Prevalencia del estreñimiento en una población de pacientes oncológicos, en seguimiento por el equipo de cuidados paliativos / Prevalence of constipation in a cancer patient population followed up by a palliative care team

Objetivos: Determinar la prevalencia del estreñimiento en una población de pacientes oncológicos en seguimiento por el equipo de cuidados paliativos. Describir los tratamientos utilizados para el estreñimiento; comparar la frecuencia de estreñimiento según el tratamiento opioide.Material y métodos: Estudio epidemiológico, observacional y transversal. Realizado íntegramente en el Hospital Universitario Arnau de Vilanova (HUAV) de Lleida. Se utilizó un cuestionario heteroadministrado para entrevistar a pacientes en régimen ambulatorio y hospitalario, con diagnóstico de enfermedad oncológica avanzada, y en seguimiento por el equipo de cuidados paliativos durante un mínimo de 5 días.Variables: La prevalencia de estreñimiento se valoró mediante la aplicación de los criterios Roma IV. Por otra parte, se registraron variables correspondientes a las características basales de los pacientes y a su enfermedad, así como los distintos tratamientos utilizados para combatir el estreñimiento y los fármacos opioides. Para la descripción de variables cualitativas, se utilizaron las frecuencias absoluta y relativa, y para las cuantitativas la media y la desviación típica; para la comparación de las mismas se utilizó el test de Chi cuadrado y la t de Student cuando procedía, con un nivel de significación de 0,05.Resultados: De los 100 pacientes incluidos, 98 fueron aptos para el análisis. Un 19,4 % cumplía los criterios Roma IV de estreñimiento en el momento de la valoración. La proporción de pacientes con diagnóstico de estreñimiento fue mayor en régimen hospitalario sin que esta variable alcanzara la significación estadística. No se detectaron diferencias estadísticamente significativas en la prevalencia de estreñimiento entre los distintos tratamientos opioides. El 53,1 % de los pacientes seguía tratamiento habitual con algún laxante, siendo el más frecuente el hidróxido de magnesio (48,1 %), y solo un 11,5 % recibía tratamiento con más de un laxante...(AU)

Objectives: To determine the prevalence of constipation in oncological patients under follow-up by a palliative care team. To describe the treatments used for constipation, comparing the frequency of constipation according to opioid therapy status.Material and methods: An epidemiological, observational, cross-sectional study. It was completely carried out at the Arnau de Vilanova University Hospital (HUAV) in Lleida. A researcher-administered questionnaire was used to interview outpatients and inpatients diagnosed with advanced cancer disease, and followed up by a palliative care team for a minimum of 5 days.Variables: The prevalence of constipation was assessed by applying the Rome IV criteria. On the other hand, variables corresponding to the baseline characteristics of the patients and their disease were recorded, as were the different treatments used to combat constipation and the use of opioid drugs. Concerning qualitative variables, the absolute and relative frequencies were used; for quantitative variables, the mean and standard deviation were used. For comparisons, the chi-square test and Student’s t-test were used when appropriate, with a significance level of 0.05.Results: Of all 100 patients included, 98 were eligible for the analysis; 19.4 % met the Roma IV criteria for constipation at the time of assessment. No statistically significant differences were detected in the prevalence of constipation between different opioid treatments. Even though the proportion of constipated patients was higher among inpatients, this was not statistically significant. In all, 53.1 % of patients were on regular treatment with some laxative, the most frequent being magnesium hydroxide (48.1 %), and only 11.5 % received treatment with more than one laxative.Conclusions: Taking into consideration all the previous information, constipation continues to be a symptom with a non-negligible prevalence among patients with advanced cancer disease..(AU)

Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol.

INTRODUCTION: The benefits of palliative care rely on how healthcare professionals assess patients' needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients. METHODS AND ANALYSIS: To design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP's acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice. ETHICS AND DISSEMINATION: Ethical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout.