (1.36±0.521), abdominalpain (1.33±0.617) and the anus and rectum straining feeling (1.28±0.513), its occurrencefrequency respectively is:33.98%,26.21%,25.24%.After one month concluded that four symptoms set:(1) psychological symptom cluster, including12symptoms. The symptoms occur infrequency from high to low in turn for: decreased sense of well-being (2.06±0.557), down(2.15±0.733), social disorder (2.04±0.803), grief (1.83±0.663), excessive attention focusedon stoma (1.79±0.588), inferiority (1.69±0.543), charm decrease (1.71±0.588), stress(1.73±0.674), anxiety (1.65±0.696), loneliness (1.57±0.620), insomnia (1.56±0.621) andirritable (1.27±0.528), its occurrence frequency respectively is:88.34%,85.43%,78.64%,69.90%,69.90%,65.05%,64.08%,61.17%,52.43%,50.48%,49.51%,24.27%.(2) lack of energy symptom cluster, including three symptoms. The symptoms occurin frequency from high to low in turn for: weight loss (1.74±0.641), fatigue (1.38±0.487),dry mouth (1.32±0.528), its occurrence frequency respectively is:64.08%,37.86%,29.13%.(3)appetite drops-excrete symptom cluster, including three symptoms. The symptomsoccur in frequency from high to low in turn for: decreased appetite (1.41±0.513), mucousfrom original anus (1.42±0.552), feces with mucous in colostomy bag (1.33±0.512), itsoccurrence frequency respectively is:39.81%,38.83%,31.07%. (4) pain symptom cluster, including four symptoms. The symptoms occur infrequency from high to low in turn for: abdominal pain (1.30±0.461), rectal or rectumstraining feeling (1.27±0.447), hip, rectal or rectum pain (1.29±0.457) and skinsurrounding the stoma pain (1.30±0.539), its occurrence frequency respectively is:30.10%,29.13%,27.18%and21.36%.3months after draw four symptoms set:(1) psychological symptom clusterⅠ, including six symptoms. The symptoms occurin frequency from high to low in turn for: social disorder (1.86±0.627）, grief (1.72±0.493）,attention, excessive attention focused on stoma (1.70±0.461）, inferiority (1.66±0.496）,charm decrease (1.68±0.546) and lonely (1.50±0.502), its occurrence frequencyrespectively is:72.82%,69.90%,69.90%,65.05%,64.08%,50.49%.(2) psychological symptom cluster Ⅱ, including six symptoms. The symptoms occurin frequency from high to low in turn for: depression (1.92±0.458), decreased sense ofwell-being (1.99±0.551), stress (1.65±0.555), anxiety (1.53±0.520), insomnia (1.44±0.554)and irritable (1.23+/-0.425), its occurrence frequency respectively is:85.44%,84.47%,61.17%,52.43%,40.77%,23.30%.(3) lack of energy symptom cluster, including three symptoms. The symptoms occurin frequency from high to low in turn for: weight loss (1.50±0.540), fatigue (1.31±0.486)and dry mouth (1.29±0.457), its occurrence frequency respectively is:48.54%,30.10%,29.13%.(4) appetite drops-excrete symptom cluster, including three symptoms. The symptomsoccur in frequency from high to low in turn for: mucous from original anus (1.39±0.490),decreased appetite (1.40±0.548), feces with mucous in colostomy bag (1.34±0.516), itsoccurrence frequency respectively is:38.83%,36.89%,32.04%.3, Analysis the severity of symptom clusters at three time points, from high to lowsort are: psychological symptom cluster (1.89±0.65,1.75±0.48,1.66±0.35), lack of energysymptom cluster (1.50±0.47,1.48±0.44,1.37±0.35), Appetite drops-excrete symptomcluster(1.47±0.52,1.39±0.42,1.38±0.41),and pain symptom cluster (1.32±0.41,1.29±0.37,0).And each severity of the symptom clusters decreased correspondingly with time.4, analysis the differences of the symptom clusters severity in temporary andpermanent Colostomy patient at three time points: The differences of the psychologicalsymptom cluster (including psychological symptoms set Ⅱ) severity, all showed that P <0.05, the difference was statistically significant. The differences of the lack of energy symptom cluster severity, only at two weeks after surgery shows P <0.05, are statisticallysignificant differences, and at a month after surgery and3months after surgery, show P>0.05, the difference was not statistically significant. The differences of Appetitedrops-excrete symptom clusterseverity, only at3months after surgery shows P <0.05,are statistically significant differences, and at two weeks and one month after surgery,show P>0.05, the difference was not statistically significant. The differences of the painsystem symptom cluster severity, all showed that P>0.05, the difference was notstatistically significant.Conclusion.1, initially constructs the Symptom Assessment Scale for Chinese colostomy patients,is suitable for the assessment of Chinese patients’ symptom. It has showed good reliabilityand validity, indicating that the scale is credible and feasible in China.2, four symptom clusters found at three time points: psychological symptoms cluster,lack of energy symptoms cluster, appetite drops-excrete symptom cluster and painsymptoms cluster. Each time point symptom clusters includes symptoms and severity ofthe symptom were different.3,severity of the psychological symptoms cluster were highest at three time points,And each severity of the symptom clusters decreased correspondingly with time.4, analysis the differences of the symptom clusters severity in temporary andpermanent Colostomy patient at three time points: the psychological symptom clusterseverity of permanent Colostomy patients were higher than the temporary Colostomypatient at three time points; the lack of energy symptom cluster severity of permanentColostomy patients were less than the temporary Colostomy patient at two weeks aftersurgery; appetite drops-excrete symptom clusterof permanent Colostomy patients wereless serious than the temporary Colostomy patient at3months after surgery.