Symptom Management Strategies Research Articles

Patterns of Symptoms Burden in Neuroendocrine Tumors: A Population-Based Analysis of Prospective Patient-Reported Outcomes.

How to best support patients with neuroendocrine tumors (NETs) remains unclear. Improving quality of care requires an understanding of symptom trajectories. Objective validated assessments of symptoms burden over the course of disease are lacking. This study examined patterns and risk factors of symptom burden in NETs, using patient-reported outcomes. A retrospective, population-based, observational cohort study of patients with NETs diagnosed from 2004 to 2015, who survived at least 1 year, was conducted. Prospectively collected patient-reported Edmonton Symptom Assessment System scores were linked to provincial administrative health data sets. Moderate-to-severe symptom scores were presented graphically for both the 1st year and 5 years following diagnosis. Multivariable Poisson regression identified factors associated with record of moderate-to-severe symptom scores during the 1st year after diagnosis. Among 2,721 included patients, 7,719 symptom assessments were recorded over 5 years following diagnosis. Moderate-to-severe scores were most frequent for tiredness (40%-51%), well-being (37%-49%), and anxiety (30%-40%). The proportion of moderate-to-severe symptoms was stable over time. Proportion of moderate-to-severe anxiety decreased by 10% within 6 months of diagnosis, followed by stability thereafter. Changes were below 5% for other symptoms. Similar patterns were observed for the 1st year after diagnosis. Primary tumor site, metastatic disease, younger age, higher comorbidity burden, lower socioeconomic status, and receipt of therapy within 30 days of assessment were independently associated with higher risk of elevated symptom burden. Patients with NETs have a high prevalence of moderate-to-severe patient-reported symptoms, with little change over time. Patients remain at risk of prolonged symptom burden following diagnosis, highlighting potential unmet needs. Combined with identified patient and disease factors associated with moderate-to-severe symptom scores, this information is important to support symptom management strategies to improve patient-centered care. This study used population-level, prospectively collected, validated, patient-reported outcome measures to appraise the symptoms burden and trajectory of patients with neuroendocrine tumors (NETs) after diagnosis. It is the largest and most detailed analysis of patient-reported symptoms for NETs. Patients with NETs present a high burden of symptoms at diagnosis that persists up to 5 years later, highlighting unmet needs. Early and comprehensive symptom screening and management programs are needed. This information should serve to devise pathways and policies to better support patients, evaluate supportive interventions, and assess the effectiveness of symptom management at the provider, institutional, and system levels.

ICanCope With Pain: Cultural Adaptation and Usability Testing of a Self-Management App for Adolescents With Persistent Pain in Norway.

BackgroundPersistent or chronic pain is a common health problem among adolescents. Thus, it is important that they receive evidence-based strategies for symptom management. iCanCope with Pain is a mobile phone app designed to help adolescents cope with chronic pain. The app comprises 5 evidence- and theory-based features: (I) symptom trackers for pain, sleep, mood, physical function, and energy; (II) goal setting to improve pain and function; (III) a coping toolbox of pain self-management strategies; (IV) social support; and (V) age-appropriate pain education. The iCanCope with Pain app is based on theory, identified health care needs, and current best practices for pain self-management.ObjectiveThe objectives of this study were to describe the translation and cultural adaptation of the app into the Norwegian context and evaluate the app’s usability using a phased approach.MethodsPhase 1 included translation and cultural adaptation of the app into the Norwegian context. This process used an expert panel of researchers and target group representatives who were responsible for the linguistic quality assurance and assessment. In phases 2 and 3 the app’s usability was tested. For phase 2, the assessments of usability and user experiences included observation, the think aloud method, audiovisual recordings, questionnaires, and individual interviews in a laboratory setting. For phase 3, the assessment of usability and user experience over a 2-week home-based test included questionnaires and individual end-user interviews. Overall, app usability was determined based on ease of use, efficiency, and user satisfaction. Qualitative data were analyzed using deductive content analysis. Descriptive statistics were calculated for quantitative data.ResultsEnd users did not report any misunderstandings or discrepancies with the words or phrasing of the translated and culturally adapted app. Participants in both the laboratory- and home-based usability tests found the app self-explanatory and reported that all 5 of its features were easy to use. All tasks were completed within the allocated time frame (ie, efficiency), with few errors. Overall System Usability Scale scores were high, with average scores of 82 and 89 out of 100 from laboratory- and field-based tests, respectively. Participants liked the idea of a social support function (feature IV), although qualitative and internet server data revealed that this feature was rarely used.ConclusionsThis study described the cultural and linguistic adaptation and usability testing of the Norwegian version of the iCanCope with Pain app. High user satisfaction, ease of use, efficiency, and only minor errors cumulatively indicated that no changes to the app were needed, with the exception of facilitating user interaction within the social support feature. The app will be used in an upcoming randomized controlled trial with a larger sample.

