University of Utah & Primary Children's Hospital, Salt Lake City, Utah, USA.
Children's Mercy Hospital, Kansas City, Missouri, USA.
J Pain Symptom Manage. 2019 Nov;58(5):774-783. doi: 10.1016/j.jpainsymman.2019.07.008. Epub 2019 Jul 16.
Cancer and symptom experiences of adolescents and young adults (AYAs) with cancer can be highly variable, creating challenges for clinicians and researchers who seek to optimize AYAs' health outcomes. Understanding the heuristics AYAs use to designate priority symptoms can provide insight into the meaning they assign to their symptoms and self-management behaviors.
This study described the frequency and characteristics of priority symptoms. It qualitatively explored reasons for a symptom's designation as a priority symptom, perceived causes of priority symptoms, and strategies AYAs use to manage priority symptoms.
Participants in this single-group, longitudinal study reported symptoms using a heuristics-based symptom reporting tool, the Computerized Symptom Capture Tool, at two scheduled visits for chemotherapy. AYAs designated priority symptoms and responded to three short answer questions: What makes this a priority symptom?, What do you think causes it?, and What do you do to make it better?
Eighty-six AYAs, 15-29 years of age (median 19 years), identified 189 priority symptoms. Priority symptoms were of greater severity (t = 3.43; P < 0.01) and distress (t = 4.02; P < 0.01) compared with nonpriority symptoms. Lack of energy, nausea, difficulty sleeping, and pain comprised 39% of priority symptoms. Reasons for priority designation included the impact of the symptom and the attributes of the symptom. Categories of self-management strategies included "Physical Care Strategies," "Things I take (or not)," and "Psychosocial Care Strategies."
Supporting AYAs to identify their priority symptoms may facilitate a more personalized approach to care. Seeking the patient's perspective regarding priority symptoms could enhance patient-clinician collaboration in symptom management.
青少年和年轻成人（AYA）癌症患者的癌症和症状体验可能高度多变，这给寻求优化 AYA 健康结果的临床医生和研究人员带来了挑战。了解 AYA 用于指定优先症状的启发式方法可以深入了解他们对症状和自我管理行为的理解。
本研究描述了优先症状的频率和特征。它从定性角度探讨了症状被指定为优先症状的原因、优先症状的潜在原因以及 AYA 用于管理优先症状的策略。
参加这项单组、纵向研究的参与者使用基于启发式的症状报告工具，即计算机化症状采集工具，在化疗的两次预定就诊时报告症状。AYA 确定了优先症状，并回答了三个简短的问题：是什么使这个成为优先症状？你认为是什么导致的？你做什么来使它好转？
86 名年龄在 15-29 岁（中位数 19 岁）的 AYA 确定了 189 个优先症状。与非优先症状相比，优先症状的严重程度（t=3.43；P<0.01）和困扰程度（t=4.02；P<0.01）更高。乏力、恶心、睡眠困难和疼痛占优先症状的 39%。优先指定的原因包括症状的影响和症状的属性。自我管理策略的类别包括“身体护理策略”、“我服用（或不服用）的东西”和“心理社会护理策略”。
支持 AYA 识别其优先症状可能有助于采用更个性化的护理方法。寻求患者对优先症状的看法可以增强患者与临床医生在症状管理方面的合作。
