“Constipation is a Simple Thing”: Exploring Healthcare Professionals’ Perspectives of Managing Constipation within Specialist Palliative Care: A Qualitative Study

Introduction: Constipation is a major problem, and significant concern, for many patients towards the end of life who are receiving specialist palliative care (SPC). Whilst clinical guidelines have been developed, there is a dearth of evidence regarding healthcare professionals (HCPs) experiences of constipation management within such settings.

Aim: To explore HCPs perspectives of managing constipation within SPC settings.

Methods: Six focus groups were undertaken with 27 HCPs (doctors n=7, nurses n=14, pharmacists n=1 and other n=5) in three SPC units across the UK from November 2016 to January 2017. The focus groups examined knowledge, clinical practices, and barriers and facilitators. All participants were female and the mean length of experience within SPC settings was 8 years. Analysis was underpinned by Braun and Clark’s framework for thematic analysis.

Results: Constipation was reported as simple to manage, however, whilst the majority discussed the physical impact of constipation, very few participants identified the social and psychological implications for the patient. Strength in pharmacological management was evident, with discussions of drug choices dominating the conversation. The implementation of lifestyle modifications was rarely discussed across the focus groups, however, difficulties were reported in their implementation. Finally, a need for education regarding the underlying physiology of constipation was recognised.

Conclusions: The simplicity of HCPs’ reporting of constipation is incongruent with the complexity of this common and distressing symptom. In line with clinical guidelines, this research identifies the need to move SPC staff towards a holistic approach to constipation management that recognises the physical, psychological, and social impact. This transition in approach, and supporting staff to further enhance clinical knowledge, can be facilitated by interprofessional education.

Funder: Marie Curie