The purpose of this study was to examine the symptom burden and severity of symptom distress reported by ICU patients at high-risk for death and to compare patient-rated symptoms and distress for concordance with symptoms reported by a family member. A prospective, correlational design with two data-points was used to study a convenience sample of 80 patients and 53 family members. The Condensed Memorial Symptom Assessment Scale (CMSAS) was used to gain patient/proxy report of symptoms on the first and third day after admission to the ICU. The majority of patients were symptomatic (98%), reporting an average of 10.23 symptoms. Most common symptoms reported on Day-1, were lack of energy (fatigue) and difficulty concentrating, with a mean symptom distress score of 2.96 (SD = 0.70) and 2.79 (SD = 0.84), scored on a scale of 1 = low symptom distress to 4 = high symptom distress, respectively. The CMSAS Total Distress Score was 2.24 (SD=0.66). The Physiological Symptom Distress Subscale (CMSAS-PHYS) score was 2.19 (SD=0.71). Approximately 97.9% of patients reported psychologic symptoms (sadness, worry, nervousness) with a mean symptom distress score of 2.45 (SD=0.66), measured by the Psychological Symptom Distress Subscale (CMSAS-PSYCH). On Day-3, 65 of the patients were still in the ICU. The most prevalent symptom reported was difficulty sleeping (90.8%), with a medium intensity distress score of 3.79 (SD=1.06). Eighty percent of patients reported additional symptoms: lack of energy, lack of appetite, pain, dry mouth, feeling drowsy, shortness of breath, and difficulty concentrating, with a moderate intensity mean score of 3.42. Overall distress increased among all symptoms, as measured by the CMSAS-Total Distress Score of 3.17 (SD=0.44), and the two distress subscales: CMSAS-PHYS mean score of 3.07 (SD=0.46) and CMSAS-PSYCH means score of 3.46 (SD=0.52). Hospital mortality was 17 (21%) during initial hospitalization and 16 (25%) at 3-months follow-up. Family members correctly estimated the presence and absence of symptoms 85.5% of the time, yet rated the patients' physiologic symptoms higher than psychological distress. This study identified ICU patients near death experience a significant burden of multiple symptoms, yet receive limited treatment for significant symptom distress. A need for widespread institution of symptom management strategies with proven effectiveness is indicated. Further research is needed to develop and test new evidence-based interventions to serve as a practice standards in the delivery of consistent, high quality care for all dying patients.
","abstract_html":"<p>The purpose of this study was to examine the symptom burden and severity of symptom distress reported by ICU patients at high-risk for death and to compare patient-rated symptoms and distress for concordance with symptoms reported by a family member. A prospective, correlational design with two data-points was used to study a convenience sample of 80 patients and 53 family members. The Condensed Memorial Symptom Assessment Scale (CMSAS) was used to gain patient/proxy report of symptoms on the first and third day after admission to the ICU. The majority of patients were symptomatic (98%), reporting an average of 10.23 symptoms. Most common symptoms reported on Day-1, were lack of energy (fatigue) and difficulty concentrating, with a mean symptom distress score of 2.96 (SD = 0.70) and 2.79 (SD = 0.84), scored on a scale of 1 = low symptom distress to 4 = high symptom distress, respectively. The CMSAS Total Distress Score was 2.24 (SD=0.66). The Physiological Symptom Distress Subscale (CMSAS-PHYS) score was 2.19 (SD=0.71). Approximately 97.9% of patients reported psychologic symptoms (sadness, worry, nervousness) with a mean symptom distress score of 2.45 (SD=0.66), measured by the Psychological Symptom Distress Subscale (CMSAS-PSYCH). On Day-3, 65 of the patients were still in the ICU. The most prevalent symptom reported was difficulty sleeping (90.8%), with a medium intensity distress score of 3.79 (SD=1.06). Eighty percent of patients reported additional symptoms: lack of energy, lack of appetite, pain, dry mouth, feeling drowsy, shortness of breath, and difficulty concentrating, with a moderate intensity mean score of 3.42. Overall distress increased among all symptoms, as measured by the CMSAS-Total Distress Score of 3.17 (SD=0.44), and the two distress subscales: CMSAS-PHYS mean score of 3.07 (SD=0.46) and CMSAS-PSYCH means score of 3.46 (SD=0.52). Hospital mortality was 17 (21%) during initial hospitalization and 16 (25%) at 3-months follow-up. Family members correctly estimated the presence and absence of symptoms 85.5% of the time, yet rated the patients' physiologic symptoms higher than psychological distress. This study identified ICU patients near death experience a significant burden of multiple symptoms, yet receive limited treatment for significant symptom distress. A need for widespread institution of symptom management strategies with proven effectiveness is indicated. Further research is needed to develop and test new evidence-based interventions to serve as a practice standards in the delivery of consistent, high quality care for all dying patients.</p>","abstract_has_math":false,"creators":["Kalowes, Peggy G., PhD, MSN, RN, CNS"],"institution":null,"degree_name":"PhD Nursing","degree_level":"Dissertation: Open Access","degree_discipline":"Nursing","degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2007,"date_issued":"2007-04-01T07:00:00Z","date_published":"2007-04-01T07:00:00Z","updated_at":"2026-07-24T05:41:20Z","subjects":["end of life care","Intensive Care Unit","life-threatening illness","nursing","symptoms","terminal illness"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://digital.sandiego.edu/dissertations/352","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Kalowes, Peggy G., PhD, MSN, RN, CNS"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2021-06-07T07:00:00Z"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Nursing"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Dissertation: Open Access"]},{"key":"thesis:degree_name","label":"Degree Name","values":["PhD Nursing"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["end