Symptoms Experience: A Concept Analysis

Terri S. Armstrong

ONF 2003, 30(4), 601-606. DOI: 10.1188/03.ONF.601-606

Purpose/Objectives: To provide a clearly constructed definition of the concept of symptoms experience.

Data Sources: Articles and book chapters.

Data Synthesis: Symptoms experience has not been explored previously. Several approaches to the concept of symptoms have been addressed, including symptom occurrence, symptom distress, and unpleasant symptoms. Limitations of these approaches may include the lack of focus on symptoms as occurring concurrently or in clusters or the multiplicative nature of symptoms. In addition, situational and existential meaning often is not explored.

Conclusions: Symptoms experience is the perception of the frequency, intensity, distress, and meaning of symptoms as they are produced and expressed. Symptoms are multiplicative in nature and may act as catalysts for the occurrence of other symptoms. Antecedents to the symptoms experience include demographic, disease, and individual factors. Consequences include the impact on mood state, psychological status, functional status, quality of life, disease progression, and survival.

Implications for Nursing: Evaluation of symptoms in patients with cancer should include a meaning-centered approach, in which symptoms are evaluated not only for occurrence characteristics and perceived distress but also for the meaning of the symptoms experience to individuals.

Jump to a section


    Bates, M.A., & Edwards, W.T. (1992). Ethnic variations in the chronic pain experience. Ethnic Diseases, 2, 63-83.

    Ben-Eliyahu, S., Page, G., & Shakar, G. (1999). Evidence that stress and surgical intervention promote tumor development by suppressing natural killer cell activity. International Journal of Cancer, 80, 880-888.

    Berg, J. (1999). The perimenopausal transition of Filipino American midlife women: Biopsychosocial and cultural dimensions. Nursing Research, 48, 71-77.

    Berg, J., & Taylor, D. (1999). The symptom experience of Filipino American midlife women. Menopause, 6, 105-114.

    Carter, J.J. (1974). Recognizing psychiatric symptoms in black Americans. Geriatrics, 29, 95-99.

    Cella, D.F., & Chenn, E.A. (1988). Quality of life during and after cancer treatment. Comprehensive Therapy, 14(5), 69-75.

    Chang, V.T., Hwang, S.S., Feuerman, M., & Kasimis, B.S. (2000). Symptom and quality of life survey of medical oncology patients at a veteran affairs medical center: A role for symptom assessment. Cancer, 88, 1175-1183.

    Cimprich, B. (1999). Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nursing, 22, 185-195.

    Cimprich, B., & Ronis, D.L. (2001). Attention and symptom distress in women with and without breast cancer. Nursing Research, 50(2), 86-94.

    Clark, J.A., & Talcott, J.A. (2001). Symptom indexes to assess outcomes of treatment for early prostate cancer. Medical Care, 39, 1118-1130.

    Cleeland, C.S., Mendoza, T.R., Wang, X.S., Chou, C., Harle, M.T., Mor-rissey, M., et al. (2000). Assessing symptom distress in cancer patients: The M.D. Anderson Symptom Inventory. Cancer, 89, 1634-1646.

    Cohen, M.Z., & Palos, G. (2001). Culturally competent care. Seminars in Oncology Nursing, 17, 153-158.

    Collins, J.J., Byrnes, M.E., Dunkel, I.J., Lapin, J., Nadel, T., Thaler, H.T., et al. (2000). The measurement of symptoms in childern with cancer. Journal of Pain and Symptom Management, 19, 363-377.

    Dales, R.E., Spitzer, W.O., Schechter, M.T., & Suissa, S. (1989). The influence of psychological status on respiratory symptom reporting. American Review of Respiratory Diseases, 137, 1459-1463.

    Degner, L.F., & Sloan, J.A. (1995). Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer. Journal of Pain and Symptom Management, 10, 423-431.

    DeVito, A.J. (1990). Dyspnea during hospitalizations for acute phase of illness as recalled by patients with chronic obstructive pulmonary disease. Heart and Lung, 19, 186-191.

    Dodd, M., Janson, S., Facione, N., Faucett, J., Froelicher, E.S., Humphreys, J., et al. (2001). Advancing the science of symptom management. Journal of Advanced Nursing, 33, 668-676.

    Dodd, M.J., Miaskowski, C., & Paul, S.M. (2001). Symptom clusters and their effects on the functional status of patients with cancer. Oncology Nursing Forum, 28, 465-470.

    Fawcett, J., Tulman, L., & Myers, S. (1988). Development of the inventory of functional status after child birth. Journal of Nurse-Midwifery, 33, 252-260.

    Given, B., Given, C., Azzouz, F., & Stommel, M. (2001). Physical functioning of elderly cancer patients prior to diagnosis and following initial treatment. Nursing Research, 50, 222-232.

    Graydon, J.E., Ross, E., & Webster, P.M. (1995). Predictors of functioning of patients with chronic obstructive pulmonary disease. Heart and Lung, 24, 369-375.

    Haberman, M. (1999). The measurement of symptom distress. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer symptom management. Boston: Jones & Barlett.

    Hoskins, C.N., Baker, S., Sherman, D., Bohlander, J., Bookbinder, M., Budin, W., et al. (1996). Social support and patterns of adjustment to breast cancer. Scholarly Inquiry for Nursing Practice, 10, 99-133.

