症狀群集之概念及研究方法探討

Symptom Clusters: Concept and Research Methodology

慢性病愚者經常經歷疾病本身及治療引起的多個症狀，症狀之間彼此會相互影響，其影響與結果往往大於單一症狀。近年來許多學者對症狀群眾現象有深入探討，對象多為癌症病人。本文主要針對症狀群集概念及研究方法加以分析。症狀群集是指由二個或以上同時發生且相關的症狀所組成，並不一定由相同的病因所導致。症狀群集的研究方法可分為，針對一群特定的病人，以涵蓋多項症狀的量表，去評估患者的所有症狀，評估之後常利用統計方式找出不同的症狀群集；另一種為找尋有相同症狀表現的病患群，首先評估病人的症狀，再利用群集分析，將有相同症狀表現的病人歸為一群。目前實證研究顯示當一個症狀發生時往往會帶來多個症狀，但於症狀群集的定義上，群集內的症狀數、彼此相關性強度及症狀病因是否相同，則尚未有明確共識。症狀群集的知識在臨床照護應用仍相當有限，且多數研究仍集中在癌症病人的症狀群集。本文期待可以闡述症狀群集概念，進而提醒臨床人員應以廣闊的視野來處理，莫忽略症狀的完整面貌。

Patients with chronic diseases often experience multiple symptoms secondary to either diseases themselves and/or a variety of treatments. Multiple existing symptoms usually affect one's wellbeing more than a single symptom does. In recent years, many scholars are devoted to advancing research on symptom clustering with a focus on cancer patients. This report focuses on the review of the concept of symptom cluster and the analysis of research methods. A symptom cluster is two or more related symptoms that exist simultaneously, although they may not be caused by the same etiology. Two research methods are adopted for symptom clusters. One research method is focusing on a particular identified group. The examiner assesses the subjects' symptom(s) with a measurement tool for multiple symptoms and then identifies different symptom clusters via statistics. The other research method is identifying a group of patients with the same symptom presentation. Currently, empirical studies show that a symptom, once occurring, often brings with it more symptoms. However, according to the definition of symptom cluster, the numbers of symptoms, their degrees of correlations, and disease etiologies cannot form a definite consensus. The knowledge of symptom cluster in clinical applications is still limited. Moreover, most research still focuses on the symptom cluster affecting cancer patients. This article describes the concept of symptom cluster and reminds clinicians to manage these symptoms with a broader perspective without ignoring the whole picture of symptoms.