The assessment and management of constipation among patients with advanced cancer in a palliative care ward in China: a best practice implementation project.

BACKGROUND: Constipation is one of the most common symptoms experienced by patients with advanced progressive illness. If constipation is not proactively managed, patients can experience negative consequences, such as anorexia, nausea, bowel impaction or bowel perforation, all of which can have an impact on quality of life. The prevention and management of constipation is an essential component of oncology nursing practice and should include evidence-based interventions.

OBJECTIVES: The aim of this project was to integrate the available evidence of assessment and management of constipation into clinical practice, and implement strategies to improve compliance with evidence-based practice.

METHODS: A pre- and post-implementation audit was conducted using the Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System, and Getting Research into Practice Programs. Five audit criteria were established according to the best available evidence on the assessment and management of constipation. The program was divided into three phases and conducted over five months in the palliative care ward, Fudan University Shanghai Cancer Centre.

RESULTS: Sixty patients and 17 palliative care nurses were involved in this project. Results from pre- and post-implementation audits indicated that the compliance rates of three criteria reached 100% after the implementation of various strategies. The results in the follow-up audit showed that the compliance rates for criterion 3 (non-pharmacological strategy) and criterion 4 (provision of treatment based on the management) achieved 93% and 97%, respectively.

CONCLUSION: The project has made a significant improvement in establishing evidence-based practice for constipation assessment and management in a palliative care ward. A further challenge is to develop ongoing strategies to sustain constipation assessment and management in this setting.