Symptom severity, hospice patient distress not necessarily linked

Feb 20 2013

By Sarah Guy, medwireNews Reporter

End-stage heart failure patients (HF) being treated in hospices have multiple symptoms with potential to cause distress, indicate US study findings.

However, the symptoms with the greatest severity are not necessarily those that cause the greatest distress, conclude the researchers in the Journal of Hospice and Palliative Nursing.

Patients in the study reported experiencing an average of 12 concurrent symptoms, including a lack of energy, shortness of breath, dry mouth, and numbness or tingling of the limbs.

Despite this, the average patient-reported symptom severity and distress scores were a respective 1.05 and 1.29, where a score of 4.0 equals greatest severity and greatest distress, indicating a low overall level of distress per symptom, notes the research team.

"It is possible that through years of experience, patients and their families had learned to manage symptoms so that these were less severe and bothersome," write Johanna Wilson and Susan McMillan, from the University of South Florida in Tampa.

"Or it might be that HF patients in hospice care are more sedentary and are thus less influenced by symptoms that might be experienced if they were leading more active lives," they continue.

The cohort included 40 HF patients being treated in a hospice in Florida. Patients were aged an average of 79 years and the majority were White men.

Of a maximum score of 32 on the Memorial Symptom Assessment Scale-Heart Failure (MSAS-HF), the mean number of symptoms was 12.1 per patient, and the researchers observed a significant positive correlation between age and the total number of MSAS-HF symptoms reported.

Symptoms with the greatest mean severity scores included difficulty breathing while lying flat, a lack of energy, and pain other than chest pain, and those with the greatest distress scores included weigh gain, difficulty sleeping, and palpitations.

Wilson and McMillan note that the distress reported by patients for MSAS-HF symptoms correlated moderately positively with the number of depressive symptoms patients identified on the Profile of Mood States Depression subscale.

"Importantly, worry was one of the most distressing symptoms experienced by HF patients," they write.

"The role of these emotional issues should not be underestimated; hospice team members need to focus on these issues as they work to improve the overall quality of life of HF patients," they conclude.

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