期刊
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
卷 64, 期 6, 页码 555-566出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jpainsymman.2022.08.018
关键词
Signs and symptoms; cancer; chronic obstructive pulmonary disease; heart failure; type 2 diabetes mellitus; surveys and questionnaires
资金
- National Institutes of Health, National Institute of Nursing Research [P30 NR016587, R00 NR017651]
- National Institutes of Health [1 OT2 OD026549, 1 OT2 OD026554, 1 OT2 OD026557, 1OT2 OD026556, 1 OT2 OD026550, 1 OT2 OD 026552, 1 OT2 OD026553, 1 OT2 OD026548, 1 OT2 OD026551, 1 OT2 OD026555, AOD 16037, HHSN 263201600085U, 5 U2C OD023196, 1 U24 OD023121, U24 OD023176, 1 U24 OD023163, 3 OT2 OD023205, 3 OT2 OD023206, 1 OT2 OD025277, 3 OT2 OD025315, 1 OT2 OD025337]
- National Institutes of Health, Office of the Director: Regional Medical Centers [1 OT2 OD026549, 1 OT2 OD026554, 1 OT2 OD026557, 1OT2 OD026556, 1 OT2 OD026550, 1 OT2 OD 026552, 1 OT2 OD026553, 1 OT2 OD026548, 1 OT2 OD026551, 1 OT2 OD026555]
- National Institutes of Health, Office of the Director: IAA [AOD 16037]
- National Institutes of Health, Office of the Director: Federally Qualified Health Centers [HHSN 263201600085U]
- National Institutes of Health, Office of the Director: Data and Research Center [5 U2C OD023196]
- National Institutes of Health, Office of the Director: Biobank [1 U24 OD023121]
- National Institutes of Health, Office of the Director: Participant Center [U24 OD023176]
- National Institutes of Health, Office of the Director: Participant Technology Systems Center [1 U24 OD023163]
- National Institutes of Health, Office of the Director: Communications and Engagement [3 OT2 OD023205, 3 OT2 OD023206]
- National Institutes of Health, Office of the Director: Community Partners [1 OT2 OD025277, 3 OT2 OD025315, 1 OT2 OD025337, 1 OT2 OD025276]
The study aims to identify symptom phenotypes of patients with four common chronic conditions and understand the factors predicting membership in these phenotypes. The results reveal different symptom phenotypes and find meaningful relationships between demographic, healthcare access and utilization, and health-related factors and symptom phenotypes.
Context. Over half of American adults are diagnosed with a chronic condition, with an increasing prevalence being diag-nosed with multiple chronic conditions. These adults are at higher risk for having unrelieved, co-occurring symptoms, known as symptom clusters. Objectives. To identify symptom phenotypes of patients diagnosed with four common chronic conditions, specifically, can-cer, chronic obstructive pulmonary disease, heart failure, and/or type 2 diabetes mellitus, and to understand factors that predict membership in symptomatic phenotypes. Methods. We conducted a retrospective, cross-sectional analysis using participant responses (N=14,127) to All of Us Research Program, a National Institutes of Health biomedical database, survey questions. We performed hierarchical clustering to gener-ate symptom phenotypes of fatigue, emotional distress, and pain and used multinomial regression to determine if demographic, healthcare access and utilization, and health-related variables predict symptom phenotype. Results. Four phenotypes, one asymptomatic or mildly symptomatic and three highly symptomatic (characterized by severe symptoms, severe pain, and severe emotional distress), were identified. The percentage of participants belonging to the severe symptoms phenotype increased with the number of chronic conditions. Most notably, foregoing or delaying medical care and rating men-tal health as poor or fair increased the odds of belonging to a highly symptomatic phenotype. Conclusion. We found meaningful relationships between demographic, healthcare access and utilization, and health-related factors and symptom phenotypes. With the increasing trends of American adults with one or more chronic conditions and a demand to individualize care in the precision health era, it is critical to understand the factors that lead to unrelieved symptoms. J Pain Symptom Manage 2022;64:555-566. (c) 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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