A qualitative study to explore psychological distress and illness burden associated with opioid-induced constipation in cancer patients with advanced disease

被引：45
作者：
Dhingra, Lara [1 ,2 ,3 ]
Shuk, Elyse [4 ]
Grossman, Bella [5 ]
Strada, Alessandra [6 ]
Wald, Emily [7 ]
Portenoy, Allison [8 ]
Knotkova, Helena [1 ,2 ,9 ]
Portenoy, Russell [1 ,2 ,10 ]
机构：
[1] Beth Israel Deaconess Med Ctr, Dept Pain Med & Palliat Care, New York, NY 10003 USA
[2] Albert Einstein Coll Med, Dept Neurol, New York, NY USA
[3] Albert Einstein Coll Med, Dept Psychiat & Behav Sci, New York, NY USA
[4] Mem Sloan Kettering Canc Ctr, Dept Psychiat & Behav Sci, New York, NY USA
[5] New Sch Social Res, New York, NY 10011 USA
[6] Calif Inst Integral Studies, East West Psychol Dept, San Francisco, CA USA
[7] Columbia Univ, Teachers Coll, New York, NY 10027 USA
[8] Cornell Univ, Ithaca, NY 14853 USA
[9] Beth Israel Deaconess Med Ctr, Dept Pain Med & Palliat Care, Dept Neurol, New York, NY 10003 USA
[10] Albert Einstein Coll Med, Dept Anesthesiol, New York, NY USA
来源：
PALLIATIVE MEDICINE | 2013年 / 27卷 / 05期
关键词：
Burden of illness; cancer; educational needs; opioid analgesics; opioid-induced constipation; psychological stress; qualitative research; INDUCED BOWEL DYSFUNCTION; SYMPTOM PREVALENCE; MANAGEMENT; PAIN; IMPACT; PERSPECTIVES; SEVERITY; SCALE;
D O I：
10.1177/0269216312450358
中图分类号：
R19 [保健组织与事业（卫生事业管理）];
学科分类号：
摘要：
Background: Constipation affects many patients receiving long-term opioid therapy for cancer pain. Little is known about the nature of psychological distress and the burden associated with this problem. This information may inform the development of effective treatment strategies and ameliorate distress. Aim: The objective was to use qualitative research methods to better understand psychological distress and the burden associated with opioid-induced constipation and its treatment in advanced cancer patients. Design: In this qualitative study, semi-structured interviews explored perceptions of psychological distress and burden from opioid-induced constipation. Interviews were analyzed using a thematic content analysis approach involving descriptive and interpretive coding and identification of recurring themes. Setting/participants: Twelve advanced cancer patients with opioid-induced constipation were recruited from a large urban hospital. Results: Patients experienced various types of negative affect and cognitions associated with opioid-induced constipation. Analyses indicated three major themes: (I) irrational thoughts and educational needs; (2) psychological distress from constipation and (3) the effects of constipation on the decision to use opioid analgesics. Irrational thoughts and educational needs included beliefs that nutrition could improve constipation, the supposition that constipation indicated deteriorating health, and catastrophic beliefs. Psychological distress included depressive symptoms and anticipatory anxiety related to constipation. Decision-making revealed cognitive dissonance about using opioids and conflicting preferences about continuing use. Conclusions: Future investigation of the multiple components of cognitive and affective burden from opioid-induced constipation is warranted. Understanding the varied nature of this burden may improve clinical recognition and assessment and promote more intensive management consistent with the distress it produces.
引用
收藏
页码：447 / 456
页数：10
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