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Symptom clusters in people living with HIV attending five palliative care facilities in two sub-Saharan African countries: A hierarchical cluster analysis

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Symptom clusters in people living with HIV attending five palliative care facilities in two sub-Saharan African countries: A hierarchical cluster analysis. / ENCOMPASS; EURO IMPACT.
In: PLoS ONE, Vol. 10, No. 5, e0126554, 12.05.2015.

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@article{c8f94c042b464f6389540c0221b10bf4,
title = "Symptom clusters in people living with HIV attending five palliative care facilities in two sub-Saharan African countries: A hierarchical cluster analysis",
abstract = "Background: Symptom research across conditions has historically focused on single symptoms, and the burden of multiple symptoms and their interactions has been relatively neglected especially in people living with HIV. Symptom cluster studies are required to set priorities in treatment planning, and to lessen the total symptom burden. This study aimed to identify and compare symptom clusters among people living with HIV attending five palliative care facilities in two sub-Saharan African countries. Methods: Data from cross-sectional self-report of seven-day symptom prevalence on the 32-item Memorial Symptom Assessment Scale-Short Form were used. A hierarchical cluster analysis was conducted using Ward's method applying squared Euclidean Distance as the similarity measure to determine the clusters. Contingency tables, X2 tests and ANOVA were used to compare the clusters by patient specific characteristics and distress scores. Results: Among the sample (N=217) the mean age was 36.5 (SD 9.0), 73.2% were female, and 49.1% were on antiretroviral therapy (ART). The cluster analysis produced five symptom clusters identified as: 1) dermatological; 2) generalised anxiety and elimination; 3) social and image; 4) persistently present; and 5) a gastrointestinal-related symptom cluster. The patients in the first three symptom clusters reported the highest physical and psychological distress scores. Patient characteristics varied significantly across the five clusters by functional status (worst functional physical status in cluster one, p<0.001); being on ART (highest proportions for clusters two and three, p=0.012); global distress (F=26.8, p<0.001), physical distress (F=36.3, p<0.001) and psychological distress subscale (F=21.8, p<0.001) (all subscales worst for cluster one, best for cluster four). Conclusions: The greatest burden is associated with cluster one, and should be prioritised in clinical management. Further symptom cluster research in people living with HIV with longitudinally collected symptom data to test cluster stability and identify common symptom trajectories is recommended.",
author = "ENCOMPASS and {EURO IMPACT} and Katrien Moens and Siegert, {Richard J.} and Steve Taylor and Eve Namisango and Richard Harding and Lucy Selman and Godfrey Agupio and Natalya Dinat and Julia Downing and Liz Gwyther and Thandi Mashao and Keletso Mmoledi and Tony Moll and Sebuyira, {Lydia M.} and Barbara Ikin and Higginson, {Irene J.} and {Van Den Block}, Lieve and {De Groote}, Zeger and Sarah Brearley and Augusto Caraceni and Joachim Cohen and Francke, {Anneke L.} and Stein Kaasa and Karen Linden and Guido Miccinesi and Bregje Onwuteaka-Philipsen and Koen Pardon and Roeline Pasman and Sophie Pautex and Sheila Payne and Deliens Luc",
year = "2015",
month = may,
day = "12",
doi = "10.1371/journal.pone.0126554",
language = "English",
volume = "10",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "5",

}

RIS

TY - JOUR

T1 - Symptom clusters in people living with HIV attending five palliative care facilities in two sub-Saharan African countries

T2 - A hierarchical cluster analysis

AU - ENCOMPASS

AU - EURO IMPACT

AU - Moens, Katrien

AU - Siegert, Richard J.

AU - Taylor, Steve

AU - Namisango, Eve

AU - Harding, Richard

AU - Selman, Lucy

AU - Agupio, Godfrey

AU - Dinat, Natalya

AU - Downing, Julia

AU - Gwyther, Liz

AU - Mashao, Thandi

AU - Mmoledi, Keletso

AU - Moll, Tony

AU - Sebuyira, Lydia M.

AU - Ikin, Barbara

AU - Higginson, Irene J.

AU - Van Den Block, Lieve

AU - De Groote, Zeger

AU - Brearley, Sarah

AU - Caraceni, Augusto

AU - Cohen, Joachim

AU - Francke, Anneke L.