Reasons for attending support groups and organizational preferences: A replication study using the North American Scleroderma Support Group Survey.

Peer-facilitated support groups are an important source for receiving disease-related information and support for people with systemic sclerosis (or scleroderma). A recent survey explored reasons for attending systemic sclerosis support groups in Europe and Australia and used exploratory factor analysis to group reasons for attendance into three main themes: (1) interpersonal and social support, (2) disease treatment and symptom management strategies, and (3) other aspects of living with systemic sclerosis. The objective of the present study was to replicate this study in a sample of patients from North America using confirmatory factor analysis. A 30-item survey was used to assess reasons for attendance and organizational preferences among systemic sclerosis patients in Canada and the United States. In total, 171 members completed the survey. In the confirmatory factor analysis, the three-factor model showed good fit to the data (χ2(399) = 646.0, p < 0.001, Tucker-Lewis index = 0.97, comparative fit index = 0.97, root mean square error approximation = 0.06). On average, respondents rated 22 (73%) of 30 items as "important" or "very important" reasons for attending support groups. Among organizational preferences, respondents emphasized the importance of the ability to share feelings and concerns, as well as educational aspects. Findings of our study suggest that reasons for attending support groups are similar for patients from Europe, Australia, and North America and that support groups should facilitate social support as well as disease education. These results inform the development of training programs for current and future systemic sclerosis support group leaders across the globe.

Irritable bowel syndrome is underdiagnosed and ineffectively managed among endurance athletes.

Lower gastrointestinal (GI) symptoms are common among endurance athletes and can impair performance. Symptom characteristics are similar to irritable bowel syndrome (IBS). No previous research has examined IBS diagnosis (medically or by diagnostic criteria) within this population. The objectives of this study were to determine the prevalence of IBS among endurance athletes and examine their GI symptom management strategies. A previously validated, online questionnaire assessed IBS diagnosis, the meeting of IBS diagnostic criteria (Rome III or Manning), general GI symptoms, and symptom mitigation strategies of endurance athletes. The questionnaire was distributed to United States athletes completing a marathon, ultra-marathon, half-distance triathlon, or full-distance triathlon. Medically diagnosed IBS was reported by 2.8% of endurance athletes. The total prevalence of IBS (n = 430) was 9.8% (medical diagnosis and Rome III). Athletes with IBS experienced more frequent symptoms during exercise as well as at rest; however, only 47.6% had consulted a medical professional. Over 56% of athletes experienced at least 1 symptom sometimes, often, or always during training and competition and 18.6% had symptoms that sometimes or often interrupted/prevented training. Almost half (45.8%) of athletes and 80.0% of athletes with IBS reported trying nutritional modifications to help ease symptoms while 20.6% and 52.4% used over-the-counter medications, respectively. Novelty Most endurance athletes who suffer from IBS are undiagnosed, while even more experience GI symptoms but do not fit diagnostic criteria. Despite using various symptom management methods, endurance athletes are still experiencing symptoms and could potentially benefit from current IBS-mitigating strategies.

Cuidado espiritual

Objetivo: describir el cuidado espiritual a partir de la revisión de literatura científica relacionada con el cuidado paliativo y su articulación con los componentes del modelo conceptual del manejo de síntomas de Patricia Larson y colaboradores. Metodología: revisión sistemática de la literatura científica sobre cuidado espiritual y paliativo, publicada entre el 2002 y el 2018, siguiendo los lineamientos de Ganong y teniendo en cuenta los componentes del modelo del manejo de síntomas de Patricia Larson y colaboradores: experiencia del síntoma, estrategia de manejo del síntoma y resultado del manejo del síntoma. Resultados: de los 56 artículos identificados inicialmente, 50 cumplieron con los criterios de selección y se clasificaron según los componentes del modelo del manejo de síntomas. Se encontró conceptualización de espiritualidad, escalas de valoración, intervenciones y beneficios del cuidado espiritual en pacientes con necesidades paliativas. Conclusiones: el cuidado espiritual parte de percibir la experiencia del proceso de enfermedad o etapa de fin de vida, para identificar las necesidades espirituales de las personas a través de la valoración con escalas validadas y el uso de diagnósticos relacionados con la dimensión espiritual. Las estrategias de manejo que incluyen el cuidado espiritual comienzan con el acompañamiento y la escucha activa del paciente, de donde se derivan las intervenciones de segundo y tercer nivel descritas en la literatura. Se requiere preparación de los profesionales en enfermería para orientar planes de cuidado espiritual fundamentados desde el modelo que exponen Larson y colaboradores para el manejo de síntomas.