of life care","Intensive Care Unit","life-threatening illness","nursing","symptoms","terminal illness"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://digital.sandiego.edu/dissertations/352"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["The purpose of this study was to examine the symptom burden and severity of symptom distress reported by ICU patients at high-risk for death and to compare patient-rated symptoms and distress for concordance with symptoms reported by a family member. A prospective, correlational design with two data-points was used to study a convenience sample of 80 patients and 53 family members. The Condensed Memorial Symptom Assessment Scale (CMSAS) was used to gain patient/proxy report of symptoms on the first and third day after admission to the ICU. The majority of patients were symptomatic (98%), reporting an average of 10.23 symptoms. Most common symptoms reported on Day-1, were lack of energy (fatigue) and difficulty concentrating, with a mean symptom distress score of 2.96 (SD = 0.70) and 2.79 (SD = 0.84), scored on a scale of 1 = low symptom distress to 4 = high symptom distress, respectively. The CMSAS Total Distress Score was 2.24 (SD=0.66). The Physiological Symptom Distress Subscale (CMSAS-PHYS) score was 2.19 (SD=0.71). Approximately 97.9% of patients reported psychologic symptoms (sadness, worry, nervousness) with a mean symptom distress score of 2.45 (SD=0.66), measured by the Psychological Symptom Distress Subscale (CMSAS-PSYCH). On Day-3, 65 of the patients were still in the ICU. The most prevalent symptom reported was difficulty sleeping (90.8%), with a medium intensity distress score of 3.79 (SD=1.06). Eighty percent of patients reported additional symptoms: lack of energy, lack of appetite, pain, dry mouth, feeling drowsy, shortness of breath, and difficulty concentrating, with a moderate intensity mean score of 3.42. Overall distress increased among all symptoms, as measured by the CMSAS-Total Distress Score of 3.17 (SD=0.44), and the two distress subscales: CMSAS-PHYS mean score of 3.07 (SD=0.46) and CMSAS-PSYCH means score of 3.46 (SD=0.52). Hospital mortality was 17 (21%) during initial hospitalization and 16 (25%) at 3-months follow-up. Family members correctly estimated the presence and absence of symptoms 85.5% of the time, yet rated the patients' physiologic symptoms higher than psychological distress. This study identified ICU patients near death experience a significant burden of multiple symptoms, yet receive limited treatment for significant symptom distress. A need for widespread institution of symptom management strategies with proven effectiveness is indicated. Further research is needed to develop and test new evidence-based interventions to serve as a practice standards in the delivery of consistent, high quality care for all dying patients.
"]},{"key":"dc:title","label":"Title","values":["Symptom Burden at End of Life in Patients with Terminal and Life-Threatening Illness in Intensive Care Units"]}]}],"canonical_facts":{"dc:creator":["Kalowes, Peggy G., PhD, MSN, RN, CNS"],"dc:date.available":["2021-06-07T07:00:00Z"],"dc:description.abstract":["The purpose of this study was to examine the symptom burden and severity of symptom distress reported by ICU patients at high-risk for death and to compare patient-rated symptoms and distress for concordance with symptoms reported by a family member. A prospective, correlational design with two data-points was used to study a convenience sample of 80 patients and 53 family members. The Condensed Memorial Symptom Assessment Scale (CMSAS) was used to gain patient/proxy report of symptoms on the first and third day after admission to the ICU. The majority of patients were symptomatic (98%), reporting an average of 10.23 symptoms. Most common symptoms reported on Day-1, were lack of energy (fatigue) and difficulty concentrating, with a mean symptom distress score of 2.96 (SD = 0.70) and 2.79 (SD = 0.84), scored on a scale of 1 = low symptom distress to 4 = high symptom distress, respectively. The CMSAS Total Distress Score was 2.24 (SD=0.66). The Physiological Symptom Distress Subscale (CMSAS-PHYS) score was 2.19 (SD=0.71). Approximately 97.9% of patients reported psychologic symptoms (sadness, worry, nervousness) with a mean symptom distress score of 2.45 (SD=0.66), measured by the Psychological Symptom Distress Subscale (CMSAS-PSYCH). On Day-3, 65 of the patients were still in the ICU. The most prevalent symptom reported was difficulty sleeping (90.8%), with a medium intensity distress score of 3.79 (SD=1.06). Eighty percent of patients reported additional symptoms: lack of energy, lack of appetite, pain, dry mouth, feeling drowsy, shortness of breath, and difficulty concentrating, with a moderate intensity mean score of 3.42. Overall distress increased among all symptoms, as measured by the CMSAS-Total Distress Score of 3.17 (SD=0.44), and the two distress subscales: CMSAS-PHYS mean score of 3.07 (SD=0.46) and CMSAS-PSYCH means score of 3.46 (SD=0.52). Hospital mortality was 17 (21%) during initial hospitalization and 16 (25%) at 3-months follow-up. Family members correctly estimated the presence and absence of symptoms 85.5% of the time, yet rated the patients' physiologic symptoms higher than psychological distress. This study identified ICU patients near death experience a significant burden of multiple symptoms, yet receive limited treatment for significant symptom distress. A need for widespread institution of symptom management strategies with proven effectiveness is indicated. Further research is needed to develop and test new evidence-based interventions to serve as a practice standards in the delivery of consistent, high quality care for all dying patients.
"],"dc:identifier":["https://digital.sandiego.edu/dissertations/352"],"dc:subject":["end of life care","Intensive Care Unit","life-threatening illness","nursing","symptoms","terminal illness"],"dc:title":["Symptom Burden at End of Life in Patients with Terminal and Life-Threatening Illness in Intensive Care Units"],"thesis:degree_discipline":["Nursing"],"thesis:degree_level":["Dissertation: Open Access"],"thesis:degree_name":["PhD Nursing"]},"updated_at":"2026-07-24T05:41:20Z"}