Constipation in palliative care : Prevalence, definitions, symptom distress and risk-factors

Abstract

Background and aims: Constipation for patients in palliative care is common and described with variations in prevalence. Side -effects from opioid- treatment, is considered to be one of the main factors leading to constipation. The overall aim of the thesis was to study constipation among patients admitted to specialized palliative care- settings in Sweden. The specific aims of the thesis were 1) To describe and explore the prevalence, definition and symptom distress of constipation by applying different definitions of constipation, in patients admitted to specialized palliative care settings in Sweden. 2) To identify factors related to constipation in patients in specialized palliative care and comparing these factors for patients with different types of constipation to patients without constipation. Methods: A literature- search were conducted where prevalence of- and factors related to constipation was explored and included in a questionnaire, developed for this thesis. Data was collected in a cross- sectional design with a response rate of 50% and analysed with logistic regression. Results: A total of 485 patients from 38 specialized palliative care- units in Sweden participated. Prevalence of constipation for patients in specialized palliative care varied between 7- 43 % depending on definition used. Two different constipation- groups were identified: Medical constipation- group 23% (MCG) and Perceived constipation- group 35% (PCG). Three sub- groups was also identified: patients with i) only ≤ 3 defecations/week, 7%, ii) only perception of being constipated, 19%, and iii) patients with both ≤ 3 defecations/ week and perception of being constipated,16%. Several factors were found to be related to constipation as hospitalisation, absence of laxative- treatment, haemorrhoids, poor appetite, hard stool form and opioids. Conclusions: Prevalence of constipation may differ depending on definitions used. Distress from constipation and other factors related to constipation, than opioids, needs to be incorporated into the clinical constipation- assessment. Validated constipation assessment tool needs to be developed.<p>The series name <em>Linköping University, Studies in Health Sciences, Thesis</em> in the Licentiate thesis is incorrect. The correct name is <em>Linköping Studies in Health Sciences. Thesis</em>.</p

Meanings of existential uncertainty and certainty for people diagnosed with cancer and receiving palliative treatment: a life-world phenomenological study

“…It is when the assurance of the day-to-day is gone and it becomes tinged with uncertainty that unfamiliar feelings and thoughts become part of their normal day and they notice their own existential uncertainty [ 24 ]. A major task for healthcare professionals is to make things easier for the person in palliative care and for their relatives, so that they, on the basis of their own wishes, can live out their remaining time together as best they can [ 40 - 42 ]. Further, it is important that healthcare professionals are conscious that patients can move between experiences of existential uncertainty and certainty, as well as having needs or distress of other kinds related to the existential or spiritual dimension of life [ 43 ], including unbearable suffering [ 44 ].…”

“…Similar results have been shown by Sand [ 24 ] where spending time with animals and nature is described as important for patients with advanced disease to feel as well as possible. Despite serious illness, it is important for the patient to continue to experience different things, for example, through nature, art and new environments [ 40 , 46 ]. Could it be that ‘nature prescriptions’, beautiful outdoor environments, pictures of nature or virtual nature scenes in healthcare settings are a step in an appropriate direction?…”