Understanding and Measuring Symptom Burden in Heart Failure: A Concept Analysis.

Heart failure is a common, complex, and costly condition accompanied by a high degree of symptom burden. The concept of heart failure symptom burden has been used and measured inconsistently in research. To develop effective symptom management and palliation strategies, a clear conceptual understanding is needed. Rodgers' evolutionary method of concept analysis was used to identify articles in CINAHL, Embase, Scopus, and PubMed focused on chronic heart failure. Analysis of 20 articles revealed key attributes (subjectivity, negative impact on daily life and/or overall functioning, synergistic symptom associations, and symptom exacerbation), related terms (symptom distress and symptom experience), a surrogate term (heart failure burden), antecedents (heart failure classification or stage), and consequences (increased morbidity/mortality, decreased functioning, increased symptom prevalence/severity, decreased quality of life, and recurrent hospital admissions). No gold standard for measurement was identified. Research is needed to validate heart failure symptom burden measurement strategies across populations.

Symptom management for medically unexplained symptoms in primary care: a qualitative study.

GPs have a central position in the care of patients with medically unexplained symptoms (MUS), but GPs find their care challenging. Currently, little is known about symptom management by GPs in daily practice for patients with MUS. This study aimed to describe management strategies used by GPs when confronted with patients with MUS in daily practice. Qualitative study in which videos and transcripts of 39 general practice consultations involving patients with MUS in the region of Nijmegen in the Netherlands in 2015 were analysed. A thematic analysis of management strategies for MUS used by GPs in real-life consultations was performed. The study revealed 105 management strategies in 39 consultations. Nearly half concerned symptom management; the remainder included medication, referrals, additional tests, follow-up consultations, and watchful waiting. Six themes of symptom management strategies emerged from the data: cognitions and emotions, interaction with health professionals, body focus, symptom knowledge, activity level, and external conditions. Advice on symptom management was often non-specific in terms of content, and ambiguous in terms of communication. Symptom management is a considerable part of the care of MUS in general practice. GPs might benefit from support in how to promote symptom management to patients with MUS in specific and unambiguous terms.

The Association Between Yoga Use, Physical Function, and Employment in Adults With Rheumatoid Arthritis.

Mind-body exercises such as yoga offer patients with rheumatoid arthritis (RA) a symptom management strategy for improving physical and mental health. Studies have evaluated yoga to manage symptoms of RA and improve physical function; however, none has examined the relationship between yoga and work status in adults with RA. The objective was to describe differences in RA symptomatology, physical function scores, and work status between adults with RA who participate in yoga and those who do not. This cross-sectional study surveyed adults with rheumatologist-diagnosed RA regarding yoga use in the past year, symptoms, physical function, and work status. Differences between yoga and non-yoga participation groups were assessed with 2-sided t tests or Pearson χ tests. Multivariate linear regression analyses were conducted to identify significant associations between yoga participation and primary outcomes. The sample included 398 adults with RA; 88% were females, 66% were white, mean age 61.8 years, mean disease duration 24.8 years; 10.6% participated in yoga. Vinyasa, Bikram, Hatha, Iyengar, and restorative yoga styles were practiced, mostly in a group setting. Yoga participants were significantly more likely to work full-time, less likely to be unable to work due to disability, and had better physical function. These findings characterize yoga practice and practitioners among adults with RA. In adults with RA, yoga participation is associated with full-time work status and better physical function than nonparticipation. This study adds additional information to the growing body of literature about adults with RA who practice yoga.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) experiences among COPD patients with comorbid gastrooesophageal reflux disease.

