Symptom cluster, healthcare use and mortality in patients with severe chronic obstructive pulmonary disease

1. Soo Kyung Park PhD, RN Assistant Professor^1,*,
2. Janet L Larson PhD, RN Professor²

Journal of Clinical Nursing

Keywords:

• chronic obstructive pulmonary disease;
• healthcare use;
• mortality;
• National Emphysema Treatment Trial;
• symptoms

Aims and objectives

To examine how subgroups of patients with chronic obstructive pulmonary disease, identified by ratings of symptoms (dyspnoea, anxiety, depression and fatigue), affect healthcare use and mortality.

Background

People with chronic obstructive pulmonary disease often experience multiple symptoms. The importance of multiple symptoms and symptom clusters has received increased attention. However, little is known about symptom clusters and their effect on healthcare use and mortality in this population.

Design

Descriptive cross-sectional study.

Methods

This secondary data analysis used data from the National Emphysema Treatment Trial. Participants (n = 597) had severe chronic obstructive pulmonary disease. Descriptive and inferential statistics were used to analyse the data that were drawn from structured interviews, questionnaires and clinical measures.

Results

Three subgroup clusters emerged based on four symptom ratings. Mean age, proportion with higher education, proportion using oxygen, disease severity, exercise capacity and quality of life differed significantly between subgroups. Participants with high levels of symptoms used healthcare services more and were more likely to have died at the five-year follow-up than those with low levels of symptoms. Symptom cluster subgroups had more significant relationship with mortality than single symptoms.

Conclusion

Patients with high levels of symptoms require greater clinical attention.

Relevance to clinical practice

Understanding subgroups of patients, based on symptom ratings and their adverse effect on outcomes, may enable healthcare providers to assess multiple symptoms and identify subgroups of patients at risk of increased healthcare use and mortality. Targeting modifiable symptoms within the cluster may be more beneficial than focusing on a single symptom for certain health-related outcome.