Burden of living with multiple concurrent symptoms in patients with end-stage renal disease.

Aims And Objectives: To explore the experience of multiple concurrent symptoms over time and their impact on daily living in patients with end-stage renal disease undergoing dialysis.

Background: Patients undergoing dialysis experienced multiple concurrent symptoms because of the disease and treatment. Evidence suggests that these symptoms cluster around and have a significant impact on quality of life. However, the experience of this impact remained not clear.

Design: A longitudinal descriptive qualitative study.

Methods: Ten patients were purposely selected from the cohort of a longitudinal quantitative study in Hong Kong. A total of 28 face-to-face semi-structured interviews were conducted between July 2017 and July 2018. Interviews were audiotaped, transcribed and analysed using a thematic analysis approach. Findings were reported following the COREQ checklist.

Results: Four themes emerged from the data. The first theme "complex symptom experience" described a dynamic pattern of symptoms among patients. Although patients were unaware of the relationships among symptoms, a cluster of tiredness, breathlessness, dizziness and sleep disturbance was identified in the narratives of individual symptoms. The report of symptom experience and its change revealed a unique pattern of symptom perception. The three other themes illustrated the impact of multiple concurrent symptoms on daily living, namely "decreased physical functioning," "changes in social functioning" and "diet and fluid restrictions."

Conclusions: Patients perceived dynamic and complex symptom experiences. This perception appears to be modulated by a number of factors. In addition, these experiences had negative and positive effects on patients' daily living.

Relevance To Clinical Practice: Patients perceived unique impact of symptoms on daily living. Therefore, a nurse-led person-centred approach of care is warranted. In addition to routine symptom assessment, nurses need to capture the specific impact of symptoms on day-to-day life. Based on this assessment, symptom management interventions (e.g. health education, referral) can be tailor-made and prioritised.