To explore perceptions of experience exacerbations of chronic obstructive pulmonary disease among chronic obstructive pulmonary disease patients with comorbid gastrooesophageal reflux disease by focusing on unravelling how patients differentiate and react to symptoms of chronic obstructive pulmonary disease and gastrooesophageal reflux disease. While gastrooesophageal reflux disease has been suggested to be a risk factor for chronic obstructive pulmonary disease exacerbations, no study has explored perceptions of the symptoms leading up to severe exacerbation of chronic obstructive pulmonary disease events among chronic obstructive pulmonary disease patients with comorbid gastrooesophageal reflux disease. Qualitative design. The analysis was performed in accordance with principles of Grounded Theory methodology. Data were collected via semi-structured interviews from 12 chronic obstructive pulmonary disease patients with endoscopy-diagnosed gastrooesophageal reflux disease who had experienced a chronic obstructive pulmonary disease exacerbation with hospitalisation. Appraisal and analysis using consolidated criteria for reporting qualitative research (COREQ) checklist were undertaken. The core category of this study was the ineffective management of exacerbation symptoms, which was associated with perceived symptoms pre-exacerbation which contained three overlapping categories of symptom presentation experienced, and chronic obstructive pulmonary disease-related coping strategies, high anxiety and a sense of helplessness in disease management. Patients with severe chronic obstructive pulmonary disease with comorbid gastrooesophageal reflux disease presented with some distinctly different atypical symptoms yet used common respiratory symptom management strategies. Patients and practitioners alike need to be more aware of the possibility of other symptoms such as nonspecific symptoms being clues of exacerbation onset for a more effective intervention. The medical community needs to educate patients to understand and manage not only chronic obstructive pulmonary disease but also gastrooesophageal reflux disease symptoms so that they are better able to identify the cause of their symptoms, treat them appropriately and seek out medical assistance when necessary.

A Protocol to Assess Feasibility, Acceptability, and Usability of Mobile Technology for Symptom Management in Pediatric Transplant Patients.

Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress, and the use of mobile health (mHealth) technologies may enhance symptom management by providing patient-generated health data to foster personalized health strategies. The aim of this study was to present a study protocol to explore feasibility, acceptability, and usability of integrating mHealth technologies to collect and monitor symptom data for PBMT patients. An exploratory mixed-methods design is employed for 20 PBMT patients to monitor symptoms using real-time data from two mHealth devices: (a) a self-developed mHealth application and (b) a wearable tracking device. Patient-Reported Outcomes Measurement Information System surveys for fatigue, pain, and sleep disturbance are obtained monthly. Interviews are conducted to obtain further feasibility and usability data. The study began in October 2017; data collection should be completed in 2018. Feasibility and usability results to monitor and record symptom-related data daily via mobile devices will be reported. Patient-Reported Outcomes Measurement Information System surveys and interviews will further explore patients' symptoms and experiences with the mobile devices. This study will be among the first to explore the feasibility, acceptability, and usability of integrating multiple mHealth technologies to obtain patient-generated symptom data for the PBMT population. Results will enhance our understanding of how these data present, interact, and cluster together throughout the posttransplant period for these children and lead to symptom management strategies. Results will focus on a high-risk population that potentially stands to benefit from the use of mobile technologies.

The Art of Living With Symptoms: A Qualitative Study Among Patients With Primary Brain Tumors Receiving Proton Beam Therapy.

BackgroundSymptom management in conjunction with proton beam therapy (PBT) from patient's perspective has not been explored. Such knowledge is essential to optimize the care in this relatively new treatment modality.ObjectiveThe aim of this study was to explore the process of symptom management in patients with brain tumor receiving PBT.MethodsParticipants were 22 patients with primary brain tumor who received PBT, recruited in collaboration with a national center for proton therapy and 2 oncology clinics at 2 university hospitals in Sweden. Interviews using open-ended questions were conducted before, during, and/or after treatment. Verbatim interview transcripts were analyzed using classic Grounded Theory.Results“The art of living with symptoms” emerged as the core concept. This encompassed 3 interconnected symptom management concepts: “Adapting to limited ability,” “Learning about oneself,” and “Creating new routines.” These concepts were summarized in a substantive theoretical model of symptom management. Despite the struggle to manage symptoms, participants lived a satisfactory life.ConclusionsSymptom management in conjunction with PBT comprises a process of action, thoughts, and emotions. The concepts that emerged indicated patients' symptom management strategies were based on their own resources.Implications for PracticeIt is important that PBT facilities develop an approach that facilitates the symptom management process based on patients' experiences of symptoms, as well as their actions and available resources.

Pilot randomized, controlled trial of a dyadic yoga program for glioma patients undergoing radiotherapy and their family caregivers.

