Exploration of symptom clusters during hemodialysis and symptom network analysis of older maintenance hemodialysis patients: a cross-sectional study

Abstract

Background Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have established networks of symptoms experienced by older patients on maintenance hemodialysis. To examine the type of symptom clusters of older maintenance hemodialysis patients during dialysis and construct a symptom network to understand the symptom characteristics of this population. Methods The modified Dialysis Symptom Index was used for a cross-sectional survey. Network analysis was used to analyze the symptom network density and node characteristics, and factor analysis was used to examine symptom clusters. Results The symptom burdens with the highest scores were dry skin, dry mouth, itching, and trouble staying asleep. Five symptom clusters were obtained from exploratory factor analysis, of which the clusters with the most severe symptom burdens were the gastrointestinal discomfort symptom cluster, sleep disorder symptom cluster, skin discomfort symptom cluster, and mood symptom cluster. Based on centrality markers, it could be seen the feeling nervous and trouble staying asleep had the highest strength, and feeling nervous and feeling irritable had the highest closeness and betweenness. Conclusions Hemodialysis patients have a severe symptom burden and multiple symptom clusters. Dry skin, itching, and dry mouth are sentinel symptoms in the network model; feeling nervous, feeling irritable, and trouble staying asleep are core symptoms of patients; feeling nervous and feeling irritable are bridge symptoms in this symptom network model. Clinical staff can formulate precise and efficient symptom management protocols for patients by using the synergistic effects of symptoms in the symptom clusters based on sentinel symptoms, core symptoms, and bridge symptoms.

Identifying central symptoms and central symptom clusters in acute myeloid leukemia patients receiving chemotherapy: A network analysis

“…Based on our ndings and previous studies, we concluded that psychological symptoms, including feeling sad, worrying, feeling nervous, panic, depression, and anxiety, were central symptoms for patients, affecting other symptoms negatively. 17,36,37 These ndings imply that clinical staff and researchers should understand the psychological states and cognitive processes of AML patients receiving chemotherapy. Additionally, it was reported that mindfulness-based interventions, meaningenhancing interventions, dignity therapy, life review, and aromatherapy could relieve the psychological burden of patients and promote positive moods, which may be essential for the emotional management of adult AML patients 34,38 .…”

“…An NA can provide supplementary data for a clinical paradigm, including strength, closeness, and betweenness data, which may contribute to developing more specialized treatments and pertinent management 14 . To date, NA studies have been conducted in patients with chronic diseases, including cancer, mental disorders, hemodialysis, and HIV [15][16][17][18] . For example, a historical cross-sectional study revealed that worrying and feeling irritable were the central symptoms across three centrality indices in 469 children with AL during chemotherapy 19 .…”