Variability in Constipation Management in Specialist Palliative Care: Findings from a Multi-site Retrospective Case Note Review

Deborah Muldrew, Emma Carduff, Mike Clarke, Anne Finucane, Lisa Graham-Wisener, F. Hasson, Noleen McCorry, Paul F Slater, Sonja J McIlfatrick

Research output: Contribution to journalConference article

Abstract

Background: Constipation is one of the most common symptoms in patients receiving specialist palliative care (SPC), contributing to considerable physical and psychological suffering for patients. Whilst clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings, the implementation of these guidelines in clinical practice is unclear.

Aim: To examine current clinical management of constipation for patients with advanced cancer in SPC settings.

Methods: A multi-site retrospective case-note review was undertaken, 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 across three SPC sites.

Results: A physical exam and bowel history was recorded for 109 patients (73%). Site variations were most evident in multidisciplinary team level of involvement in assessment, patient education, non-pharmacological strategies, and management strategies for opioid induced constipation and bowel obstruction. Ninety-six percent of case notes recorded pharmacological interventions compared to 73% recording lifestyle alterations. Sodium docusate and Senna were the preferred laxatives across all sites, however, 33% of patient charts recorded no information on the titration of laxatives.

Conclusion: Variations in assessment and management strategies were evident across sites. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation. More focus is required on the implementation and recording of non-pharmacological approaches to management.

Funder: Marie Curie

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Constipation
Palliative Care
Laxatives
Dioctyl Sulfosuccinic Acid
Guidelines
Patient Education
Opioid Analgesics
Life Style
Neoplasms
History
Pharmacology
Psychology
Education
Pain

Cite this

@article{2befa8b396504a1f946e2b2d5b0b0a2c,
title = "Variability in Constipation Management in Specialist Palliative Care: Findings from a Multi-site Retrospective Case Note Review",
abstract = "Background: Constipation is one of the most common symptoms in patients receiving specialist palliative care (SPC), contributing to considerable physical and psychological suffering for patients. Whilst clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings, the implementation of these guidelines in clinical practice is unclear.Aim: To examine current clinical management of constipation for patients with advanced cancer in SPC settings.Methods: A multi-site retrospective case-note review was undertaken, 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 across three SPC sites.Results: A physical exam and bowel history was recorded for 109 patients (73{\%}). Site variations were most evident in multidisciplinary team level of involvement in assessment, patient education, non-pharmacological strategies, and management strategies for opioid induced constipation and bowel obstruction. Ninety-six percent of case notes recorded pharmacological interventions compared to 73{\%} recording lifestyle alterations. Sodium docusate and Senna were the preferred laxatives across all sites, however, 33{\%} of patient charts recorded no information on the titration of laxatives.Conclusion: Variations in assessment and management strategies were evident across sites. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation. More focus is required on the implementation and recording of non-pharmacological approaches to management.Funder: Marie Curie",
author = "Deborah Muldrew and Emma Carduff and Mike Clarke and Anne Finucane and Lisa Graham-Wisener and F. Hasson and Noleen McCorry and Slater, {Paul F} and McIlfatrick, {Sonja J}",
year = "2019",
month = "5",
day = "21",
doi = "https://doi.org/10.1177/0269216319844405",
language = "English",
journal = "Palliative Medicine",
issn = "0269-2163",
number = "EAPC Abstracts",

}

Variability in Constipation Management in Specialist Palliative Care: Findings from a Multi-site Retrospective Case Note Review. / Muldrew, Deborah; Carduff, Emma; Clarke, Mike; Finucane, Anne; Graham-Wisener, Lisa; Hasson, F.; McCorry, Noleen; Slater, Paul F; McIlfatrick, Sonja J.

In: Palliative Medicine, No. EAPC Abstracts, 21.05.2019.

Research output: Contribution to journalConference article

TY - JOUR

T1 - Variability in Constipation Management in Specialist Palliative Care: Findings from a Multi-site Retrospective Case Note Review

AU - Muldrew, Deborah

AU - Carduff, Emma

AU - Clarke, Mike

AU - Finucane, Anne

AU - Graham-Wisener, Lisa

AU - Hasson, F.

AU - McCorry, Noleen

AU - Slater, Paul F

AU - McIlfatrick, Sonja J

PY - 2019/5/21

Y1 - 2019/5/21

N2 - Background: Constipation is one of the most common symptoms in patients receiving specialist palliative care (SPC), contributing to considerable physical and psychological suffering for patients. Whilst clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings, the implementation of these guidelines in clinical practice is unclear.Aim: To examine current clinical management of constipation for patients with advanced cancer in SPC settings.Methods: A multi-site retrospective case-note review was undertaken, 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 across three SPC sites.Results: A physical exam and bowel history was recorded for 109 patients (73%). Site variations were most evident in multidisciplinary team level of involvement in assessment, patient education, non-pharmacological strategies, and management strategies for opioid induced constipation and bowel obstruction. Ninety-six percent of case notes recorded pharmacological interventions compared to 73% recording lifestyle alterations. Sodium docusate and Senna were the preferred laxatives across all sites, however, 33% of patient charts recorded no information on the titration of laxatives.Conclusion: Variations in assessment and management strategies were evident across sites. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation. More focus is required on the implementation and recording of non-pharmacological approaches to management.Funder: Marie Curie

AB - Background: Constipation is one of the most common symptoms in patients receiving specialist palliative care (SPC), contributing to considerable physical and psychological suffering for patients. Whilst clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings, the implementation of these guidelines in clinical practice is unclear.Aim: To examine current clinical management of constipation for patients with advanced cancer in SPC settings.Methods: A multi-site retrospective case-note review was undertaken, 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 across three SPC sites.Results: A physical exam and bowel history was recorded for 109 patients (73%). Site variations were most evident in multidisciplinary team level of involvement in assessment, patient education, non-pharmacological strategies, and management strategies for opioid induced constipation and bowel obstruction. Ninety-six percent of case notes recorded pharmacological interventions compared to 73% recording lifestyle alterations. Sodium docusate and Senna were the preferred laxatives across all sites, however, 33% of patient charts recorded no information on the titration of laxatives.Conclusion: Variations in assessment and management strategies were evident across sites. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation. More focus is required on the implementation and recording of non-pharmacological approaches to management.Funder: Marie Curie

U2 - https://doi.org/10.1177/0269216319844405

DO - https://doi.org/10.1177/0269216319844405

M3 - Conference article

JO - Palliative Medicine

T2 - Palliative Medicine

JF - Palliative Medicine

SN - 0269-2163

IS - EAPC Abstracts

ER -