Contemporary theoretical models conceptualize symptoms as multidimensional interactive phenomena. This research examined the symptoms experienced by patients on hemodialysis within this paradigm. The intensity (severity), timing (frequency and duration), distress (bother), and concurrence (co-occurring symptoms) associated with symptoms were explored. A multidimensional profile constructed for each of the symptoms demonstrated that those rated as the most severe were not necessarily the most frequently occurring, longest lasting, or most distressing to patients. Symptoms also occurred in groups. Patients reported individual symptoms as increasingly troublesome and quality of life progressively lower as they experienced more of the symptoms in a grouping. These findings suggest the need to view patients' symptom experiences more broadly. Symptom assessment should include the full complement of symptoms patients experience and move beyond the current practice of assessment of severity alone to include all symptom dimensions.
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