BACKGROUND Constipation is a common symptom for patients receiving palliative care. Whilst international clinical guidelines are available on the clinical management of constipation for people with advanced cancer receiving specialist palliative care (SPC), the extent to which the guidelines are implemented in practice is unclear. This study aimed to examine clinical practices for the assessment and management of constipation for patients with advanced cancer within inpatient SPC settings. METHODS A multi-site retrospective case-note review was conducted, consisting of 150 patient case-notes from three inpatient SPC units across the United Kingdom between August 2016 and May 2017. The variables selected for review were determined by the recommendations within the clinical guidelines. Descriptive statistics, cross tabulation, chi square, and bivariate correlations were used to examine clinical practices compared to policy guidelines for the assessment and management of constipation. Reporting was structured by the STROBE checklist for observational research (Additional File 2). RESULTS A comprehensive assessment, including a full history and performing a physical exam, was recorded for 109 patients (73%), however, no standardised documentation was utilised. Assessment was nurse led, with variable involvement across sites of other members of the multidisciplinary team (MDT). Education on prevention was documented in 30 (20%) case-notes, and 53% recorded evidence of non-pharmacological intervention. Age, gender, and reason for admission did not impact on the likelihood of receiving a comprehensive assessment, education, or non-pharmacological intervention, however, significant differences were evident between sites. Pharmacological management was well developed and aligned to the guidelines however, 33% of patient case-notes recorded no information on the titration of laxatives. Twelve percent of patients experienced partial or complete bowel obstruction, and management strategies were variable. CONCLUSIONS Constipation management is driven by a pharmacological approach, with little evidence of the implementation of preventative and non-pharmacological strategies. The nurse plays a key coordinating role in assessment; however, involvement and roles of the wider MDT varies. Accurate recording of care is essential when examining clinical practice and identifying areas for improvement. Further education is needed to equip HCPs with the knowledge and skills to ensure consistency in assessment and implementation of appropriate non-pharmacological/ preventative strategies.

中文翻译：

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检查接受专业姑息治疗的晚期癌症患者的便秘评估和管理：临床实践的多地点回顾性病例记录审查。


背景便秘是接受姑息治疗的患者的常见症状。虽然针对接受专科姑息治疗 (SPC) 的晚期癌症患者的便秘临床管理已有国际临床指南，但该指南在实践中的实施程度尚不清楚。本研究旨在探讨住院 SPC 环境中晚期癌症患者便秘评估和管理的临床实践。方法进行了多地点回顾性病例记录审查，包括 2016 年 8 月至 2017 年 5 月期间来自英国三个住院 SPC 单位的 150 名患者病例记录。选择用于审查的变量是根据临床指南中的建议确定的。使用描述性统计、交叉表、卡方和双变量相关性来检查临床实践，并与便秘评估和管理的政策指南进行比较。报告由观察研究的 STROBE 检查表构建（附加文件 2）。结果 对 109 名患者 (73%) 进行了全面评估，包括完整的病史和体检，但没有使用标准化文件。评估由护士主导，多学科团队 (MDT) 的其他成员在不同地点参与。 30 个 (20%) 病例记录中记录了预防教育，53% 记录了非药物干预的证据。年龄、性别和入院原因并不影响接受综合评估、教育或非药物干预的可能性，但不同地点之间存在明显差异。 药理学管理非常完善并且符合指南，但是 33% 的患者病例记录没有记录有关泻药滴定的信息。 12% 的患者出现部分或完全肠梗阻，且治疗策略各不相同。结论 便秘管理是由药物方法驱动的，几乎没有证据表明预防性和非药物策略的实施。护士在评估中起着关键的协调作用；然而，更广泛的 MDT 的参与和作用各不相同。在检查临床实践和确定需要改进的领域时，准确的护理记录至关重要。需要进一步的教育，使 HCP 具备知识和技能，以确保评估和实施适当的非药物/预防策略的一致性。