    Kaasa, S., Mastekaasa, A., & Thorud, E. (1988). Toxicity, physical function and everyday activity reported by patients with inoperable non-small cell lung cancer in a redomized trial (chemotherapy versus radiotherapy). Acta Oncologica, 27, 343-349.

    Kiecolt-Glaser, J., Page, G., Marucha, P., MacCallum, R., & Glaser, R. (1998). Psychological influences on surgical recovery. American Psychologist, 53, 1209-1218.

    Leidy, N.K. (1990). A structural model of stress, psychosocial resources, and symptomatic experience in chronic phsyical illness. Nursing Research, 39, 230-236.

    Lenz, E.R., Pugh, L.C., Milligan, R.A., Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-27.

    Leventhal, H., & Johnson, F.E. (1983). Laboratory and field experimentation development of a theory of self regulation. In P.H. Woolridge, M.H. Schmitt, & J.K. Skipper (Eds.), Behavior science and nursing theory (pp. 189-262). St. Louis, MO: Mosby.

    McClement, S.E., Woodgate, R.L., & Degner, L. (1997). Symptom distress in adult patients with cancer. Cancer Nursing, 20, 236-243.

    McCorkle, M., & Quint-Benoliel, J. (1983). Symptom distress, current concerns and mood disturbance after diagnosis of life-threatening disease. Social Science Medicine, 17, 431-438.

    McCorkle, R. (1987). The measurement of symptom distress. Seminars in Oncology Nursing, 3, 248-256.

    McCorkle, R., Jepson, C., Malone, D., Lusk, E., Braitman, L., Buhler-Wilkerson, K., et al. (1994). The impact of posthospital care on patients with cancer. Research in Nursing and Health, 17, 243-251.

    McKenna, H. (1997). Nursing theories and models. London: Rutledge.

    Mernam-Webster. (2001). Retrieved October 20, 2001, from

    Milligan, R.A., Parks, P.L., & Lenz, E.R. (1991, June). Interaction between social support and predictors of postpartum fatigue. Paper presented at the Eighth Annual Convention of NAACOG, the Organization of Obstetric, Gynecologic, and Neonatal Nurses; Orlando, FL.

    Molassiotis, A., Van Den Akker, O.B., Milligan, D.W., Goldman, J.M., Boughton, B.J., & Holmes, J.A. (1996). Psychological adaptation and symptom distress in bone marrow transplant recipients. Psycho-Oncology, 5, 9-22.

    Nerenz, D.R., Leventhal, H., & Love, R.R. (1982). Factors contributing to emotional distress during cancer chemotherapy. Cancer, 50, 1020-1027.

    Page, G., & Ben-Eliyahu, S. (1997). The immune-suppressive nature of pain. Seminars in Oncology Nursing, 13, 10-15.

    Portenoy, R.K., Thaler, H.T., Kornblith, A.B., Lepore, J.M., Fnedlander-Klar, K., Coyle, N., et al. (1994). Symptom prevalence, characteristics, and distress in a cancer population. Quality of Life Research, 3, 183-189.

    Pugh, L.C. (1990). Psychophysiologic correlates of fatigue during childbear-ing. Dissertation Abstracts International, 51, 01B.

    Pugh, L.C., & Milligan, R.A. (1995). Patterns of fatigue during pregnancy. Applied Nursing Research, 8, 140-143.

    Ream, E., & Richardson, A. (1996). Fatigue: A concept analysis. Interna-tional Journal of Nursing Studies, 33, 519-529.

    Rhodes, V.A., & McDaniel, R.W. (1999). The symptom experience and its impact on quality of life. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer symptom management (pp. 1-9). Boston: Jones and Barlett.

    Rhodes, V.A., & Watson, P.M. (1987). Symptom distress: The concept past and present. Seminars in Oncology Nursing, 3, 242-247.

    Richer, M.C., & Ezer, H. (2000). Understanding beliefs and meanings in the experience of cancer: A concept analysis. Journal of Advanced Nurisng, 32, 1108-1115.

    Rittenhouse, C., & Lee, K. (1993). Biopsychosocial correlates of perceived perimenstrual weight gain. Journal of Women's Health, 2, 145-148.

    Sarna, L. (1998). Effectiveness of structured nursing assessment of symptom distress in advanced lung cancer. Oncology Nursing Forum, 25, 1041-1048.

    Strickland, O.L. (1992). Measures and instruments. In Patient outcomes research: Examining the effectiveness of nursing practice (pp. 145-153). U.S. Department of Health and Human Services. NIH Publication No. 93-3411. Washington, DC: U.S. Government Printing Office.

    Tamburini, M., Brunelli, C., Rosso, S., & Ventrafridda, V. (1996). Prognostic value of quality of life scores in terminal cancer patients. Journal of Pain and Symptom Management, 11, 32-41.

    Tishelman, C., Taube, A., & Sachs, L. (1991). Self-reported symptom distress in cancer patients: Reflections of disease, illness, or sickness? Social Science Medicine, 33, 1229-1240.

    Todd, K.H., Samaroo, N., & Hoffman, J.R. (1993). Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA, 269, 1537-1539.

    Walker, L.O., & Avant, K.C. (1995). Strategies for theory construction in nursing. Norwalk, CT: Apleton and Lange.