While the use of behavioral medicine in managing glioma patients' symptoms is not well studied, the high symptom burden in patients and their family caregivers is well established. We conducted a pilot randomized, controlled trial to examine the feasibility and preliminary efficacy of a dyadic yoga (DY) intervention as a supportive care strategy. Glioma patients undergoing radiotherapy and their caregivers were randomized to a 12-session DY or waitlist control (WLC) group. Prior to radiotherapy and randomization, both groups completed measures of cancer-related symptoms (MD Anderson Symptom Inventory-Brain Tumor module), depressive symptoms (Center for Epidemiological Studies-Depression measure), fatigue (Brief Fatigue Inventory), and overall quality of life (QOL; Medical Outcomes Study 36-item short-form survey). Dyads were reassessed at the last day of radiotherapy. Twenty patients (mean age: 46 years, 50% female, 80% WHO grade IV and caregivers (mean age: 50 years, 70% female, 50% spouses) participated in the trial. A priori feasibility criteria were met regarding consent (70%), adherence (88%), and retention (95%) rates. Controlling for relevant covariates, change score analyses revealed clinically significant improvements for patients in the DY compared with the WLC group for overall cancer symptom severity (d = 0.96) and symptom interference (d = 0.74), depressive symptoms (d = 0.71), and mental QOL (d = 0.69). Caregivers in the DY group reported clinically significant improvements in depressive symptoms (d = 1.12), fatigue (d = 0.89), and mental QOL (d = 0.49) relative to those in the WLC group. A DY intervention appears to be a feasible and beneficial symptom and QOL management strategy for glioma patients undergoing radiotherapy and their caregivers. An efficacy trial with a more stringent control group is warranted. NCT02481349.

Integrating Mobile Health Technology for Symptom Management in Acute Pediatric Blood and Marrow Transplant Patients

Introduction: Pediatric Blood and Marrow Transplant (PBMT) is an intense treatment fraught with significant symptom burden for patients. Mobile health (mHealth) and wearable technologies provide patient generated health data which may enhance understanding of complex symptom patterns, trajectories, and interactions. Improved monitoring and understanding may result in the development of precision symptom management strategies, yet limited research exists for integrating these technologies into acute patient care.Methods: We conducted a pilot study to determine the feasibility of integrating mHealth technology into symptom management for PBMT patients. Patient data includes: 1) an Apple Watch to collect objective data (heart rate, daily step count), and 2) a self-developed app to collect subjective symptom data. Patients were followed for up to 120 days, which could include both inpatient and outpatient days. Patients were asked to record within the mobile app daily and keep the wearable device (Apple Watch) on throughout each day and night with removal only to charge.The number of days the mobile app and wearable device were used by each patient was assessed to determine compliance to study protocol. In addition, transplant, engraftment, hospital discharge, and study discharge dates were used as 4 discrete time points to determine study feasibility. For transplant and engraftment, the patient must have recorded in the app within a week of the event to be considered an interaction to account for increased fatigue and duress during these times. On completion of the study, patients also completed feasibility questionnaires and interviews.Results: Twelve patients were approached and 10 patients enrolled in the study. Three patients withdrew early from the study citing the devices were to difficult to manage with their health status. Of the remaining 7 patients included in analysis, one went to the ICU on day 40. On average, the 7 patients charted data in the app for an average of 46.10% of their days involved in the study and the most commonly reported symptoms included pain (52%), fatigue (13%), fever (9%), and rash (9%). Patients wore the wearable device during 40.29% of their total days in the study. From their compiled 551 days in the study, this equates to 254 total days of app interaction and 222 days of using the wearable (Figure 1). Four patients completed all four discrete time points. Two patients are currently in the study (one has completed hospital discharge but not study discharge, and one has completed transplant and engraftment). For app interaction during discrete time points, the patients interacted with the mobile app 17 of 23 times. Furthermore, there was a 100% app usage during transplant and engraftment periods. When evaluating the app data jointly with the wearable data, it was determined that 71% of patients were interactive with the app and used the wearable device during transplant and 57% of patients were compliant with both the app and wearable device during engraftment.Interview data of all patients at study completion (n=4) found the devices easy to use, useful, and helpful, with comments: “I liked it because it was easy to keep track of how I felt. I liked looking back and comparing how I felt as the days went by”. However, when they felt poorly, they didn't use them as frequently, “sometimes I just didn't feel good and didn't want to use them”.Conclusion: There has been significant patient interest in participating in the study with the majority of patients approached also enrolling in the study. Study patients had variable compliance, which on average was nearly every other day. Limitations to app included patient fatigue and forgetfulness. Pain, itching, and battery life limited wearable compliance. Our findings suggest it is feasible to obtain data from mobile devices, although need to account for gaps in data due to significant symptoms and complications. Daily data collection may be difficult for acutely ill PBMT patients, however, combining both active and passive data collection measures may improve symptom cluster understanding and result in better symptom management interventions and strategies. DisclosuresShah:Novartis: Research Funding, Speakers Bureau.

