Correlation Between Symptom Clusters and Self-Management Among Maintenance Haemodialysis Patients: A Cross-Sectional Study

Abstract

Aims and Objectives: The purpose of this study was to explore the relationship between symptom clusters and self-management among maintenance haemodialysis (MHD) patients. Background: MHD patients experience disease progression and multiple symptom burdens that severely impact quality of life, and self-management of symptoms may significantly improve patient-reported outcomes. Design: A cross-sectional study. Methods: This cross-sectional descriptive study included 194 patients undergoing MHD. The patients were assessed using the Dialysis Symptom Index (DSI) and the Haemodialysis Self-Management Instrument (HD-SMI). We used descriptive analysis, exploratory factor analysis, Pearson's correlation analysis and linear regression analysis to examine (1) the level of individual self-management, (2) the presence of symptom clusters by symptom severity and (3) the correlation between symptom clusters and self-management behaviours. This study was conducted in accordance with the STROBE checklist. Results: The top five most severe symptoms among the patients were itching, feeling tired or lack of energy, difficulty sleeping, dry mouth and dry skin. We identified five groups of symptoms: (1) poor sleep, (2) neuromuscular, (3) gastrointestinal, (4) skin irritation and (5) psychological. In the present study, MHD patients reported low to moderate levels of self-management behaviours (50.84 ± 10.56), and low self-management ability was correlated with greater severity of the five symptom clusters (p < 0.01). Linear regression analysis revealed that all five symptom clusters were included in the regression equation, explaining 30% of the total variance in self-management skills among MHD patients. Conclusion: Enhanced awareness of symptom clusters and comprehensive symptom management are necessary to improve patients' quality of life. Clinical Relevance: Nursing practices should incorporate comprehensive symptom assessments to help patients develop effective self-management strategies to improve quality of life.