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Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death

The use of opioids to control pain at the end of life may cause constipation, a symptom that can negatively influence the well-being of patients and caregivers. The main aim of this study was to evaluate the impact of constipation on symptomatic control and patients’ overall quality of life at this...

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Autores principales: Ribeiro, Hugo, Magalhães, Júlia, Cardoso, Tatiana, Chaves-Castro, Isabel, Lopes-Mota, Carla, Costa, Elisabete, Rocha, Patrícia, Lopes, Luísa, Bouça, Ângela, Pereira, Cristina, Paulo Andrade, José, Dourado, Marília
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857563/
https://www.ncbi.nlm.nih.gov/pubmed/36701723
http://dx.doi.org/10.1097/MD.0000000000032718
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author Ribeiro, Hugo
Magalhães, Júlia
Cardoso, Tatiana
Chaves-Castro, Isabel
Lopes-Mota, Carla
Costa, Elisabete
Rocha, Patrícia
Lopes, Luísa
Bouça, Ângela
Pereira, Cristina
Paulo Andrade, José
Dourado, Marília
author_facet Ribeiro, Hugo
Magalhães, Júlia
Cardoso, Tatiana
Chaves-Castro, Isabel
Lopes-Mota, Carla
Costa, Elisabete
Rocha, Patrícia
Lopes, Luísa
Bouça, Ângela
Pereira, Cristina
Paulo Andrade, José
Dourado, Marília
author_sort Ribeiro, Hugo
collection PubMed
description The use of opioids to control pain at the end of life may cause constipation, a symptom that can negatively influence the well-being of patients and caregivers. The main aim of this study was to evaluate the impact of constipation on symptomatic control and patients’ overall quality of life at this stage. A particular focus was placed on opioids. We also intended to investigate whether constipation and caregiver fatigue is related to the place of death (hospital vs home). The approach of 121 patients followed in 2021 in their last week of life by a home team specialized in palliative care was analyzed in an observational, retrospective, non-interventional study. The patients were followed up for an average of 39.7 days. A total of 82.6% wished to die at home, which occurred in 74% of the cases. The constipation prevention protocol reduced constipation by 55.1%. It seems that morphine is more related with constipation and tapentadol seems to reduce constipation induced by opioids. Patients tended to die in hospitals when their caregivers were exhausted; however, it was not possible to determine a cutoff point using the Zarit scale, which was used to assess caregiver burden. Constipation in the last week of life does not seem to influence the well-being of patients or their caregivers significantly and the individualization of intensive treatment of constipation is needed. Different opioids have different probabilities of causing adverse effects such as constipation. Future special support mechanisms can be created and activated for the most tired caregivers to avoid exhaustion and promote death at home, if that is the patient’s will.
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spelling pubmed-98575632023-01-24 Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death Ribeiro, Hugo Magalhães, Júlia Cardoso, Tatiana Chaves-Castro, Isabel Lopes-Mota, Carla Costa, Elisabete Rocha, Patrícia Lopes, Luísa Bouça, Ângela Pereira, Cristina Paulo Andrade, José Dourado, Marília Medicine (Baltimore) 6100 The use of opioids to control pain at the end of life may cause constipation, a symptom that can negatively influence the well-being of patients and caregivers. The main aim of this study was to evaluate the impact of constipation on symptomatic control and patients’ overall quality of life at this stage. A particular focus was placed on opioids. We also intended to investigate whether constipation and caregiver fatigue is related to the place of death (hospital vs home). The approach of 121 patients followed in 2021 in their last week of life by a home team specialized in palliative care was analyzed in an observational, retrospective, non-interventional study. The patients were followed up for an average of 39.7 days. A total of 82.6% wished to die at home, which occurred in 74% of the cases. The constipation prevention protocol reduced constipation by 55.1%. It seems that morphine is more related with constipation and tapentadol seems to reduce constipation induced by opioids. Patients tended to die in hospitals when their caregivers were exhausted; however, it was not possible to determine a cutoff point using the Zarit scale, which was used to assess caregiver burden. Constipation in the last week of life does not seem to influence the well-being of patients or their caregivers significantly and the individualization of intensive treatment of constipation is needed. Different opioids have different probabilities of causing adverse effects such as constipation. Future special support mechanisms can be created and activated for the most tired caregivers to avoid exhaustion and promote death at home, if that is the patient’s will. Lippincott Williams & Wilkins 2023-01-20 /pmc/articles/PMC9857563/ /pubmed/36701723 http://dx.doi.org/10.1097/MD.0000000000032718 Text en Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle 6100
Ribeiro, Hugo
Magalhães, Júlia
Cardoso, Tatiana
Chaves-Castro, Isabel
Lopes-Mota, Carla
Costa, Elisabete
Rocha, Patrícia
Lopes, Luísa
Bouça, Ângela
Pereira, Cristina
Paulo Andrade, José
Dourado, Marília
Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death
title Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death
title_full Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death
title_fullStr Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death
title_full_unstemmed Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death
title_short Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death
title_sort opioids and constipation therapy in the last week of life: their impact on patients, caregivers, and the location of death
topic 6100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857563/
https://www.ncbi.nlm.nih.gov/pubmed/36701723
http://dx.doi.org/10.1097/MD.0000000000032718
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