Operationalizing Symptom Distress in Adults With Cancer: A Literature

Digital Object Identifier: 10.1188/05.ONF.E42-E47 Symptom distress often is used to describe the subjective experience of people in various states of health and illness. Multiple studies have shown that symptom distress is related to quality of life, treatment tolerance, and even survival in patients with cancer and other illnesses. The importance of symptom distress as a multidimensional concept in cancer has been demonstrated repeatedly and is supported by theory. Yet, despite or perhaps because of its ubiquity, symptom distress remains largely undefined and undeveloped conceptually (McClement, Woodgate, & Degner, 1997). The significance of symptom distress mandates the development of a uniform and valid definition, conceptualization, and operationalization. This article summarizes and interprets the literature about symptom distress in adults with cancer, describes definitions and conceptualizations of symptom distress, differentiates symptom distress from related terms, and highlights issues raised by the lack of consensus regarding symptom distress. Gaps in the literature are identified, and future directions in concept development are suggested. This literature synthesis was carried out according to the five-stage process described by Cooper (1998). In this model, the problem is formulated, data are collected, quality of the data is evaluated, data are analyzed and interpreted, and results are presented. In the first stage, problem formulation, the nature of the sources to be included and excluded is determined. Figure 1 summarizes the criteria used to identify sources to be included in this literature synthesis. To include the many valuable sources in which implicit models of symptom distress are used, rather than clearly explicated ones, this review does not exclude articles that have left the concept undefined or failed to articulate implicit conceptual models of symptom distress. In cases where symptom distress remains undefined, the ways in which authors have Operationalizing Symptom Distress in Adults With Cancer: A Literature Synthesis