Management of Opioid-Induced Constipation in Hospice Patients. 2018

Leah Sera, and Mary Lynn McPherson
1 Department of Pharmacy Practice and Science, The University of Maryland School of Pharmacy, Baltimore, MD, USA.

BACKGROUND Constipation is a common symptom in patients with advanced disease taking opioids. Opioid-induced constipation (OIC) is commonly treated with laxatives and stool softeners. Recently, newer agents have come to market which broaden options for patients in whom first-line therapies are not effective. OBJECTIVE To determine what pharmacologic regimens are currently used in hospice programs to prevent and treat OIC, whether those regimens have changed with the introduction of newer agents and evidence discouraging the use of docusate, and whether hospice programs are standardizing the management of OIC. METHODS An online 10-item questionnaire was disseminated by the National Hospice and Palliative Care Organization. Questions addressed demographics; first-, second- and third-line pharmacologic treatments included in bowel protocols; whether prescribing practices have changed in the last 5 years; and percentage of patients receiving specific constipation therapies. RESULTS The majority of organizations (68.8%) responded that at least 90% of patients were prescribed a bowel regimen on admission to hospice and 84.4% stated that they have a guideline or protocol for managing OIC. The most commonly used preparations for the treatment of OIC for patients during their length of stay in hospice were senna plus docusate, senna alone, docusate alone, bisacodyl, polyethylene glycol 3350, and lactulose. Over 75% of hospice organizations claimed they never used methylnaltrexone, linaclotide, lubiprostone, or naloxegol. CONCLUSIONS This survey provides insight into recent practices of hospice organizations in the treatment of OIC. As more agents come to market, it is likely that management of OIC will continue to evolve.

UI MeSH Term Description Entries
D010146 Pain An unpleasant sensation induced by noxious stimuli which are detected by NERVE ENDINGS of NOCICEPTIVE NEURONS. Suffering, Physical,Ache,Pain, Burning,Pain, Crushing,Pain, Migratory,Pain, Radiating,Pain, Splitting,Aches,Burning Pain,Burning Pains,Crushing Pain,Crushing Pains,Migratory Pain,Migratory Pains,Pains, Burning,Pains, Crushing,Pains, Migratory,Pains, Radiating,Pains, Splitting,Physical Suffering,Physical Sufferings,Radiating Pain,Radiating Pains,Splitting Pain,Splitting Pains,Sufferings, Physical
D010166 Palliative Care Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed) Palliative Treatment,Palliative Supportive Care,Palliative Surgery,Palliative Therapy,Surgery, Palliative,Therapy, Palliative,Care, Palliative,Palliative Treatments,Supportive Care, Palliative,Treatment, Palliative,Treatments, Palliative
D002400 Cathartics Agents that are used to stimulate evacuation of the bowels. Bowel Evacuant,Bowel Preparation Solution,Cathartic,Purgative,Purgatives,Bowel Evacuants,Bowel Preparation Solutions,Evacuant, Bowel,Evacuants, Bowel,Preparation Solution, Bowel,Preparation Solutions, Bowel,Solution, Bowel Preparation,Solutions, Bowel Preparation
D002985 Clinical Protocols Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy. Protocols, Clinical,Research Protocols, Clinical,Treatment Protocols,Clinical Protocol,Clinical Research Protocol,Clinical Research Protocols,Protocol, Clinical,Protocol, Clinical Research,Protocols, Clinical Research,Protocols, Treatment,Research Protocol, Clinical,Treatment Protocol
D003248 Constipation Infrequent or difficult evacuation of FECES. These symptoms are associated with a variety of causes, including low DIETARY FIBER intake, emotional or nervous disturbances, systemic and structural disorders, drug-induced aggravation, and infections. Colonic Inertia,Dyschezia
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000701 Analgesics, Opioid Compounds with activity like OPIATE ALKALOIDS, acting at OPIOID RECEPTORS. Properties include induction of ANALGESIA or NARCOSIS. Opioid,Opioid Analgesic,Opioid Analgesics,Opioids,Full Opioid Agonists,Opioid Full Agonists,Opioid Mixed Agonist-Antagonists,Opioid Partial Agonists,Partial Opioid Agonists,Agonist-Antagonists, Opioid Mixed,Agonists, Full Opioid,Agonists, Opioid Full,Agonists, Opioid Partial,Agonists, Partial Opioid,Analgesic, Opioid,Full Agonists, Opioid,Mixed Agonist-Antagonists, Opioid,Opioid Agonists, Full,Opioid Agonists, Partial,Opioid Mixed Agonist Antagonists,Partial Agonists, Opioid
D012959 Socioeconomic Factors Social and economic factors that characterize the individual or group within the social structure. Economic and Social Factors,Social Inequalities,Social Inequality,Social and Economic Factors,Socioeconomic Characteristics,Factors, Socioeconomic,High-Income Population,Land Tenure,Standard of Living,Characteristic, Socioeconomic,Factor, Socioeconomic,High Income Population,High-Income Populations,Inequality, Social,Living Standard,Living Standards,Population, High-Income,Socioeconomic Characteristic,Socioeconomic Factor,Tenure, Land
D054368 Laxatives Agents that produce a soft formed stool, and relax and loosen the bowels, typically used over a protracted period, to relieve CONSTIPATION. Bulk Laxative,Laxative,Bulk Laxatives,Laxative, Bulk,Laxatives, Bulk

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