Cross-Cutting Symptom Burden and Health-Related Quality of Life in Hospitalized Patients With Chronic Illness: A Cross-Sectional Study
6 affiliations
- 1Department of Adult Health Nursing, Maharajgunj Nursing Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
- 2Department of Nursing, National Academy of Medical Sciences, National Trauma Center,Mahankal Kathmandu, Nepal
- 3Department of Emergency Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
- 4Department of Pedriatric Nursing, National Academy of Medical Sciences, Bir Hospital Nursing Campus, Mahaboudha, Kathmandu, Nepal
- 5Department of Research and Academics, Kathmandu Cancer Center, Tathali, Nala Road, Bhaktapur, Province Bagmati, Nepal
- 6Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation (NHRIF), Lalitpur, Nepal
Abstract
Introduction: Chronic illnesses pose significant global and individual health challenges, with patients experiencing high symptom burden that adversely affects health-related quality of life (HRQoL). Despite this, symptoms are underreported, and many patients with substantial needs do not receive palliative care. This study aimed to assess symptom burden and HRQoL of hospitalized adults with diverse chronic conditions at tertiary centers in Nepal, and examine their association.
Methods: A descriptive cross-sectional study was conducted from September to October 2023 among 164 adult patients admitted to selected tertiary hospitals. Participants were recruited using non-probability purposive sampling. Data was collected through face-to-face interviews using the ESAS-r and the SF-36. Descriptive statistics (frequency, percentage, median, interquartile range) and inferential tests (chi-square, continuity correction, Fisher’s exact test, and Spearman’s rank correlation) were applied, with significance set at P < 0.05.
Results: The median age was 55.5 years (IQR 40–57.5), and 56.7% were male. Nearly 30% had chronic kidney disease, and 62.8% had comorbidities. Median duration since diagnosis was 2 years (IQR 1–2). Overall, 92.1% reported high symptom burden (median 50.5; IQR 40–57.5), 95% CI [48.00–53.00], with fatigue the most severe symptom (68.3%). Poor HRQoL was reported by 65.9% (median 44.29; IQR 33.63–55.50; 95% CI [39.75–47.25]). Among heart failure patients, 57.1% experienced severe symptoms, and all reported diminished HRQoL. Symptom burden was significantly associated with comorbidities and hospital admissions (P < 0.05). HRQoL was significantly associated with sex, education, employment, marital status, family type, disease duration, and comorbidities (P < 0.05). A strong negative correlation was found between symptom burden and HRQoL (rs= -0.620, 95% CI [-0.941 to -0.641], P < 0.001).
Conclusion: Patients with diverse chronic illnesses experience substantial symptom burden strongly related to reduced HRQoL, which is hypothesis-generating rather than causal. This underscores the need for routine assessment, referral for symptom management, and integrated palliative care.
Related
- Obesity-Related Indices and Hospitalized Acute Exacerbation in COPD Patients: Sex-Stratified Associations from a Retrospective Cross-Sectional Study.
- Insufficient dietary intake and symptom burden are associated with early nutritional decline in hospitalized patients with cancer.
- Cross-sectional correlates and indirect associations linking parental warmth to scores on a study-specific gaming-related symptom index in senior-high-school and university students
- Associations of TNF-α, Uric Acid, and the Leptin/Adiponectin Ratio with HOMA-IR in Hospitalized Adults: A Cross-Sectional Secondary Analysis of 147 Patients
- Symptom clusters and symptom network characteristics in chronic fatigue syndrome patients: a cross-sectional study
BibTeX
@article{shrestha2026crosscutting,
title = {{Cross-Cutting Symptom Burden and Health-Related Quality of Life in Hospitalized Patients With Chronic Illness: A Cross-Sectional Study}},
author = {Helika Shrestha and Lalita Rai and Roshani Gautam and Samriddhi Thapa and Sochana Sapkota and Sunil Shrestha},
journal = {Inquiry: A Journal of Medical Care Organization, Provision and Financing},
year = {2026},
month = sep,
doi = {10.1177/00469580261489187},
url = {https://doi.org/10.1177/00469580261489187},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Cross-Cutting Symptom Burden and Health-Related Quality of Life in Hospitalized Patients With Chronic Illness: A Cross-Sectional Study
AU - Helika Shrestha
AU - Lalita Rai
AU - Roshani Gautam
AU - Samriddhi Thapa
AU - Sochana Sapkota
AU - Sunil Shrestha
PY - 2026
DA - 2026/09/17
JO - Inquiry: A Journal of Medical Care Organization, Provision and Financing
DO - 10.1177/00469580261489187
UR - https://doi.org/10.1177/00469580261489187
AB - Introduction: Chronic illnesses pose significant global and individual health challenges, with patients experiencing high symptom burden that adversely affects health-related quality of life (HRQoL). Despite this, symptoms are underreported, and many patients with substantial needs do not receive palliative care. This study aimed to assess symptom burden and HRQoL of hospitalized adults with diverse chronic conditions at tertiary centers in Nepal, and examine their association. Methods: A descriptive cross-sectional study was conducted from September to October 2023 among 164 adult patients admitted to selected tertiary hospitals. Participants were recruited using non-probability purposive sampling. Data was collected through face-to-face interviews using the ESAS-r and the SF-36. Descriptive statistics (frequency, percentage, median, interquartile range) and inferential tests (chi-square, continuity correction, Fisher’s exact test, and Spearman’s rank correlation) were applied, with significance set at P < 0.05. Results: The median age was 55.5 years (IQR 40–57.5), and 56.7% were male. Nearly 30% had chronic kidney disease, and 62.8% had comorbidities. Median duration since diagnosis was 2 years (IQR 1–2). Overall, 92.1% reported high symptom burden (median 50.5; IQR 40–57.5), 95% CI [48.00–53.00], with fatigue the most severe symptom (68.3%). Poor HRQoL was reported by 65.9% (median 44.29; IQR 33.63–55.50; 95% CI [39.75–47.25]). Among heart failure patients, 57.1% experienced severe symptoms, and all reported diminished HRQoL. Symptom burden was significantly associated with comorbidities and hospital admissions (P < 0.05). HRQoL was significantly associated with sex, education, employment, marital status, family type, disease duration, and comorbidities (P < 0.05). A strong negative correlation was found between symptom burden and HRQoL (rs= -0.620, 95% CI [-0.941 to -0.641], P < 0.001). Conclusion: Patients with diverse chronic illnesses experience substantial symptom burden strongly related to reduced HRQoL, which is hypothesis-generating rather than causal. This underscores the need for routine assessment, referral for symptom management, and integrated palliative care.
SN - 0046-9580
SN - 1945-7243
ER -