Screening for Constipation in Palliative Care Patients

Introduction: The objective of this study was to establish screening criteria for constipation in palliative care and, subsequently, to determine data for diagnostic suspicion of constipation in a palliative care population. Also we investigate the incidence of fecal impaction in the same sample of palliative care patients. Materials and methods: A descriptive, multicenter cross-sectional study was done. All patients in active care by a group of hospital and home palliative care teams were studied. A questionnaire on signs (frequency and consistency of stools) and symptoms (pain, discomfort, or a sensation of incomplete evacuation when having a bowel movement) of constipation in last weeks, and a verbal numerical scale (VNS) (0-10) on discomfort or difficulty with constipation was completed by the patients. The patients were asked about impaction in the last 3 months. Results: One hundred twenty patients from 21 palliative care teams were included; the majority of patients received opiates (66%) and also laxatives (60%). Bowel movement rate less than three stools per week was found in 13% of patients, stools harder than normal were experienced in 24% patients, and 33% exhibited pain, discomfort, or sensation of incomplete evacuation. Of the patients studied 13% had some signs of habitual constipation but they did not complain of symptoms, others (17%) had some discomfort in spite of not having signs of constipation. As screening criteria for constipation in palliative care we elected to include indistinct presence of constipation symptoms or constipation signs in recent weeks. A diagnosis of suspicion of constipation was established in almost 1 of 2 patients (48%) of our palliative care population. VNS with cutoff point of 3 or more of 10, showed a sensitivity of 0.70 and a specificity of 0.74 and positive predictive value (PPV) of 73% positive and negative predictive value (NPV) of 70%. In addition to these findings a considerable number of our palliative care patients (20%) reported episodes of fecal impaction in the last 3 months. Conclusion: The screening for constipation in palliative care should be performed exploring subjective symptoms and other objective signs. A diagnosis of suspected constipation was found in almost half of the palliative care patients studied. A VNS of constipation did not produce good predictive values for the detection of constipation in our sample.