“Take more laxatives was their answer to everything.”: A qualitative exploration of the patient, carer and healthcare professional experience of constipation in specialist palliative care

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

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Abstract

Background: Constipation is a major problem for many older adults, more so for those who are receiving specialist palliative care. However, limited research reports the subjective experiences of constipation, despite evidenced differences between the healthcare professional and patient/carer perspective. Aim: The main aim of this study is to explore the experience of how constipation is assessed and managed within specialist palliative care from the patient, carer and healthcare professional perspective. Design: Exploratory, qualitative design, utilising focus groups and interviews, and analysed using thematic analysis. Setting/participants: Six focus groups with 27 healthcare professionals and semi-structured interviews with 13 patients and 5 family caregivers in specialist palliative care units across three regions of the United Kingdom. Results: Constipation impacted physically, psychologically and socially on patients and families; however, they felt staff relegated it on the list of importance. Lifestyle modifications implemented at home were not incorporated into their specialist palliative care plan within the hospice. Comparatively, healthcare professionals saw constipation solely as a physical symptom. Assessment focused on the physical elements of constipation, and management was pharmacologically driven. Healthcare professionals reported patient embarrassment as a barrier to communicating about bowel care, whereas patients wanted staff to initiate communication and discuss constipation openly. Conclusion: Assessment and management of constipation may not yet reflect the holistic palliative care model. A focus on the pharmacological management may result in lifestyle modifications being underutilised. Healthcare professionals also need to be open to initiate communication on bowel care and consider non-pharmacological approaches. It is important that patients and families are supported in self-care management, alongside standardised guidelines for practice and for healthcare professionals to facilitate this.

Original languageEnglish
Pages (from-to)1057-1066
Number of pages10
JournalPalliative Medicine
Volume34
Issue number8
Early online date23 Dec 2019
DOIs
Publication statusPublished - 30 Sep 2020

Bibliographical note

Funding Information:
The authors would like to thank Professors Mike Clarke, Jo Coast, Max Watson, Dr John MacArtney, Ms Rachel Perry and Mrs Eileen Wright for their contribution to the wider research project from which this manuscript was developed. The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research was funded by a research grant awarded to Prof. Sonja McIlfatrick by Marie Curie UK (grant no. MCCC-RP-16-A20993).

Funding Information:
Assessment and management of constipation may not yet reflect the holistic palliative care model. A focus on the pharmacological management may result in lifestyle modifications being underutilised. Healthcare professionals also need to be open to initiate communication on bowel care and consider non-pharmacological approaches. It is important that patients and families are supported in self-care management, alongside standardised guidelines for practice and for healthcare professionals to facilitate this. Constipation symptom management palliative care hospice quality of care qualitative research edited-state corrected-proof typesetter ts1 The authors would like to thank Professors Mike Clarke, Jo Coast, Max Watson, Dr John MacArtney, Ms Rachel Perry and Mrs Eileen Wright for their contribution to the wider research project from which this manuscript was developed. Author’s Contribution All authors contributed to the conception and design of this work, acquisition, analysis and interpretation of data or drafting and revising it critically for intellectual content. All authors have approved the version to be published. Data sharing Further data can be accessed by contacting the corresponding author. Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. Ethical approval Full ethical approval was obtained from the Office for Research Ethics Committees Northern Ireland (ORECNI) (application no. 16/WM/0352). Governance was provided by each specialist palliative care unit. Funding The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research was funded by a research grant awarded to Prof. Sonja McIlfatrick by Marie Curie UK (grant no. MCCC-RP-16-A20993). ORCID iDs Felicity Hasson https://orcid.org/0000-0002-8200-9732 Deborah Muldrew https://orcid.org/0000-0003-2845-1922 Anne Finucane https://orcid.org/0000-0002-3056-059X Noleen Mccorry https://orcid.org/0000-0002-8542-7665 Sonja McIlfatrick https://orcid.org/0000-0002-1010-4300

Publisher Copyright:
© The Author(s) 2019.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • Constipation
  • hospice
  • palliative care
  • qualitative research
  • quality of care
  • symptom management
  • Anesthesiology and Pain Medicine
  • General Medicine

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