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Constipation in palliative care: Prevalence, definitions, symptom distress and risk-factors
Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
2015 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. , 56 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 130
Keyword [en]
Palliative care, constipation, prevalence, definition, symptom-distress, risk factors
National Category
Other Medical Sciences Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-117188DOI: 10.3384/lic.diva-117188ISBN: 978-91-7519-101-0 (print)OAI: oai:DiVA.org:liu-117188DiVA: diva2:806785
Presentation
2015-05-21, K2, Kåkenhus, Campus Norrköping, Norrköping, 09:00 (Swedish)
Supervisors
Note

The series name Linköping University, Studies in Health Sciences, Thesis in the Licentiate thesis is incorrect. The correct name is Linköping Studies in Health Sciences. Thesis.

Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2016-12-09Bibliographically approved
List of papers
1. Constipation in specialized palliative care: prevalence, definition and patient perceived symptom distress
Open this publication in new window or tab >>Constipation in specialized palliative care: prevalence, definition and patient perceived symptom distress
2015 (English)In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 18, no 7, 585-592 p.Article in journal (Refereed) Published
Abstract [en]

Context: The prevalence of constipation among patients in palliative care has varied in prior research, from 18-90 %, depending on different study factors.

Objectives: The aim of this study was to describe and explore the prevalence and symptom distress of constipation, using different definitions of constipation, in patients admitted to specialized palliative care settings.

Methods: Data was collected in a cross-sectional survey from 485 patients in 38 palliative care units in Sweden. Variables were analyzed using logistic regression and summarized as odds ratio (OR).

Result: The prevalence of constipation varied between 7 – 43 %, depending on the definition used. Two constipation- groups were found: (i) Medical constipation- group (MCG; ≤ 3 defecations/week n=114; 23%); (ii) Perceived constipation- group (PCG; Patients with a perception of being constipated the last two weeks; n= 171; 35%). Three sub-groups emerged: patients with (a) only medical constipation (7 %), (b) only perceived constipation (19 %), and (c) with both medical and perceived constipation (16%). There were no differences in symptom severity between groups; 71% of all constipated patients had severe constipation.

Conclusion: The prevalence of constipation may differ, depending on the definition used and how constipation is assessed. In this study we found two main groups and three sub-groups, analyzed from the definitions of frequency of bowel movements and experience of being constipated. To be able to identify constipation, the patients’ definition has to be further explored and assessed.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2015
Keyword
Palliative care, constipation, prevalence, definition, symptom-distress
National Category
Other Medical Sciences Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-117184 (URN)10.1089/jpm.2014.0414 (DOI)000361880600005 ()25874474 (PubMedID)
Note

At the time for thesis presentation publication was in status: Manuscript

Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2017-12-04Bibliographically approved
2. Constipation in specialized palliative care: factors related to constipation when applying different definitions
Open this publication in new window or tab >>Constipation in specialized palliative care: factors related to constipation when applying different definitions
2016 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 2, 691-698 p.Article in journal (Refereed) Published
Abstract [en]

CONTEXT:

For patients in palliative care, constipation is primarily a result of opioid treatment. Impacts from other factors related to constipation in palliative care are rarely studied.

OBJECTIVES:

The aim was to identify factors related to constipation in patients in palliative care, and then to compare these factors between patients with different types of constipation and patients without constipation.

METHODS:

Cross-sectional data on constipation was collected with a 26-item questionnaire from 485 patients in 38 specialist palliative care units in Sweden. Three different constipation groups were used; MC ONLY, PC ONLY, and MC & PC. Logistic regression analyses were used to calculate odds ratios.

RESULTS:

Patients with <3 defecations/week, MC ONLY, (n = 36) had higher odds of being hospitalized, bed-restricted, in need of personal assistance for toilet visits, and of having a poor fluid intake. Patients with the perception of being constipated, PC ONLY, (n = 93) had higher odds of having poor appetite, hemorrhoids, hard stool, more opioid treatment, less laxative treatment and of being more dissatisfied with constipation information. Patients with both <3 defecations/week and a perception of being constipated, MC & PC, (n = 78) had higher odds of having cancer- disease.

CONCLUSION:

There were several significant factors related to constipation with higher odds than opioid- treatment, for patients in palliative care, such as; hard stool, cancer diagnosis, dissatisfaction with information, low fluid intake, hemorrhoids, bed restriction, hospitalization, and need of personal assistance for toilet visits.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2016
Keyword
Constipation, Palliative care, Risk factors, Symptom assessment
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-121720 (URN)10.1007/s00520-015-2831-5 (DOI)000367458200022 ()26160464 (PubMedID)
Funder
Medical Research Council of Southeast Sweden (FORSS), 228731
Note

At the time for thesis presentation publication was in status: Manuscript

Funding agencies: Medical Research Council of Southeast Sweden (FORSS); Vrinnevi Hospital Research Board

Available from: 2015-10-02 Created: 2015-10-02 Last updated: 2017-04-21Bibliographically approved

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