A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings

Sonja J McIlfatrick, Deborah Muldrew, F. Hasson, Paul F Slater, Emma Carduff, Mike Clarke, Jo Coast, Anne Finucane, Lisa Graham-Wisener, Philip J Larkin, John MacArtney, Noleen McCorry, Max Watson, Eileen Wright

Research output: Contribution to journalConference article

Abstract

Background: Constipation is a common symptom for patients receiving palliative care. Whilst national clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings, questions exist around clinical practice and the extent to which the guidelines are implemented in practice. This study examine current clinical practice for management of constipation for patients with advanced cancer in SPC settings.
Methods: A multi-site retrospective case-note review was conducted, consisting of 150 patient case-notes from three SPC units across the United Kingdom between August 2016 and May 2017. Descriptive statistics were used to compare clinical practices to national policy guidelines for constipation.
Results: A physical exam and bowel history was recorded for 109 patients (73%). Whilst the Bristol Stool Chart was used frequently across sites (96%), involvement of the multidisciplinary team varied. Almost a third of patient charts (27%) recorded no evidence of non-pharmacological management strategies. Pharmacological management was recorded frequently, with sodium docusate or senna as the preferred laxatives across all sites, however, 33% of patient charts recorded no information on the titration of laxatives. There were no consistent management strategies recorded for opioid induced constipation or bowel obstruction
Conclusion: Assessment and management of constipation in SPC settings is highly variable. Variations in assessment; limited use of non-pharmacological and preventative strategies, and absence of consistent strategies for opioid induced constipation or bowel obstruction are evident. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation.
LanguageEnglish
Pages371-372
JournalBMJ Supportive & Palliative Care
Volume8
Issue number3
Early online date1 Sep 2018
Publication statusE-pub ahead of print - 1 Sep 2018

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Constipation
Palliative Care
Laxatives
Guidelines
Opioid Analgesics
Dioctyl Sulfosuccinic Acid
Practice Management
Neoplasms
History
Pharmacology
Education

Cite this

McIlfatrick, Sonja J ; Muldrew, Deborah ; Hasson, F. ; Slater, Paul F ; Carduff, Emma ; Clarke, Mike ; Coast, Jo ; Finucane, Anne ; Graham-Wisener, Lisa ; Larkin, Philip J ; MacArtney, John ; McCorry, Noleen ; Watson, Max ; Wright, Eileen. / A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings. In: BMJ Supportive & Palliative Care. 2018 ; Vol. 8, No. 3. pp. 371-372.
@article{f77115b9056d41a7ba4992be8df52fed,
title = "A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings",
abstract = "Background: Constipation is a common symptom for patients receiving palliative care. Whilst national clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings, questions exist around clinical practice and the extent to which the guidelines are implemented in practice. This study examine current clinical practice for management of constipation for patients with advanced cancer in SPC settings.Methods: A multi-site retrospective case-note review was conducted, consisting of 150 patient case-notes from three SPC units across the United Kingdom between August 2016 and May 2017. Descriptive statistics were used to compare clinical practices to national policy guidelines for constipation.Results: A physical exam and bowel history was recorded for 109 patients (73{\%}). Whilst the Bristol Stool Chart was used frequently across sites (96{\%}), involvement of the multidisciplinary team varied. Almost a third of patient charts (27{\%}) recorded no evidence of non-pharmacological management strategies. Pharmacological management was recorded frequently, with sodium docusate or senna as the preferred laxatives across all sites, however, 33{\%} of patient charts recorded no information on the titration of laxatives. There were no consistent management strategies recorded for opioid induced constipation or bowel obstructionConclusion: Assessment and management of constipation in SPC settings is highly variable. Variations in assessment; limited use of non-pharmacological and preventative strategies, and absence of consistent strategies for opioid induced constipation or bowel obstruction are evident. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation.",
author = "McIlfatrick, {Sonja J} and Deborah Muldrew and F. Hasson and Slater, {Paul F} and Emma Carduff and Mike Clarke and Jo Coast and Anne Finucane and Lisa Graham-Wisener and Larkin, {Philip J} and John MacArtney and Noleen McCorry and Max Watson and Eileen Wright",
year = "2018",
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McIlfatrick, SJ, Muldrew, D, Hasson, F, Slater, PF, Carduff, E, Clarke, M, Coast, J, Finucane, A, Graham-Wisener, L, Larkin, PJ, MacArtney, J, McCorry, N, Watson, M & Wright, E 2018, 'A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings', BMJ Supportive & Palliative Care, vol. 8, no. 3, pp. 371-372.

