The assessment of the diagnostic tools for constipation in palliative care patients

Constipation, although it is the most frequent symptoms in palliative care patients, remains diagnostic and therapeutic problem. The main difficulty derives from its multifactorial etiology, as well as in shortness of standardized diagnostic and treatment monitoring tools. Using such tools is recommended by the Polish Society for Paliative Medicine. The aim of this study was the assessment of reliability and usefulness of available constipation diagnostic and monitoring tools in routine palliative practice. The additional goal was establishing definitions of small and large opioid doses, as to enable further investigating the correlation with frequency of constipation. The study consisted in filling out Bowel Function Assessment Questionnaire (BFAQ), the pilot tool implemented in routing diagnosing and monitoring of constipation in patients. The tool consisted of questions on the objective symptoms of constipation, as well as the available BFI and PAC-SYM scales. The sample contained 232 patients in home and ambulatory care as well as in the hospice and palliative care ward. 196 questionnaires were included in the analysis. The linear correlation was revealed between the objective symptoms of constipation and BFI questions, at high rates of completion. For PAC-SYM, only for the total index and the question about hard stools, such correlation was proved. The opioid doses distribution, as equianalgetic morphine dose, appeared right-sloped with median at 90 mg/day, and with distinct gap between 90 and 1200 mg/day doses.
Conclusions: BFI and PAC-SYM appeared well correlated with frequency of bowel movements and are linearly correlated with each other, however due to their complexity and uselessness of some questions, they may not be useful in routine practice. The routine questions should be about the number of bowel movements in the last 7 days, difficulty of bowel movements and hard stools, using simplified scale.