Assessing and managing constipation for patients receiving palliative care in a hospice setting: a systematic review of the literature

Sonja McIlfatrick, Deborah Preshaw, Felicity Hasson, Emma Carduff, Mike Clarke, Jo Coast, Claire Ferguson, Anne Finucane, Lisa Graham, Philip Larkin, Noleen McCorry, Paul Slater, Max Watson, Eileen Wright

Research output: Contribution to journalArticle

Abstract

Introduction Constipation causes considerable suffering, either as a direct result of physical symptoms or due to related social and psychological problems. Despite this, uncertainty persists about the best management within hospice settings.Aim To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a hospice setting.Methods A systematic search of MEDLINE, Embase, Cinahl, Scopus, and Cochrane databases was undertaken in April 2017 for empirical studies, written in English, on the assessment and management of constipation in the hospice, between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction and undertook a thematic analysis.Results Fourteen studies were included in the review including randomised trials (n=3), observational (n=5), and descriptive studies (n=6). The majority of the research was conducted in palliative care units and targeted either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation. Clinicians experienced challenges in constipation assessment, with a need to combine patient reports with physical examination. Clinicians focused on pharmacological management, however, consideration around non-pharmacological aspects is also essential. Finally, the need to assess current practice for the management of constipation in light of changing priorities of care at end of life was emphasised.Discussion Supporting clinicians to more effectively assess and manage the complexities of constipation in this setting is essential in improving overall symptom management. Gaps in the evidence base included defining constipation, constipation prevention, non-pharmacological management, and management in the dying patient.
LanguageEnglish
JournalBMJ Supportive and Palliative Care
Volume7
Issue number3
Early online date1 Sep 2017
DOIs
Publication statusE-pub ahead of print - 1 Sep 2017

Fingerprint

Hospices
Constipation
Palliative Care
Terminal Care
Practice Management
Social Problems
Psychological Stress
MEDLINE
Physical Examination
Uncertainty
Research Personnel
Databases
Pharmacology
Psychology
Delivery of Health Care

Keywords

  • constipation
  • assessment
  • management
  • palliative care
  • patients
  • hospices
  • systematic review

Cite this

McIlfatrick, Sonja ; Preshaw, Deborah ; Hasson, Felicity ; Carduff, Emma ; Clarke, Mike ; Coast, Jo ; Ferguson, Claire ; Finucane, Anne ; Graham, Lisa ; Larkin, Philip ; McCorry, Noleen ; Slater, Paul ; Watson, Max ; Wright, Eileen. / Assessing and managing constipation for patients receiving palliative care in a hospice setting: a systematic review of the literature. In: BMJ Supportive and Palliative Care. 2017 ; Vol. 7, No. 3.
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Assessing and managing constipation for patients receiving palliative care in a hospice setting: a systematic review of the literature. / McIlfatrick, Sonja; Preshaw, Deborah; Hasson, Felicity; Carduff, Emma; Clarke, Mike; Coast, Jo; Ferguson, Claire; Finucane, Anne; Graham, Lisa; Larkin, Philip; McCorry, Noleen; Slater, Paul; Watson, Max; Wright, Eileen.

In: BMJ Supportive and Palliative Care, Vol. 7, No. 3, 01.09.2017.

Research output: Contribution to journalArticle

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T1 - Assessing and managing constipation for patients receiving palliative care in a hospice setting: a systematic review of the literature

AU - McIlfatrick, Sonja

AU - Preshaw, Deborah

AU - Hasson, Felicity

AU - Carduff, Emma

AU - Clarke, Mike

AU - Coast, Jo

AU - Ferguson, Claire

AU - Finucane, Anne

AU - Graham, Lisa

AU - Larkin, Philip

AU - McCorry, Noleen

AU - Slater, Paul

AU - Watson, Max

AU - Wright, Eileen

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Introduction Constipation causes considerable suffering, either as a direct result of physical symptoms or due to related social and psychological problems. Despite this, uncertainty persists about the best management within hospice settings.Aim To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a hospice setting.Methods A systematic search of MEDLINE, Embase, Cinahl, Scopus, and Cochrane databases was undertaken in April 2017 for empirical studies, written in English, on the assessment and management of constipation in the hospice, between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction and undertook a thematic analysis.Results Fourteen studies were included in the review including randomised trials (n=3), observational (n=5), and descriptive studies (n=6). The majority of the research was conducted in palliative care units and targeted either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation. Clinicians experienced challenges in constipation assessment, with a need to combine patient reports with physical examination. Clinicians focused on pharmacological management, however, consideration around non-pharmacological aspects is also essential. Finally, the need to assess current practice for the management of constipation in light of changing priorities of care at end of life was emphasised.Discussion Supporting clinicians to more effectively assess and manage the complexities of constipation in this setting is essential in improving overall symptom management. Gaps in the evidence base included defining constipation, constipation prevention, non-pharmacological management, and management in the dying patient.

AB - Introduction Constipation causes considerable suffering, either as a direct result of physical symptoms or due to related social and psychological problems. Despite this, uncertainty persists about the best management within hospice settings.Aim To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a hospice setting.Methods A systematic search of MEDLINE, Embase, Cinahl, Scopus, and Cochrane databases was undertaken in April 2017 for empirical studies, written in English, on the assessment and management of constipation in the hospice, between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction and undertook a thematic analysis.Results Fourteen studies were included in the review including randomised trials (n=3), observational (n=5), and descriptive studies (n=6). The majority of the research was conducted in palliative care units and targeted either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation. Clinicians experienced challenges in constipation assessment, with a need to combine patient reports with physical examination. Clinicians focused on pharmacological management, however, consideration around non-pharmacological aspects is also essential. Finally, the need to assess current practice for the management of constipation in light of changing priorities of care at end of life was emphasised.Discussion Supporting clinicians to more effectively assess and manage the complexities of constipation in this setting is essential in improving overall symptom management. Gaps in the evidence base included defining constipation, constipation prevention, non-pharmacological management, and management in the dying patient.

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KW - management

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KW - patients

KW - hospices

KW - systematic review

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DO - 10.1136/bmjspcare-2017-001407.58

M3 - Article

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JO - BMJ Supportive and Palliative Care

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JF - BMJ Supportive and Palliative Care

SN - 2045-435X

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