A Study Of The Symptomatic Experience Of Kidney Transplant Recipients Based On A Symptomatic Experience Model

Objective:(1)to describe the symptoms experience by kidney transplant recipients and explore the symptom clusters;(2)to explore the influencing factors of symptom clusters among kidney transplant recipiennts;(3)to analyze the relationship among the antecedent(demographic characteristics,disease characteristics and individual characteristics),symptom experience and the quality of life of kidney transplant recipients by structural equation modeling.Methods:This was a cross-srctional survey.By convenient sampling method,295 kidney transplant recipients were recruited when they visited the transplant follow-up clinic in Tianjin First Center Hospital from October in 2017 to January in 2018.The demographic characteristics,disease characteristics,individual characteristics,symptom experience and the quality of life were measured with general questionnaire,Sense of Coherence-13(SOC-13),Revised Life Orientation Test(LOT-R),symptom questionnaire and the MOS 36-item Short Form Health Survey(MOS SF-36).Results:(1)In this study,kidney transplant recipients experienced a median of 18 symptoms(range:0 to 60).There were five highest prevalence of symptoms including thinning of hair/hair loss(61.02%),trembling hands(60.34%),excessive appetite(59.66%),concentration or memory problems(58.31%)and tiredness(54.92%);thinning of hair/hair loss,concentration or memory problems,joint pain,difficulty seeing well and diarrhea were the most severe symptoms;impotence(for male recipients persons only),cognitive decline,swollen glands,shortness of breath and changed sense of taste were the most distressing symptoms.(2)Through exploratory factor analysis,a total of 5 symptom clusters were extracted,namely,emotional-sleep symptom cluster(anxiety,restlessness/nervousness,depression,mood swings,nightmares,sleep difficulties and palpitations),pain-gastrointestinal symptom cluster(chest pain,back pain,wind,diarrhea,muscle aches,stomach complaints/nausea/vomiting and joint pain),immune-related symptom cluster(swollen gums,brittle fingernails,bruises,sores on lips or in mouth and tiredness),lack of energy symptom cluster(poor appetite,changed sense of taste,constipation,lack of energy and brittle skin)and visual dysfunction symptom cluster(difficulty seeing well,sensitivity to light and muscle cramps),which explained 50.53%of the variance of symptom experience.The Cronbach’s a coefficients of symptom clusters were 0.888,0.830,0.758,0.801,and 0.692,respectively.(3)Multivariate analysis showed that the main factors related to the emotional-sleep symptom cluster were the sense of coherence,post-transplant period and the type of ISM,which explained 31.3%of the variance of emotional-sleep symptom cluster;the main factors related to the pain-gastrointestinal symptom cluster were the sense of coherence,transplantation period and complication,which explained 18.2%of the variance of pain-gastrointestinal cluster;the main factors related to the immune-related symptom cluster were the sense of coherence,post-transplant period,complications and the type of ISM,which explained 21.0%of the variance of immune-related cluster;the main factors related to the lack of energy symptom cluster were the sense of coherence,post-transplant period and age,which explained 26.3%of the variance of lack of energy cluster;the main factors related to the visual dysfunction symptom cluster were the sense of coherence,age and complications,which explained 14.9%of the variance of visual dysfunction cluster.(4)In this study,the physical component summary of quality of life was directely predicted by age,complications,sense of coherence and symptom experience;the mental component summary of quality of life was directely predicted by sense of coherence and symptom experience.In addition,symptom experience mediated between the antecedent and quality of life.Conclusion:Kidney transplant recipients experienced a complex series of symptoms and some symptoms which were related to each other formed a symptom cluster.There were many factors which could affect symptom cluster and some symptom clusters had common influencing factors.Therefore,comprehensive symptom management strategies are required.Besides,the symptom experience mediated between the antecedent and the quality of life which can provide a theoretical basis for the health care providers.