title: Integrative Review of Co-Occurring Symptoms Across Etiologies of Chronic Liver Disease and Implications for Symptom Management Research and Practice.
abstract: OBJECTIVE
  Chronic liver disease affects over 30 million people worldwide, and despite advances in medical management that have increased survival, a majority of these individuals report multiple symptoms that severely impair function and quality of life. The purpose of this integrative review was to examine and summarize the current literature focused on self-reported symptoms in individuals with chronic liver disease in order to inform the development and delivery of symptom management strategies in clinical practice.
  
  
  METHODS
  Combinations of search terms related to the symptom experience were used to search three electronic databases. Inclusion criteria were empirical studies that measured self-reported symptoms in populations with chronic liver disease published in English between 2003 and 2014. The literature search initially yielded 112 results; 26 quantitative studies met the inclusion criteria.
  
  
  CONCLUSIONS
  The symptom of fatigue was commonly reported across chronic liver disease populations and was often found to co-occur with other distressing symptoms, including depression, sleep disturbance, pain, cognitive impairment, and dizziness associated with autonomic dysfunction. Due to the high prevalence and persistence of these "core" symptoms, the use of core symptom measures integrated longitudinally across populations would inform the development and delivery of symptom management interventions as well as enhance the ability of nurses to incorporate population-level symptom management programs.
  
  
  CONCLUSIONS
  Nurses play an important role in symptom assessment and may use the findings from the integrative review to incorporate core symptom measures across chronic liver disease populations and advance the development and delivery of symptom management interventions.
authors.affiliation: Gamma Omega, Associate Professor, Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Kyungeh
authors.initials: K
authors.lastname: An
authors.affiliation: Gamma Omega, Assistant Professor, Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Jallo
authors.affiliation: Gamma Omega, Associate Professor, Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Menzies
authors.affiliation: Gamma Omega, Assistant Professor, Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Kinser
authors.affiliation: Gamma Omega, Assistant Professor, Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Jo Lynne W
authors.initials: JL
authors.lastname: Robins
authors.affiliation: Gamma Omega, Associate Professor, Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Starkweather
mesh_terms: D002908:Chronic Disease; D003072:Cognition Disorders / Q000209:etiology; D003866:Depressive Disorder / Q000209:etiology; D019468:Disease Management; D004244:Dizziness / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000209:etiology
keywords: Chronic liver disease; symptom clusters; symptom management; symptoms