N24 A longitudinal qualitative exploration of symptom clusters in new diagnosed patients with Crohn’s disease
L Chen, Y ZhouAbstract
Background
There is a burgeoning recognition that symptoms frequently coexist in ‘symptom clusters’, and comprehending these clusters may enhance the management of unrelieved symptoms in patients with Crohn’s disease. However, the nature and dynamics of the symptom clusters among newly diagnosed Chinese Crohn’s disease patients remain poorly understood.
Methods
A longitudinal qualitative study was adopted to explore the evolution of symptom clusters in newly diagnosed patients with Crohn’s disease within one year. Eighteen patients from two tertiary hospitals in southeast China were recruited through purposive sampling. Semi-structured interviews were conducted on four occasions: soon after diagnosis, 3, 6 and 12 months post-diagnosis. Data analysis of each time point was based on conventional content analysis. Afterwards, the data of each time point were compared longitudinally to capture the trend.
Results
Although some patients were unaware of the relationships among their symptoms, three clusters were identified in their narratives of individual symptoms. These symptom clusters included abdominal pain/ vomiting/ nausea/ sleep disorders (Cluster 1), diarrhea/ urgency/ bloating/ fatigue/ weight loss (Cluster 2), and anxiety/ depression/ fear/ abdominal discomfort/ loose stools (Cluster 3), all of which are shown in figure 1. As the disease duration increased, the number of patients reporting Cluster 1 decreased. Similarly, the Cluster 2 exhibited a gradual decline over time, albeit it was still the most frequently reported cluster by the participants. In addition, the occurrence of Cluster 3 did not change significantly over time.
Conclusion
Overall, the symptom cluster burden in Crohn’s disease patients gradually decreased over time, while the psychological symptoms related cluster remained stable. Due to the brain-gut axis, the psychological distress and gastrointestinal discomforts mutually influence each other, warranting additional attention. Healthcare providers ought to develop tailored interventions, aligned with the distinctive features of symptom clusters present at various stages, in order to mitigate the symptom burden and enhance the quality of life for patients diagnosed with Crohn’s disease. Furthermore, considering the limited awareness of symptom clusters among certain patients, it’s imperative to strengthen symptom related education to increase their health literacy.