Survey of Integrative Medicine in Myeloproliferative Neoplasms (The SIMM Study-2)

Background:Polycythemia vera (PV), essential thrombocytosis (ET), and myelofibrosis (MF) are chronic myeloproliferative neoplasms (MPNs) characterized by clonal cell proliferation, splenomegaly, and significant symptom burden. Integrative medicine interventions may offer unique symptom management strategies. (Gowin, et al., EHA 2017). Here we describe integrative interventions utilized and association with symptom burden, quality of life, depression, and fatigue adjusted for lifestyle confounders.Methods:Patients were recruited via social media. Consent and online self-report surveys were completed capturing patient demographics, disease-specific data, integrative medicine utilization, symptom burden via MPN-Symptom Assessment Form Total Symptom Score (MPN-SAF TSS), depression screening via Patient Health Questionnaire (PHQ)-2, fatigue via Brief Fatigue Inventory (BFI), and overall quality of life (QoL). MPN-SAF TSS, QoL, BFI, and PHQ2 were compared by participation in the most frequently utilized interventions (Yes vs No). Intervention comparisons were adjusted for alcohol consumption, smoking status, BMI, current dietary modification, and MPN type using multiple linear and logistic regression.Results:Patients:A total of1087 patient surveys were consented. Of these, 858 had 10 or more responses. See Table 1 for patient characteristics.Integrative Medicine Therapies Descriptive Analysis:Integrative medicine therapies most frequently utilized by patients included aerobic activity (51.5%), massage (28.4%), yoga (25.6%), nutrition (25.2%), strength training (23.8%), acupuncture (19.3%), meditation (19%), breathing exercises (18.4%), chiropractic (16.2%), support groups (14.5%), mindfulness based stress reduction (13.6%), walking meditation (12.0%), pet therapy (9.4%), aromatherapy (8.6%), music therapy (8.0%), progressive muscle relaxation (7.0%), guided imagery (6.4%), homeopathy (6.3%), manual therapy (osteopathy/cranial sacral) (6.2%), reiki (5.8%), therapeutic touch (5.7%), Tai Chi (5.2%), art therapy (4.9%), traditional Chinese medicine (4.3%), Qigong (3.5%), cooking classes (3.0%), laughter therapy (2.9%), Ayurveda (2.4%), biofeedback (2.2%), dance therapy (2.1%), hypnosis (2.0%), resilience training (0.9%), IV vitamin therapy (0.8%), and narrative medicine (storytelling) (0.3%).Diet modification was reported in 47.7% of patients, including Mediterranean diet (19.0%), paleo/high protein/low carbohydrate (8.9%), vegetarian (8.6), plant based (5.2%), gluten free (5.2%), low FODMAP (1.8%), vegan (1.2%), and raw (0.6%) diets. Only 24% of patients reported receiving nutrition advice from their healthcare practitioner (HCP).Supplement utilization by MPN type was 162 patients (48.4%)in ET, 80 patients (42.8%) in MF, and 142 patients (45.2%) in PV. Overall, 20.6% patients reported not disclosing their natural product usage to their HCP. The most frequently utilized supplements included vitamin D, multivitamin, magnesium, omega 3, and calcium.Adjusted symptom association with integrative therapy intervention:MPN symptom burden: Aerobic activity (P=<.001)and strength training (P=.01) was associated with lower mean symptom burden. Use of massage (P=<001) and support groups (P=<.001) was associated with higher levels of symptom burden.QOL:Higher quality of life was reported in those receiving massage (P=.04)and support groups (P=.002). Lower quality of life was noted in those using aerobic activity (P=<.001)and strength training (P=.001).Depression (PHQ-2):Lower depression screening score was noted in those participating in aerobic activity (P=.006), yoga (P=.03), and strength training (P=.02).Fatigue (BFI):Lower fatigue was noted in those participating in aerobic activity (P=<.001) and strength training (P=.03). Higher fatigue was noted in those participating in massage (P=<.001) and breathing techniques (P=.02). See Table 2.Conclusion:In a geographically diverse MPN patient population, and when adjusting for healthy lifestyle practices overall, patterns of lower symptom burden, fatigue, depression, and higher QoL were revealed with integrative medicine utilization. Although limited by gender discrepancy and patient reported data, this study may offer a foundation to structure future integrative medicine trials to complement standard therapies in MPN patients. [Display omitted] DisclosuresGowin:Incyte: Consultancy, Other: Scientific Advisory Board, Speakers Bureau. Mesa:UT Health San Antonio - Mays Cancer Center: Employment; Promedior: Research Funding; NS Pharma: Research Funding; CTI Biopharma: Research Funding; Genentech: Research Funding; Gilead: Research Funding; Incyte Corporation: Research Funding; Novartis: Consultancy; Pfizer: Research Funding; Celgene: Research Funding.

