Symptom manageability in Swiss HIV-infected patients Katharina Fierz, PhD, RPN a, b, ⁎, Sandra Engberg, PhD, RN c , Dunja Nicca, PhD, RN a, d , Kimberly Moody, PhD, RN e , Manuel Battegay, MD f , Rebecca Spirig, PhD, RN a, g a Institute of Nursing Science, University of Basel, Basel, Switzerland b Department of Nursing and Allied Health Professions, University Hospital Basel, CH-4056 Basel, Switzerland c University of Pittsburgh School of Nursing, University of Pittsburgh, Pittsburgh, USA d Department of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland e School of Nursing, University of Southern Maine, Maine Medical Center, Brackett Street, Portland, Maine, 04104, USA f Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland g Center of Clinical Nursing Science, University Hospital Zurich, CH-8091 Zurich, Switzerland abstract article info Article history: Received 10 August 2012 Revised 27 January 2013 Accepted 28 January 2013 Keywords: HIV Symptom manageability Symptom experience Assessment Symptom distress Background: Managing symptoms in daily life is a challenging problem for people living with HIV. As traditional parameters used to identify symptoms needing management do not integrate aspects of daily living with symptoms, we introduced ‘perceived symptom manageability’ to fill this gap. Aim: The aim of this study was to quantitatively explore ‘perceived symptom manageability’ in a sample of 268 persons living with HIV. Methods: Secondary analysis of existing cross-sectional data. Social support, gender, age, depressive and anxiety symptoms were bivariately and multivariately analyzed and related to symptom experience and manageability as measured by the HIV Symptom Assessment Scale and the HIV Symptom Manageability Scale. Results: Least manageable symptoms were hair loss, vomiting and insomnia. Multivariately, age (beta =-.11; p =.024), symptom distress (beta =-.62; p b .001) and total anxiety and depressive symptoms (beta =-.18; p = .003) were statistically significant correlates of symptom manageability. Conclusions: Although a promising concept to identify symptoms needing management, further research employing primary data is recommended. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Despite improvements in antiretroviral therapy and access to care in developed countries, Persons Living With the Human Immunode- ficiency Virus (PLWH) may experience a host of disturbing symptoms (Nicca, 2009) across their illness trajectory. As it is for other patients with chronic illnesses, managing symptoms and integrating them in daily living remain a major portion of illness management for PLWH. Although a great share of the illness management is performed by patients outside the health care setting, health care providers represent important collaborators for PLWH in identifying and negotiating symptoms needing management, as well as initiating appropriate management strategies (Bodenheimer, 2003). It is widely accepted that an individual's symptom experience, an amalgamation of emotional and cognitive components, should serve as the basis for determining symptom management needs. However, the traditional parameters representing symptom experience may not adequately identify symptoms needing management in persons living with a chronic illness. More specifically, symptom severity, frequency, and associated distress (Leventhal, Diefenbach, & Leventhal, 1992; Portenoy, 1994; Spirig, Moody, Battegay, & De Geest, 2005) do not take into account the context of living with symptoms and managing them in every-day life. Therefore, we propose that the introduction of a concept representing the patients' perspective on symptoms needing management is timely and necessary. Based on the clinical observation that PLWH often use ‘not manageable’ when describing symptoms interfering with their lives and that these symptoms may or may not be severe, frequently occurring, or even distressing, we hypothesized that ‘perceived symptom manageability’ holds promise to expand the current focus on symptom experience assessment by providing a comprehensive understanding of symptom management as perceived by PLWH. In an Applied Nursing Research 26 (2013) 110–115 This work was supported by: unrestricted educational grants from Nora van Meeuwen–HaefligerStiftung, Glaxo-SmithKline AG, Merck Sharp &Dohme-Chibret, Roche Pharma AG, Bristol-Myers Squibb GmbH, BoehringerIngelheim, the Swiss National Science Foundation Grant Nr 3346-100884 and by the Swiss National Science Foundation Grant Nr 33CSCO-108787 which supported the Swiss HIV Cohort Study. Conflicts of interest: none. ⁎ Corresponding author. Tel.: +41 61 267 09 54(work), +41 44 491 80 32(home). E-mail addresses: katharina.fierz@unibas.ch (K. Fierz), sje1@pitt.edu (S. Engberg), Dunja.Nicca@kssg.ch (D. Nicca), kmoody@usm.maine.edu (K. Moody), mbattegay@uhbs.ch (M. Battegay), rebecca.spirig@usz.ch (R. Spirig). 0897-1897/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.apnr.2013.01.006 Contents lists available at SciVerse ScienceDirect Applied Nursing Research journal homepage: www.elsevier.com/locate/apnr