| Objective This study aims to develop a symptom assessment scale for lymphoma patients which based on the frame of MSAS,a widely-used scale in the world,in order to provide a specific practical tool to the clinical symptom assessment;Then the scale is used to describe the symptom status of lymphoma patients in China and explore the internal composition between symptoms in clusters,so as to lay theoretical foundation for clinical symptom management.Methods Based on the frame of Memorial Symptom Assessment Scale,literature review,semistructured interview and brainstorming were used to construct the lymphoma patient symptom item bank.The Lymphoma Symptom Assessment Scale was formed after expert consult,expression adjustment and pre-test to confirm the reliability and validity.310 adult lymphoma patients in the department of hematology were recuited into a cross-sectional survey,to describe the frequency,severity and distress of symptoms during chemotherapy.,and exploratory factor analysis was used to extract the symptom clusters.Results Through literature review,patient interview and medical staff brainstorming,a total of 40 symptoms were summarized,including physical discomforts and psychological changes caused by the disease and treatment.Expression of five symptoms was adjusted and localized through a patient interview,and two symptoms that not relevant to lymphoma were deleted by expert review.The remaining 38 symptoms combined with the frame of MSAS,was confirmed with good reliability and validity(Cronbach’s α of the scale is 0.800 and the expert content validity is 0.90.)and could be applied in clinical assessment in lymphoma patients.The cross-sectional study showed that the most common symptoms of lymphoma patients during chemotherapy are fatigue,worry,sweating,restless sleep,hair loss,lump,constipation,mouth pain,weight loss and skin changes.The most frequent symptoms include restless sleep,decreased appetite and fatigue.The most serious symptoms are nasal congestion,fever,vomiting,decreased social activity and restless sleep.The most disturbing symptoms are nasal congestion,fever,difficulty swallowing,restless sleep and nausea.Five symptom clusters were found in the cross-sectional study:(1)Side-effect symptom cluster(oral pain,fever,hair loss,night sweats,constipation);(2)Neuropsychological symptom cluster(tension,worry,decreased social activity);(3)Digestion-sleep symptom cluster(nausea,fatigue,restless sleep,decreased appetite);(4)Sickness behavior symptom cluster(dry mouth,feeling drowsy,dizzy,taste change);(5)Skin-related symptom cluster(skin change,numbness,pain,itching,lump).Multidimensional comparison showed that although symptoms in the cluster are not completely the same,the number and characteristic of the symptom clusters could be basically consistent.The severity ratings fit the data better than did the ratings of distress.Conclusion Based on MSAS,a symptom assessment scale which includes 38 symptoms was developed for lymphoma patients.The scale was confirmed with good reliability and validity,and suitable for clinical symptom evaluation of lymphoma patients.Lymphoma patients are troubled with multiple somatic and mental symptoms from disease and treatment during chemotherapy.Self-report and follow-up during chemotherapy intermission should be enhanced and standardized clinical assessment should be conducted to promote better assistance to patients.Five symptom clusters may exist in patients with lymphoma during chemotherapy.Multidimensional comparison confirms the rationality of cluster structure and the existence of stable symptom combinations/symptom pairs,which lay a foundation for verification and biological mechanism research in the future. |
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