Treatment and nursing care of patients in palliative constipation

Objective: To conduct a literature review on the management of constipation using a performance algorithm in caring for terminally ill patients with constipation. Material and methods: A systematic review UpToDate database, PubMed, MD Consult and Cochrane, using as keywords: constipation, constipation palliative care and palliative care management. Inclusion criteria: Articles published until November 2010 in Spanish or in English, referring to constipation in adults, including opioid-induced constipation. Guidelines for symptom control in palliative care and manuals fundamental in routine clinical practice. Exclusion criteria: Publications other than English or Spanish, general articles, constipation, in paediatric, obstetrics and surgical patients and rare disease cases. Results: We analysed 12 articles and 2 publications. The course of action should start from an accurate assessment of constipation (frequency and consistency of stools, change in bowel habits, the presence of discomfort or pain with bowel movements, the feeling of complete evacuation and assessment of environmental factors). General preventive measures should always be established. Intestinal obstruction should be ruled out beforehand. If this is ruled out, specific treatment should be established based on the digital rectal examination. Conclusion: After performing this literature review we have seen that the mechanism of action must be taken into account before recommending any type of laxative. It must be made clear that rectal measures should never be the first choice. We believe that it is very useful to have an algorithm that easily includes recommendations for the assessment, prevention and treatment of constipation, and may be a useful tool for daily clinical practice. (C) 2010 Sociedad Espanola de Cuidados Paliativos. Published by Elsevier Espana, S.L. All rights reserved.