Sarna L
School of Nursing, University of California, Los Angeles, USA.
Oncol Nurs Forum. 1998 Jul;25(6):1041-8.
PURPOSE/OBJECTIVES: To test the efficacy of structured symptom assessment on level and rate of change in symptom distress over time.
Prospective six-month randomized control trial.
Outpatient oncology offices and clinics in California.
48 subjects newly diagnosed with advanced lung cancer, predominantly non-small cell. Most subjects received chemotherapy, 50% were women, and their average age was 62 years. 190 observations were analyzed.
Subjects were assigned randomly to structured assessment or usual care. Both groups completed the Symptom Distress Scale (SDS) monthly. After bivariate screening of potential predictors, a multivariate regression model for level and rate of change in SDS scores was created.
Symptom distress, functional status, and emotional distress.
Fatigue was the most common severely distressing symptom. In a multivariate model, chemotherapy and systematic assessment were associated with less symptom distress over time. Higher scores in depression and more functional limitations were related to higher levels of overall distress. Weight loss had a small impact.
Systematic use of structured symptom assessment forestalled increased symptom distress over time. Chemotherapy lessened symptom distress, but the impact diminished with time. Subjects with more depression and greater functional limitations had greater symptom distress.
During the course of advanced lung cancer, systematic ongoing nursing assessment of symptoms may be the first step in enhancing interventions to decrease distress. Patients at highest risk for symptom distress are those who experience emotional distress and functional limitations.
目的/目标：检验结构化症状评估对症状困扰程度及随时间变化率的疗效。
前瞻性为期六个月的随机对照试验。
加利福尼亚州的门诊肿瘤科室和诊所。
48名新诊断为晚期肺癌的患者，主要为非小细胞肺癌。大多数患者接受化疗，50%为女性，平均年龄62岁。共分析了190次观察结果。
将患者随机分配至结构化评估组或常规护理组。两组均每月完成症状困扰量表（SDS）。在对潜在预测因素进行双变量筛选后，建立了SDS评分水平及变化率的多变量回归模型。
症状困扰、功能状态和情绪困扰。
疲劳是最常见的严重困扰症状。在多变量模型中，化疗和系统评估与随时间推移症状困扰减轻相关。抑郁得分较高和功能受限较多与总体困扰水平较高相关。体重减轻影响较小。
系统使用结构化症状评估可预防随时间推移症状困扰增加。化疗减轻了症状困扰，但随着时间推移影响减弱。抑郁程度较高和功能受限较大的患者症状困扰更严重。
在晚期肺癌病程中，系统持续的护理症状评估可能是加强干预以减轻困扰的第一步。症状困扰风险最高的患者是那些经历情绪困扰和功能受限的患者。
