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The management of constipation in palliative care: clinical practice recommendations

Senior Lecturer in Nursing (Palliative Care), School of Nursing and Midwifery, Aras Moyola, The National University of Ireland, Galway philip.larkin{at}nuigalway.ie

NP Sykes

Medical Director and Consultant in Palliative Medicine, St Christopher's Hospice, London

C Centeno

Consultant in Palliative Care, Clínica Universitaria, University of Navarra, Pamplona

JE Ellershaw

Professor of Palliative Medicine, University of Liverpool, Liverpool; Director, Marie Curie Palliative Care Institute, Liverpool

F Elsner

Assistant Professor and Assistant Medical Director, Department of Palliative Medicine, University Hospital Aachen, Aachen

B Eugene

Palliative Care Nurse, Hospices Civils de Lyon, Lyon

JRG Gootjes

Care Manager, Hospice Kuria, Amsterdam

M Nabal

Consultant in Palliative Medicine, Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova, Lleida

A Noguera

Clinical Research Fellow, Palliative Care Unit, Clínica Universitaria, University of Navarra, Pamplona

C Ripamonti

Specialist in Oncology Medicine and Clinical Pharmacology, Rehabilitation and Palliative Care Operative Unit, IRCCS Foundation, National Cancer Institute of Milan, Milan

F Zucco

Director of the Department of Anaesthesia, Hospice Garbagnate, Cure Palliative AO Salvini, Milan

WWA Zuurmond

Professor of Palliative Care and Pain Relief, Vrije Universiteit Medical Centre Amsterdam, Hospice Kuria, Amsterdam

On behalf of The European Consensus Group on Constipation in Palliative Care

Constipation is one of the most common problems in patients receiving palliative care and can cause extreme suffering and discomfort. The aims of this study are to raise awareness of constipation in palliative care, provide clear, practical guidance on management and encourage further research in the area. A pan-European working group of physicians and nurses with significant experience in the management of constipation in palliative care met to evaluate the published evidence and produce these clinical practice recommendations. Four potentially relevant publications were identified, highlighting a lack of clear, practical guidance on the assessment, diagnosis and management of constipation in palliative care patients. Given the limited data available, our recommendations are based on expert clinical opinion, relevant research findings from other settings and best practice from the countries represented. Palliative care patients are at a high risk of constipation, and while general principles of prevention should be followed, pharmacological treatment is often necessary. The combination of a softener and stimulant laxative is generally recommended, and the choice of laxatives should be made on an individual basis. The current evidence base is poor and further research is required on many aspects of the assessment, diagnosis and management of constipation in palliative care.

Key Words: clinical practice recommendations • constipation • palliative care

Palliative Medicine, Vol. 22, No. 7, 796-807 (2008)
DOI: 10.1177/0269216308096908


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