Risk factors and clinical management of constipation for terminally ill cancer patients

Autor: Mei-Feng Su, 蘇梅鳳
Rok vydání: 2005
Druh dokumentu: 學位論文 ; thesis
Popis: 93
Constipation is a common clinical problem among terminally ill cancer patients and if is not handled properly, will result in complications, physical and psychological distress, and poor quality of life. However, the issue of constipation among cancer patients is under-researched and sometimes neglected. The aims of this study, therefore, are to explore the prevalence of constipation among terminally ill cancer patients, its manifestations, risk factors, clinical management, and patients’ satisfaction to the management. This is a cross-sectional survey study. Ninety eligible patients were recruited in the cancer or inpatient hospice wards of a medical center in central Taiwan from April to May 2005. Data were collected with the following instruments: (A) basic demographics list; (B) checklist for the risk factors of constipation during hospitalization; (C) Constipation Assessment Scale (CAS) for objective assessments of constipation and one question for subjective assessment; (D) self-developed questions for assessment of associated symptoms and clinical management of constipation, and patients’ satisfaction. Personal interviews and chart review were conducted for data collection. Statistical analyses include descriptive statistics, bivariate and multivariate statistics. Results are summarized as follows: First, the prevalence of constipation in terminally ill cancer patients was 58.9% by subjective assessments, or 83.3% by objective assessments. Second, the most common associated symptoms assessed by CAS was abdominal distension (M=1.78), followed by urge but inability to pass stool (M=1.69) and decreased defecation frequency (M=1.68). On the other hand, the most common associated symptoms assessed by self-developed scale for physiological symptoms was abdominal distension (M=2.92), followed by poor appetite (M=2.32) and pain on defecation (M=2.04). Whereas the most common associated symptoms assessed by self-developed scale for psychological symptoms was restlessness (M=1.92), followed by low mood (M=1.77). Third, several risk factors for subjective assessments of constipation have been identified by multivariate logistic regression, including: use of hypnotics/sedatives (odds ratio [OR] 6.66, 95% confidence interval [CI] 1.72~25.76), daily fiber consumption less or equal to 6 gram (OR 11.15, 95% CI 3.39~36.68), and daily intake of water less or equal to 1500 ml (OR 4.05, 95% CI 1.38~11.93). Risk factors for objective assessments of constipation were analyzed by multiple linear regression analysis. Results from the final multiple linear regression model showed that mean CAS score would be increased by 0.33 when the total score of environment increases by 1 unit (p=0.002), holding other factors constant. Mean CAS score would be 1.74 higher in patients whose daily fiber consumption were less or equal to 6 gram (p=0.004) than those who have higher daily fiber consumption, controlling for other factors. Controlling other factors, mean CAS score would be 1.35 higher in patients ever taking hypnotics/sedatives than patients never taking hypnotics/sedatives (p=0.033). Fourth, for the clinical management, it has been found that 53 patients (58.9%) had complaints of constipation out of 90 participants, while only 32.1% of those complaints were documented by physicians. The kappa between patients’ complaints and physicians’ documentations was 0.17, suggesting very poor agreement between them. On the other hand, 39.6% of the 53 patients were documented by nurses as experiencing constipation. The kappa between patients’ complaints and nurses’ documentations was 0.24, also suggesting poor agreement between them. Among all measures of health education in preventing constipation, the suggestion of increasing water intake (73.6%) and the suggestion of increasing fiber consumption (69.8%) were most often used. Approximately one-third (32.1%) of the medical staff applied abdominal palpitation to diagnose constipation, followed by digital examination of anus (9.4%) and abdominal x-ray (7.5%). Laxatives (92.4%) and enema (67.9%) were the most frequent used clinical managements of constipation. Health education (43.4%), abdominal massage (20.8%), and digital (11.3%) were less commonly used. The overall effects of clinical management was perceived as between neutral and mildly improved (M=3.02). Patients felt mostly benefited from the improvement in effort of defecation and improved global constipation problem (M=3.15), followed by shortened defecation time (M=2.98) and increased defecation frequency (M=2.75). The overall satisfaction of patients about the clinical management was between neutral and satisfactory (M=15.13). Patients were most satisfied when nursing staff concerned about their bowel habits (M=3.7). The therapeutic effect of constipation management was ranked as lowest (M=3.21). In summary, more than half of hospitalized terminally ill cancer patients suffered from constipation, especially in patients affected by environment, with little fiber or water intake, and taking hypnotics/sedatives. However, constipation was ignored by a great number of clinicians according to the documentation. The results of this study highlight the importance of management of constipation in terminally ill cancer patients. We should improve the clinical management of constipation, screen the high risk group of constipation, and perform preventive intervention. When all of these are done, patients’ quality of life may be improved.
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