Background
Constipation is a common symptom in patients with advanced disease in the specialist palliative care (SPC) setting, yet there is a dearth of evidence focused on clinical assessment or management.
Aim: To examine the clinical assessment and management of constipation for people with advanced cancer in Specialist palliative care settings.
Methods
A four-stage multiple method study was undertaken. Phase 1 involved a systematic review of the literature. Phase 2: comprised a retrospective analysis of patient medical records (n=150) collected from three hospice sites across the UK. Phase 3: involved qualitative interviews and six focus groups with health care professionals (n=27) and patient and carer interviews (n=18) Phase 4; test and pilot an educational resource for use in specialist palliative care professionals. Qualitative data was analysed thematically and quantitative data was descriptively analysed using SPSS.
Findings
The literature indicated that there is a lack of standard assessment of constipation for patients in specialist palliative care (SPC) setting and there is a need to assess current practice for the management of constipation in the dying patient. The chart reviewed noted that whilst 96% of patients admitted to the hospice were assessed within 24 hours, assessment tools for constipation varied. Management was pharmacologically led with sodium docusate and Senna most frequently administered. Focus groups data found that symptoms of constipation were often underestimated owing to challenges when undertaking comprehensive assessment. Communication with the patient was reported to be problematic, and information was often sought from family members. Whilst the value of non-pharmacological interventions was recognised, professionals’ management of constipation focused more on pharmacological treatments.
Conclusion:
The nurse has a key role in assessing constipation; however, questions exist around the involvement of other members of the MDT. Accurate recording of care is essential to identify areas for improvement. Further education is needed to equip HCPs with the knowledge and skills to perform a full assessment, and to use appropriate non-pharmacological and preventative strategies that are currently neglected.