AU - Kaasa, Stein

AU - Linden, Karen

AU - Miccinesi, Guido

AU - Onwuteaka-Philipsen, Bregje

AU - Pardon, Koen

AU - Pasman, Roeline

AU - Pautex, Sophie

AU - Payne, Sheila

AU - Luc, Deliens

PY - 2015/5/12

Y1 - 2015/5/12

N2 - Background: Symptom research across conditions has historically focused on single symptoms, and the burden of multiple symptoms and their interactions has been relatively neglected especially in people living with HIV. Symptom cluster studies are required to set priorities in treatment planning, and to lessen the total symptom burden. This study aimed to identify and compare symptom clusters among people living with HIV attending five palliative care facilities in two sub-Saharan African countries. Methods: Data from cross-sectional self-report of seven-day symptom prevalence on the 32-item Memorial Symptom Assessment Scale-Short Form were used. A hierarchical cluster analysis was conducted using Ward's method applying squared Euclidean Distance as the similarity measure to determine the clusters. Contingency tables, X2 tests and ANOVA were used to compare the clusters by patient specific characteristics and distress scores. Results: Among the sample (N=217) the mean age was 36.5 (SD 9.0), 73.2% were female, and 49.1% were on antiretroviral therapy (ART). The cluster analysis produced five symptom clusters identified as: 1) dermatological; 2) generalised anxiety and elimination; 3) social and image; 4) persistently present; and 5) a gastrointestinal-related symptom cluster. The patients in the first three symptom clusters reported the highest physical and psychological distress scores. Patient characteristics varied significantly across the five clusters by functional status (worst functional physical status in cluster one, p<0.001); being on ART (highest proportions for clusters two and three, p=0.012); global distress (F=26.8, p<0.001), physical distress (F=36.3, p<0.001) and psychological distress subscale (F=21.8, p<0.001) (all subscales worst for cluster one, best for cluster four). Conclusions: The greatest burden is associated with cluster one, and should be prioritised in clinical management. Further symptom cluster research in people living with HIV with longitudinally collected symptom data to test cluster stability and identify common symptom trajectories is recommended.

AB - Background: Symptom research across conditions has historically focused on single symptoms, and the burden of multiple symptoms and their interactions has been relatively neglected especially in people living with HIV. Symptom cluster studies are required to set priorities in treatment planning, and to lessen the total symptom burden. This study aimed to identify and compare symptom clusters among people living with HIV attending five palliative care facilities in two sub-Saharan African countries. Methods: Data from cross-sectional self-report of seven-day symptom prevalence on the 32-item Memorial Symptom Assessment Scale-Short Form were used. A hierarchical cluster analysis was conducted using Ward's method applying squared Euclidean Distance as the similarity measure to determine the clusters. Contingency tables, X2 tests and ANOVA were used to compare the clusters by patient specific characteristics and distress scores. Results: Among the sample (N=217) the mean age was 36.5 (SD 9.0), 73.2% were female, and 49.1% were on antiretroviral therapy (ART). The cluster analysis produced five symptom clusters identified as: 1) dermatological; 2) generalised anxiety and elimination; 3) social and image; 4) persistently present; and 5) a gastrointestinal-related symptom cluster. The patients in the first three symptom clusters reported the highest physical and psychological distress scores. Patient characteristics varied significantly across the five clusters by functional status (worst functional physical status in cluster one, p<0.001); being on ART (highest proportions for clusters two and three, p=0.012); global distress (F=26.8, p<0.001), physical distress (F=36.3, p<0.001) and psychological distress subscale (F=21.8, p<0.001) (all subscales worst for cluster one, best for cluster four). Conclusions: The greatest burden is associated with cluster one, and should be prioritised in clinical management. Further symptom cluster research in people living with HIV with longitudinally collected symptom data to test cluster stability and identify common symptom trajectories is recommended.

U2 - 10.1371/journal.pone.0126554

DO - 10.1371/journal.pone.0126554

M3 - Journal article

C2 - 25966420

AN - SCOPUS:84930614402

VL - 10

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 5

M1 - e0126554

ER -