Journal of Clinical Nursing最新文献

Aims: To identify symptom clusters in haematological malignancy patients during chemotherapy and determine the factors associated with different symptom clusters.

Design: A cross-sectional study.

Method: Convenience sampling was used to investigate haematological malignancy patients hospitalised for chemotherapy at a tertiary teaching hospital in Chengdu, China, from January 2021 to December 2023. Participants completed the Chinese version of the Condensed Memorial Symptom Assessment Scale. Hierarchical cluster analysis was used to identify symptom clusters; univariate analyses and logistic regression analyses were used to determine their related factors. This study was reported following the STROBE checklist.

Results: A total of 600 participants were included in the study. We have identified the psychological, sleep, pain-fatigue, gastrointestinal-asthenia symptom clusters in haematological malignancy patients during chemotherapy. Binary logistic regression analysis indicated that being female and having lactate dehydrogenase levels of 220 IU/L or higher are associated with an increased risk for the psychological symptom cluster. The sleep symptom cluster is more likely to occur in females, those with a prognostic nutritional index < 45, lactate dehydrogenase ≥ 220 IU/L and platelet-to-lymphocyte ratio ≥ 107.85. Female, the prognostic nutritional index < 45 and age ≥ 60 years are correlated with the pain-fatigue symptom cluster. The gastrointestinal-asthenia symptom cluster is related to female, a diagnosis of acute leukaemia or lymphoma, lactate dehydrogenase ≥ 220 IU/L and prognostic nutritional index < 45.

Conclusion: Adult haematological malignancy patients undergoing chemotherapy experience multiple symptoms that can be further divided into four symptom clusters. The occurrence of symptom clusters is influenced by a combination of patient sociodemographic characteristics, disease conditions and biochemical indicators.

Relevance to clinical practice: The symptom burden is a major issue for haematological malignancy patients during chemotherapy. Health caregivers should focus on the connection between symptoms rather than individual symptoms when developing and providing interventions. Identifying the factors influencing symptom clusters in haematological malignancy patients should be the basis for accurate, efficient and cost-effective interventions.

Patient or public contribution: The patients completed the questionnaires during the data collection in this study.

Background: Surrogates make decisions for critically ill patients in intensive care units (ICUs). Because such decisions are critical, many surrogates experience decisional conflict, which can lead to long-term regret and psychological distress. Understanding surrogates' needs during decision-making, particularly when invasive procedures are involved, is essential to improving patient outcomes.

Aim: To identify and analyse the needs of surrogates and the decisional conflict they experience during the decision-making process for invasive procedures in ICUs.

Methods: This convergent, parallel, mixed-methods study was conducted at a tertiary medical centre in southern Taiwan. Eligible participants were surrogates aged 20 years or older. The patients represented by these surrogates had a Glasgow Coma Scale (GCS) score of < 12 and were expected to undergo at least one invasive procedure. Quantitative data were collected from 100 surrogates using a structured questionnaire assessing decisional conflict and needs, and qualitative data were obtained through in-depth interviews with 13 surrogates.

Results: The following factors were significantly associated with decisional conflict: lower education level (β = -6.24, p = 0.042), lower family income (β = -9.91, p = 0.027), and resuscitative types of invasive procedure (β = -6.40, p = 0.045). Information needs were the most critical because information is often overwhelming without a medical background. Meeting surrogates' support needs, including the need for support from family members, can help reduce isolation in decision-making. The findings also indicate that internal resources played a key role in alleviating decisional conflict in surrogates.

Conclusion: The informational, support, and resource needs of surrogates play a critical role in decision-making for invasive procedures. Their informational needs primarily indicate difficulties in comprehending and integrating complex medical information within a limited timeframe. Clear, structured communication and emotional support may reduce decisional conflict and long-term regret.