Proposed Criteria for Constipation in Palliative Care Patients. A Multicenter Cohort Study.

Tomasz Dzierżanowski,Philip Larkin

doi:10.3390/jcm10010040

Abstract

Although constipation is one of the most frequently reported symptoms in palliative care, there is no widely accepted definition of constipation and none suitable for patients unable to self-report or express symptoms. This study aimed to verify the objective and subjective symptoms of constipation to develop a diagnostic algorithm for constipation, which is also feasible in unconscious patients. In a pooled analysis of two observational studies, 369 out of 547 adult end-stage cancer patients met the inclusion criteria. The patient-reported difficulty of defecation correlated with observable measures, such as days since last bowel movement, and frequency of bowel movements. Difficulty became at least moderate when there were no bowel movements for ≥2 days, or the frequency of bowel movements was ≤3 per week. The diagnostic algorithm, comprising these three symptoms offers a simple, rapid, and comprehensive tool for palliative care, independent of the patient’s state of consciousness. A clinical trial is necessary to confirm its validity and usefulness.

Highlights

The prevalence rate of constipation varies from 40% to 90% in palliative care patients [1], highly dependent on the definition of constipation, its objective and subjective metrics, and the discriminating cut-off values used [2,3,4]
Based on previous research [14,15], we identified four symptoms that seemed possible candidates for such criteria: the difficulty of constipation, necessity of laxatives, days since the last bowel movements (BM), and frequency of BM
This study aimed to address the following clinical questions: (1) In adult palliative care cancer patients, what is the correlation between patientreported assessment of constipation and the observable criteria of constipation: frequency of BM, days since the last BM, and the necessity of laxatives?

Summary

Introduction

The prevalence rate of constipation varies from 40% to 90% in palliative care patients [1], highly dependent on the definition of constipation, its objective and subjective metrics, and the discriminating cut-off values used [2,3,4]. The available definitions of constipation include (1) the patient’s subjective perception, reflecting the level of their discomfort and changes in bowel movements (BM) pattern, and (2) observable (measurable) symptoms, such as the frequency of defecation [4]. Only one out of 20 definitions of constipation identified in this review included a patient’s self-assessment as the main reason to diagnose constipation, which contrasts with the subjective nature of the symptom [4]. 50% of patients understand constipation differently from their physicians, and the physician should ensure that this misunderstanding is avoided [5,6]

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