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    How Hospice Pharmacists Deal with Constipation

    Helping ease constipation in the hospice setting.


    While constipation is a common presenting symptom in community pharmacies, it is also a condition commonly seen by pharmacists in the hospice setting.

    “Pharmacists play a huge role in end-of-life care,” says Jason Kimbrel, PharmD, BCPS, vice president of operations and clinical services, Optum Hospice Pharmacy Services. “Pharmacists can help the healthcare team not only by communicating to patients about the importance of their medications, but by addressing the goals/outcomes of the medications.”

    Kimbrel notes that at the end of life, most patients are receiving an opioid for either pain or for another symptom such as dyspnea. “Since many of these patients could develop opioid-induced constipation, the hospice team works to ensure patients are on bowel regimens, and that bowel movements are occurring regularly regardless of opioid use.

    How Pharmacists Can Help

    Pharmacists, when dispensing or consulting with a patient who takes an opioid, can stress the importance of having regular bowel movements, Kimbrel says. “Advising patients that constipation can lead to other symptoms like nausea and vomiting will enable patients to work closely with their hospice interdisciplinary team in achieving quality of life goals,” Kimbrel says. The pharmacist on the team can also address polypharmacy issues, leading to the elimination of a medication that might be contributing to a patient’s constipation, Kimbrel says.

    Evidence-based recommendations state that hospice patients who are taking opioids should be getting a laxative and stool softener, says Kimbrel.  The most common agent used in hospice is a combination of sennosides and docusate (Senna S) “Fiber can be dangerous in hospice patients,” Kimbrel says, because of their diminished water intake. “This can lead to further constipation, nausea, and even obstruction issues.”

     Although cancer is commonly associated with hospice care, only about 40% of patients who are receiving end-of-life care have the disease, Kimbrel says. The other 60% includes patients with conditions such as congestive heart failure, COPD, dementia, liver and/or renal failure, stroke, and AIDS. Pharmacists are also involved in the care of patients with neuromuscular diseases such as Parkinson’s disease and ALS. Patients with all those conditions often use opioids for pain and dyspnea as part of their end-of-life journey, Kimbrel concludes.

    Kathleen Gannon Longo
    Kathleen Gannon Longo is a Contributing Editor.


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