Identification of symptom clusters and their synergistic effects on quality of life in rheumatoid arthritis patients.

To examine the presence of symptom clusters and synergistic effects of symptom clusters on quality of life in rheumatoid arthritis patients. Rheumatoid arthritis patients frequently experience multiple concurrent symptoms of pain, fatigue, and depression. A nonexperimental, cross-sectional correlation design. The study participants were 179 rheumatoid arthritis patients. Data were collected between August and December 2016. A hypothetical model was developed based on the Theory of Unpleasant Symptoms Model: physiological antecedents included disease activity and obesity; symptoms of pain, fatigue, and depression were hypothesized as being clustered, and quality of life was taken as the outcome variable. Disease activity had significant direct effects on pain, fatigue, and depression and indirect effects on fatigue and depression, whereas obesity had a significant direct effect on fatigue alone. Three symptom clusters, namely, pain fatigue, fatigue depression, and pain-fatigue depression were identified and found to have significant synergistic effects on quality of life. Our findings support the importance of managing clusters of symptoms simultaneously, that is, collective symptom management. Inter-cluster dynamics between symptoms should be considered when nurses develop symptom management strategies or self-management programs to improve the quality of life of rheumatoid arthritis patients.

Examination of Current Treatments and Symptom Management Strategies Used by Patients With Mal De Debarquement Syndrome.

Introduction: Mal de Debarquement Syndrome (MdDS) is a neurological disorder which affects the vestibular system pathways, manifesting as a constant sensation of movement in the form of rocking, bobbing, or swaying. The mechanism of MdDS is poorly understood and there is a lack of awareness amongst medical professionals about the condition. This study aimed to examine treatments and symptom management strategies used by MdDS patients and evaluate their self-reported effectiveness.Method: Motion-Triggered and Spontaneous/Other onset MdDS patients responded to a set of comprehensive questions as a retrospective survey regarding epidemiological details, diagnostic procedures, onset, and symptom triggers, hormonal influences as well as treatments and symptom management strategies used to reduce symptoms. The Motion-Triggered questionnaire was made available through Survey Monkey and the Spontaneous/Other Onset questionnaire through Qualtrics. The link for each questionnaire was made available on online MdDS support groups and on various research websites. Descriptive statistics were used for epidemiological data and Pearson's Chi Square tests were used for comparisons between and within both subtype groups.Results: A total of 370 patients participated in the surveys, with 287 valid responses collected for the section regarding treatment and symptom management strategies. The success of the treatments and symptom management strategies did not vary between subtypes Benzodiazepines/Antidepressants were reported as being most beneficial in reducing symptoms in both groups.Conclusion: This was the first attempt to evaluate the reported success of treatments and symptom management strategies in MdDS patients by assessing the patients' perceived helpfulness. The treatments and symptom management strategies reported to be the most helpful in managing and/or reducing symptoms are proposed to be effective due to their stress-reducing capacities. We hope this study will broaden MdDS awareness and that this study will increase patient knowledge regarding treatments and symptom management strategies that other patients found helpful.

Testing Strategies to Improve Hand Circulation and Reduce Symptoms Among Administrative Assistants

Abstract Date Presented 4/20/2018 The effectiveness of two thermal modalities to improve hand circulation and decrease symptoms was tested. Results indicated no changes in hand strength and perfusion but showed improved functionality. Findings contribute to research concerning strategies for hand symptom management and prevention. Primary Author and Speaker: Ashley Lee Contributing Authors: Dragana Krpalek, Heather Javaherian-Dysinger, Doug Rakoski, Traci Marin

Physical Activity Intensity is Associated with Symptom Distress in the CNICS Cohort.