A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings. / McIlfatrick, Sonja J; Muldrew, Deborah; Hasson, F.; Slater, Paul F; Carduff, Emma; Clarke, Mike; Coast, Jo; Finucane, Anne; Graham-Wisener, Lisa; Larkin, Philip J ; MacArtney, John; McCorry, Noleen; Watson, Max; Wright, Eileen.

In: BMJ Supportive & Palliative Care, Vol. 8, No. 3, 01.09.2018, p. 371-372.

Research output: Contribution to journalConference article

TY - JOUR

T1 - A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings

AU - McIlfatrick, Sonja J

AU - Muldrew, Deborah

AU - Hasson, F.

AU - Slater, Paul F

AU - Carduff, Emma

AU - Clarke, Mike

AU - Coast, Jo

AU - Finucane, Anne

AU - Graham-Wisener, Lisa

AU - Larkin, Philip J

AU - MacArtney, John

AU - McCorry, Noleen

AU - Watson, Max

AU - Wright, Eileen

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Constipation is a common symptom for patients receiving palliative care. Whilst national clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings, questions exist around clinical practice and the extent to which the guidelines are implemented in practice. This study examine current clinical practice for management of constipation for patients with advanced cancer in SPC settings.Methods: A multi-site retrospective case-note review was conducted, consisting of 150 patient case-notes from three SPC units across the United Kingdom between August 2016 and May 2017. Descriptive statistics were used to compare clinical practices to national policy guidelines for constipation.Results: A physical exam and bowel history was recorded for 109 patients (73%). Whilst the Bristol Stool Chart was used frequently across sites (96%), involvement of the multidisciplinary team varied. Almost a third of patient charts (27%) recorded no evidence of non-pharmacological management strategies. Pharmacological management was recorded frequently, with sodium docusate or senna as the preferred laxatives across all sites, however, 33% of patient charts recorded no information on the titration of laxatives. There were no consistent management strategies recorded for opioid induced constipation or bowel obstructionConclusion: Assessment and management of constipation in SPC settings is highly variable. Variations in assessment; limited use of non-pharmacological and preventative strategies, and absence of consistent strategies for opioid induced constipation or bowel obstruction are evident. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation.

AB - Background: Constipation is a common symptom for patients receiving palliative care. Whilst national clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings, questions exist around clinical practice and the extent to which the guidelines are implemented in practice. This study examine current clinical practice for management of constipation for patients with advanced cancer in SPC settings.Methods: A multi-site retrospective case-note review was conducted, consisting of 150 patient case-notes from three SPC units across the United Kingdom between August 2016 and May 2017. Descriptive statistics were used to compare clinical practices to national policy guidelines for constipation.Results: A physical exam and bowel history was recorded for 109 patients (73%). Whilst the Bristol Stool Chart was used frequently across sites (96%), involvement of the multidisciplinary team varied. Almost a third of patient charts (27%) recorded no evidence of non-pharmacological management strategies. Pharmacological management was recorded frequently, with sodium docusate or senna as the preferred laxatives across all sites, however, 33% of patient charts recorded no information on the titration of laxatives. There were no consistent management strategies recorded for opioid induced constipation or bowel obstructionConclusion: Assessment and management of constipation in SPC settings is highly variable. Variations in assessment; limited use of non-pharmacological and preventative strategies, and absence of consistent strategies for opioid induced constipation or bowel obstruction are evident. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation.

M3 - Conference article

VL - 8

SP - 371

EP - 372

JO - BMJ Supportive and Palliative Care

T2 - BMJ Supportive and Palliative Care

JF - BMJ Supportive and Palliative Care

SN - 2045-435X

IS - 3

ER -