Symptom Cluster Experiences in Patients with Oral Cancer using Mixed Methods

By using a convergent mixed method design, the study employed a novel approach to examining symptom cluster (SC) experiences in patients who have been operated for oral cancer. Quantitatively identified patient subgroups and predictors were triangulated with qualitatively obtained patient perception and contextual insights on SC experiences, thus adding credibility and depth to distinct SC experiences. The quantitative aspect of the study was guided by the Symptom Management Theory, and aimed to identify distinct patient subgroups based on SC experiences using two different statistical methods, assessing concordance between the solutions obtained from these two methods, and determining associations with sociodemographic and clinical characteristics. Symptoms were assessed for 300 patients using the MD Anderson Symptom Inventory - Head & Neck. Based on the 11 most severe symptoms, which were also prevalent in more than or equal to 30% of sample, hierarchical cluster analysis (HCA) identified two subgroups, while latent profile analysis (LPA) identified five distinct subgroups of patients. LPA provided more nuanced information on symptom cluster patterns than HCA. Significant differences were found among the five groups on body mass index, time since diagnosis, time since treatment completion, current use of symptom management medications, cancer stage, and treatment completed. Phenomenological exploration of lived experiences of SCs among 20 patients was conducted. Thematic analysis revealed that time and living with SCs lead to what we describe as a pathway to resigned acceptance. Participants described a shared set of experiences on this pathway that were captured through six themes - Acknowledged Disruptions, Inner Dialogue, Shifting Expectations, Floods of Emotions, Exercising Control, and Resigned Acceptance.