Symptom distress remains a challenging aspect of living with HIV. Physical activity is a promising symptom management strategy, but its effect on symptom distress has not been examined in a large, longitudinal HIV-infected cohort. We hypothesized that higher physical activity intensity would be associated with reduced symptom distress. We included 5370 people living with HIV (PLHIV) who completed patient-reported assessments of symptom distress, physical activity, alcohol and substance use, and HIV medication adherence between 2005 and 2016. The most frequent and burdensome symptoms were fatigue (reported by 56%), insomnia (50%), pain (46%), sadness (45%), and anxiety (45%), with women experiencing more symptoms and more burdensome symptoms than men. After adjusting for age, sex, race, time, HIV medication adherence, alcohol and substance use, site, and HIV RNA, greater physical activity intensity was associated with lower symptom intensity. Although individual symptoms may be a barrier to physical activity (e.g. pain), the consistent association between symptoms with physical activity suggests that more intense physical activity could mitigate symptoms experienced by PLHIV.

Modelo conceptual del manejo del síntoma: evaluación y crítica

Objetivos: evaluar, analizar y criticar el modelo conceptual del manejo del síntoma a partir de los pasos planteados por Fawcett en 2013, y mostrar la relevancia que tiene este ejercicio académico en el área investigativa, tanto a nivel académico como asistencial en enfermería. Materiales y métodos: se realizó una búsqueda sistemática de piezas de investigación, las cuales fueron sometidas a un proceso de lectura crítica por medio de la aplicación de las siguientes herramientas: Critical Appraisal Skills Programme (CAPS) para las piezas de investigación cualitativas, MacMaster University para la piezas de investigación de tipo cuantitativo, el rigor metodológico y la estructura conceptual teórico-empírica planteada por Fawcett en 2013, con lo cual se garantizó la calidad de las piezas de investigación seleccionadas. Resultados: se logró identificar los planteamientos del Modelo conceptual del manejo del síntoma y de investigaciones donde se utilizó este modelo como marco teórico para realizar una evaluación y crítica de este, en la que se tuvieron en cuenta: sus orígenes, el enfoque único del modelo, su congruencia lógica, la generación de teoría, su credibilidad y las contribuciones para la disciplina de enfermería, que corresponden a los pasos recomendados por Fawcett para la evaluación crítica de modelos conceptuales. Conclusión: a pesar de ser un modelo conceptual nuevo cuenta con fuertes bases teóricas y filosóficas que permiten su aplicación a cualquier fenómeno referente a la experiencia de los síntomas; sin embargo, se debe realizar más investigación donde se haga uso de las dimensiones de “los componentes de estrategias de manejo de los síntomas” y “resultados”, ya que un amplio volumen de investigación realizada hasta el momento ha hecho uso de la dimensión “la experiencia de los síntomas”.

Questionnaire on Irritable Bowel Syndrome and Symptom Management Among Endurance Athletes Is Valid and Reliable.

Gastrointestinal symptoms are reported in a large proportion of endurance athletes, with similarities in symptom type and distribution to irritable bowel syndrome (IBS). The objective of this study was to develop and validate a questionnaire to assess IBS diagnoses or fit to IBS diagnostic criteria in this population along with nutritional habits, gastrointestinal symptoms, and symptom management strategies. A 93-item Endurance Athlete Questionnaire was developed to address the objective, targeted at American endurance athletes completing a marathon, ultra-marathon, half-distance triathlon, and/or full-distance triathlon that year. Content validity was established by expert reviewers (n = 6), and face validity was evaluated by endurance athletes (n = 9). Test-retest reliability was assessed by target athletes (n = 51). Participants completed two rounds of the questionnaire, separated by 1-2weeks. Results were analyzed using Pearson and Spearman correlations and paired comparisons. Slight modifications in wording and three demographic questions were added based on the input of expert and athlete reviews. Pearson correlation coefficient of test-retest total questionnaire scores was significant at 0.839 (P < 0.001). Paired comparison of individual questions found significant differences in 10 of 236 analyzed responses; however, these did not affect fit to IBS diagnostic criteria for those without other GI diseases/disorders. The Endurance Athlete Questionnaire proved to be a valid and reliable measure of IBS diagnostic criteria, gastrointestinal symptoms, nutritional habits, and symptom management strategies among endurance athletes. Future implementation will help inform gastroenterologists with endurance athlete patients and can elucidate whether certain behaviors could be contributing to athlete gastrointestinal symptoms.