All ETDs from UAB

Advisory Committee Chair

Marie Bakitas

Advisory Committee Members

Christopher S Lee

James N Dionne-Odom

Andres Azuero

Bradley Aouizerat

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


Individuals living with heart failure experience a high symptom burden that must be addressed to improve their quality of life as well as the quality of life of their family caregivers. This is a challenging task as different situational and individual factors, including clinical/physiological factors and cultural factors, can affect an individual’s symptom experience. The purpose of this dissertation study was to examine existing symptom pattern trajectories and associated factors (sociodemographic, clinical/physiological characteristics, dyadic health) among a sample of under-resourced and racially diverse older adults with advanced heart failure living in the Deep South. This purpose was accomplished through four manuscripts: 1) a literature review and concept analysis focused on operationalizing and measuring symptom burden in previous heart failure empirical studies, 2) an observational study of baseline data from the ENABLE CHF-PC parent trial which examined clinical trial recruitment, enrollment outcomes, and racial differences in baseline socio-demographic, clinical characteristics, and patient reported outcomes, 3) a secondary analysis of longitudinal data which identified distinct symptom pattern trajectories among a diverse sample of older adults living with advanced heart failure in the Deep South, and explored associations between individual and clinical factors (sociodemographic characteristics and clinical/physiological characteristics) and identified symptom pattern trajectories, and 4) a secondary analysis which explored associations between care recipient heart failure symptom burden trajectories on both the care recipient’s and the family caregiver’s mental and physical health. In the main findings of this dissertation study (Manuscripts III and IV), we found two distinct symptom burden trajectories (high and low). Individuals in the high symptom burden trajectory group were more likely to be women, have a higher weight, and have lower rated physical and mental health. The relationship between the care recipients’ symptom burden and family caregivers’ health was less clear. Future palliative and symptom management interventions need to consider important cultural and gen-der-based differences in patient symptoms and include family caregivers who would benefit from interventional services.

Included in

Nursing Commons



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