| ObjectiveTo establish the symptom clusters of NPC patients by exploratory factor analysis,and to determine the type and internal composition of the symptom clusters of NPC patients during radiotherapy.To follow up and investigate the change trend of the symptom clusters and comfort status of NPC patients at different time points(every week)during radiotherapy,and to explore the relationship between them.It is hoped that the study can provide reference for symptom management and lay a foundation for comfortable nursing.MethodsWith convenient sampling method,153 NPC patients who were treated with radiotherapy in two Grade-A hospitals in Qingdao from September 2018 to June 2019 were recruited as the study objects.They were investigated by General Data Questionnaire,MDASI-HN and Radiotherapy Comfort Questionnaire after weekly radiotherapy(T1?T6).SPSS 21.0 software was used for data analysis.The measurement data was described by mean±standard deviation,and the counting data was described by frequency and composition ratio.The symptom clusters were constructed by exploratory factor analysis,and Cronbach's ? was used to evaluate the reliability of symptom clusters.The number of symptoms,the severity of symptom and symptom clusters,and the score of comfort condition were compared by ANOVA.The relationship between symptom clusters and comfort condition were analyzed by Pearson correlation analysis.Results1.During T1?T6 radiotherapy,the number of symptoms increased from(4.58±1.29)to(14.56±2.58),of which,T2?T3 symptoms increased the fastest,and the number of T5?T6 symptoms tended to change smoothly.The incidence and severity of each symptom increased with the accumulation of radiation dose.The main symptom experiences of patients in different stages were different.2.A total of 5 symptom clusters were extracted.The occurrence time and internal symptom composition of symptom clusters changed with the progress of radiotherapy.Among them,fatigue sleep emotion symptom cluster and oral mucosa symptom cluster persisted at 6 time points T1?T6;dysphagia symptom cluster and gastrointestinal symptom cluster appeared at T3 and lasted to T6;nervous system related symptom cluster only existed at T6.There was a significant difference in the severity of symptom clusters at different time points(F=43.369?688.434,P<0.05),among which the symptom cluster of oral mucosa was more serious.3.The overall comfort level of NPC patients decreased with the progress of radiotherapy,and the score of each time point fluctuated from(85.84±8.30)to(104.44±9.71).In the scores of comfort in all dimensions of NPC patients,the comfort in physiological dimension and psychological dimension decreased with the increase of radiotherapy times,and decreased to the lowest level in T6.However,the social dimension comfort increased with the increase of radiotherapy times,and the social comfort level was the lowest in T1;the change of environmental dimension comfort level increased first and then decreased with the increase of radiotherapy times,reaching the peak in T2,then decreased in T2,and the lowest in T6.By repeated measurement analysis of variance,the scores of overall comfort and comfort in all dimensions of NPC patients at different time points were statistically significant(F=9.152?260.826,P<0.05).4.The symptom clusters of NPC patients at all time points during radiotherapy were negatively correlated with their overall comfort(r=-0.194?-0.892,P<0.05).In the correlation analysis of the symptom clusters and the comfort status of each dimension,there were negative correlations between the symptom clusters and the physiological comfort status during T1?T6(r=-0.214?-0.883,P<0.05).In addition,the fatigue sleep emotion symptom cluster and the oral mucosa symptom cluster were highly negatively correlated with their psychological comfort and environmental comfort during T1?T6(r=-0.249?-0.794,P<0.05);There were positive correlations between oral mucosa symptom cluster,dysphagia symptom cluster and social dimension comfort during T5?T6(r=0.163?0.184,P<0.05).ConclusionThere are many symptoms and heavy burden in NPC patients during radiotherapy.The symptoms that need to be observed and controlled at different time points of radiotherapy are different.By tracking the change of symptom clusters,we find that thedynamic of symptom clusters are not only reflected in the change of severity,but also in the duration and internal composition.The symptom clusters of NPC patients at each time point during radiotherapy are negatively correlated with the overall comfort status,suggesting that the management of symptom clusters could improve the comfort level of patients and lay a foundation for providing comprehensive comfortable nursing. |
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