Decoding Symptom Complexity for Clinical Nursing Assessment: A Systematic Review of Simplification Strategies in Hemodialysis Patients

BACKGROUND: Patients with chronic kidney disease on hemodialysis experience complex symptom clusters that impact their quality of life. Simplifying symptom management is essential to improve patient care and outcomes. However, there is no comprehensive evaluation of these simplification methods in current literature. AIM: To evaluate and synthesize strategies for simplifying the symptomatology associated with hemodialysis to improve patient outcomes and management practices. METHODS: We conducted a systematic review. We performed a comprehensive literature search across Pubmed, CINAHL, Embase, Web of Science, Scopus, CNKI, VIP database, and Wanfang in April 2024. Data synthesis was narrative due to the heterogeneity of the methodologies. Studies were selected based on predefined criteria focused on symptom simplification strategies among adult hemodialysis patients. Articles were retrieved and assessed for relevance and quality through April 2024. RESULTS: We identified 18 eligible studies from an initial pool of 18,324 records, focusing on variable-centered, person-centered approaches and approaches to identifying the main symptoms to symptom simplification. The studies varied significantly in their methodological quality and findings but commonly reported symptom clusters that correlated with poor patient outcomes. LINKING EVIDENCE TO ACTION: This review underlines critical areas for advancement in hemodialysis patient care through strategic symptom management integration. Our findings emphasize the necessity of implementing simplified symptom assessment protocols in routine clinical practice, thereby enhancing patient engagement and outcomes. Additionally, the results advocate for ongoing research into personalized care approaches, underscoring the potential for these strategies to decrease symptom burden significantly. These insights should inform both policy and educational programs, encouraging the adoption of standardized practices across healthcare systems. Moreover, the study highlights the need for management strategies that align with patient-reported outcomes, fostering a more patient-centered approach in healthcare settings. Ultimately, this evidence should guide educational efforts to better equip healthcare providers with the tools necessary for effective symptom management in hemodialysis care. TRIAL REGISTRATION: PROSPERO: CRD42023473789.