Constipation is a common symptom in patients with advanced disease in the specialist palliative care (SPC) setting, yet there is a dearth of evidence reporting on its clinical assessment or management. This study aims to examine the clinical assessment and management of constipation for people with advanced cancer in SPC settings.
Retrospective analysis of patient medical records (n=150) and practice was further queried via focus groups with twenty-seven palliative care professionals. Twenty-seven palliative care professionals (PCPs) from across the United Kingdom participated in six focus groups. One hundred and fifty patient charts reviews were retrospectively collected from three hospices. Qualitative data was analysed thematically and quantitative data was descriptively analysed using SPSS.
Findings reveal that whilst 96% of patients admitted to the hospice were assessed within 24 hours, assessment tools for constipation varied. The most common patient symptoms reported were infrequent bowel movements (45%) and nausea (38%). Management was pharmacologically led with sodium docusate and Senna most frequently administered. Focus groups data revealed that symptoms of constipation were often underdressed as staff lacked skills to carry out a full assessment. Communication with the patient was reported to problematic, and information often sought from family members. Whilst the value of non-pharmacological interventions was recognised, professionals’ management of constipation was focused on pharmacological treatments.
Clinical processes for constipation assessment and management are problematic at an organizational and individual/staff level. Further education is needed to equip PCPs with the knowledge and skills to perform a full assessment, and to utilize appropriate non-pharmacological strategies which are currently neglected. SPC settings need to put structures in place to support improvement to practice