• Katherine Clark, Joanna M Smith, and David C Currow.
• Department of Palliative Care, Calvary Mater Newcastle, Waratah, New South Wales, Australia. katherine.clark@calvarymater.org.au
• J Pain Symptom Manage. 2012 Jun 1;43(6):993-1000.

ContextConstipation and other disturbances of bowel function are distressing problems for people with specialist palliative care needs. Recent observations suggest that such problems may worsen as people become more unwell, but the changes in intensity over time are not well documented.ObjectivesThe objectives of this work were to understand the prevalence, intensity, and progression of self-reported bowel disturbances across a community palliative care population, which included people with cancer and noncancer diagnoses.MethodsAll people referred to a community-based palliative care service over a period of 6.3 years had their bowel problem scores reported, using a numerical rating score at every clinical encounter until their death, at four discrete time points, namely, 90, 60, 30, and seven days before death. This allowed change over three time periods to be considered. At the same time, other symptom scores were collected including nausea, fatigue, pain, appetite problems, and breathing problems. Patients were categorized according to the underlying disease that accounted for their referral to palliative care, namely, cancer diagnoses (upper gastrointestinal cancers, lower gastrointestinal cancers, cancers of the associated digestive organs, and other cancers) and nonmalignant diagnoses. Group differences over the time periods were assessed using analysis of variance. Bivariate analysis was used to explore the relationship between bowel disturbances and other symptoms using Spearman's Rho correlation.ResultsFor 7772 patients, data were collected an average of 22.5 times, generating 174,783 data collection points over an average of 98.6 days on the service. At the time of referral to the service, 3248 (42.4%) people had disturbed bowel scores, 548 (7.2%) of whom described these as severe. Only 1020 (13.1%) people never described disturbed bowel function over their time in palliative care. At each time point, approximately one-third were experiencing disturbed bowel function, with proportionally greater numbers of people experiencing more significant problems as death approached (Χ(2) (9)=119.3; P<0.001). Most referrals to the service were because of cancer diagnoses, with no significant differences noted between the bowel disturbance scores of those with cancer diagnoses compared with those with nonmalignant disease. Associations between bowel problem score and appetite problems, nausea, breathing problems, fatigue, and pain were explored. Although weak, there were statistically significant associations between all symptoms and bowel problem scores except for breathing problems.ConclusionIn conclusion, disturbed bowel function consistently remains a problem for people under the care of palliative care services, with the proportion of people with severe problems increasing as death approaches. This is despite the time and number of interventions currently used to palliate these problems.Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

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