症状群:症状管理研究的新前沿。

Symptom clusters: the new frontier in symptom management research.

作者信息

Miaskowski Christine, Dodd Marylin, Lee Kathryn

机构信息

Department of Physiological Nursing, University of California, San Francisco, 94143-0610, USA.

出版信息

J Natl Cancer Inst Monogr. 2004(32):17-21. doi: 10.1093/jncimonographs/lgh023.

Abstract

The majority of clinical studies on pain, fatigue, and depression associated with cancer are focused on one symptom. Although this approach has led to some advances in our understanding of a particular symptom, patients rarely present with a single symptom. Therefore, even though research focused on single symptoms needs to continue, it is imperative that symptom management research begins to focus on evaluating multiple symptoms, using cross-sectional and longitudinal study designs. In addition, research needs to focus on evaluating the relationships among multiple symptoms, specific interventions, and patient outcomes. One of the initial challenges in research regarding multiple symptoms is the terminology that should be used to describe the concept (e.g., symptom cluster, symptom constellation). Another significant area related to this aspect of symptom management research is determining the nature of clinically significant clusters of symptoms and their associated prevalence rates. Equally important is the need to determine what types of tools/instruments will provide the most valid and reliable data for the assessment of symptom clusters. Other areas that need to be considered as related to the assessment of symptom clusters include the establishment of cut points for symptom severity that would qualify a symptom for inclusion in a cluster; the focus of the assessment; and the choice of the outcome measures that will be used to judge the effect of a symptom cluster on the patient. In the area of intervention studies for symptom clusters, research will need to build on the limited number of clinical trials with single symptoms. Additional considerations related to research on symptom clusters include the determination of the mechanisms underlying the development of symptom clusters; the timing of the measurements for symptom clusters; and statistical challenges in the evaluation of symptom clusters. Research on symptom clusters in patients with cancer is cutting-edge science and a new frontier in symptom management research, and it needs to be done in tandem with research on single symptoms.

摘要

大多数关于癌症相关疼痛、疲劳和抑郁的临床研究都聚焦于单一症状。尽管这种方法在我们对特定症状的理解上取得了一些进展,但患者很少仅表现出单一症状。因此,尽管专注于单一症状的研究仍需继续,但症状管理研究必须开始聚焦于使用横断面和纵向研究设计来评估多种症状。此外,研究需要聚焦于评估多种症状、特定干预措施和患者结局之间的关系。关于多种症状的研究最初面临的挑战之一是用于描述该概念的术语(例如,症状群、症状组合)。与症状管理研究这一方面相关的另一个重要领域是确定具有临床意义的症状群的性质及其相关患病率。同样重要的是需要确定哪些类型的工具/仪器将为症状群的评估提供最有效和可靠的数据。与症状群评估相关的其他需要考虑的领域包括确定症状严重程度的切点,该切点将使症状有资格纳入症状群;评估的重点;以及用于判断症状群对患者影响的结局指标的选择。在症状群的干预研究领域,研究将需要以有限数量的单一症状临床试验为基础。与症状群研究相关的其他考虑因素包括确定症状群发展的潜在机制;症状群测量的时间;以及症状群评估中的统计挑战。癌症患者症状群的研究是前沿科学,也是症状管理研究的新领域,需要与单一症状的研究同步进行。

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