P-152 YI A Modified Theory of Unpleasant Symptoms for Inflammatory Bowel Disease

Abstract

BACKGROUND: People with IBD experience multiple distressing symptoms that are associated with reduced quality of life. Symptoms are a subjective multidimensional experience that do not occur isolation; but rather, occur in clusters. IBD healthcare providers infrequently ask about the impact of symptoms on quality of life. In addition, there has been a lack of consistency in IBD symptom research. The gap between practice, research and patient experience may be due to lack of a theory base. Research and practice without theory has limited structure, organization of knowledge, and ability to describe, explain and predict. SIGNIFICANCE TO NURSING PRACTICE: A focus of nursing is to “eliminate and manage symptoms causes by illness.” Using theory to guide research, assessment, and treatment of symptoms has the potential to lead to effective symptom assessment and symptom management interventions and thus reduce symptom burden and increase quality of life. METHODS: Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched. Search terms included: inflammatory bowel disease, ulcerative colitis, Crohn's disease, symptoms and quality of life and limited to English. RESULTS: Thirty-two articles were reviewed. No explicit theories were used in any of the articles. While multiple symptoms were assessed in the articles only the impact of individual symptoms was explored. Pain, fatigue, diarrhea, depression and anxiety were the most commonly occurring symptoms in IBD, persisted in remission, and were associated with reduced quality of life, and reduced ability to work and participate in leisure activities. However, none of the studies asked about disturbed sleep, which is common in IBD. The Theory of Unpleasant Symptoms was modified for IBD. The theory includes influencing factors (psychological factors, physiologic factors, and situational factors) symptom experience (pain, fatigue, diarrhea, depression, anxiety, and sleep disturbance) and performance (quality of life, ability to participate in leisure activities, and work). CONCLUSIONS: Symptom research in IBD lacks structure and thus has not been able to comprehensively capture the symptom experience in IBD; thus the research has a limited ability to guide practice. The modified Theory of Unpleasant Symptoms for IBD may capture the unique symptom experience in IBD and provides a framework for symptom management in practice and research to advance this important area. Research is needed to test this modified theory to determine its usefulness. Additional research is needed to explore the interaction of multiple symptoms as symptoms rarely occur in isolation. Methods, such as symptom clusters, are needed to understand multiple symptoms. IMPLICATIONS TO IBD NURSING PRACTICE: Nurses need to assess for multiple symptoms in a multidimensional way in IBD and to assess for the impact of symptoms. Symptom management is urgently needed in IBD. Symptom assessment and symptom management interventions need to be based on relevant theories such as the Modified Theory of Unpleasant Symptoms for IBD and empiric evidence. (Figure Presented).