Background:
Narcotic‐induced constipation (NIC) is a common complaint among patients taking narcotics and significantly impedes optimal pain control and recovery. Its most feared and potentially fatal complication is fecal impaction with subsequent bowel perforation, Although NIC is effectively managed with laxatives and enemas, it remains prevalent in hospitals. Our objective is to evaluate the role of communication between the patient and the medical team in NIC treatment outcome.
Methods:
This was a prospective, multicenter, controlled study. Patients on the hospitalists' service at 2 teaching hospitals who received narcotics for at least 1 week were classified as cases if they were constipated (using Rome III critena) or as controls if they were not, A 9‐point scale questionnaire was administered to the patients, their nurses, and providers in order to assess the severity of constipation, its impact on patients' quality of life, and the effectiveness of its treatment, Differences between patients, providers, and nurses were compared between cases and controls. Single and multivariale logistic regression was used to identify independent predictors of large differences in the assessment of constipation between medical teams and patients.
Results:
Twenty‐three cases and 23 controls were enrolled and were comparable in sex, ethnicity, BMI, home narcotic use, and work experience of the medical team. Sixty‐five percent of the providers and 48% of the nurses caring for cases underestimated the degree of their patients” constipation by at least 2 points compared with 9% (P < 0.05) and 22% (P < 0.05), respectively, for controls, Thirty‐five percent of providers and 26% of nurses caring for cases underestimated the importance of patients being constipation free compared with 35% of providers (P = 1.00) and 9% of nurses (P < 0.05) caring for controls. Moreover, 43% of providers and 21% of nurses caring for cases overestimated how well the constipation was treated by at least 2 points, whereas 40% of the providers and 38% of the nurses caring for cases underestimated the negative impact of constipation on patient quality of life by at least 2 points. Although all providers were aware of the need for treatment, 23% of cases were given no medications for constipation, whereas the remainder received them in suboptimal doses. Ethnicity (odds ratio 4.6) and BMI (odds ratio 1.08 per unit) were the only tested variables to independently predict an at least 2‐point underestimation of constipation by the providers and the nurses, respectively.
Conclusions:
Our results clearly show that providers and nurses underestimate NIC severity and its impact on the quality of life of patients receiving narcotics relative to the patients' assessments. Ethnicity and BMI were independent predictors of such underestimation by the providers and nurses, respectively, Improving communication between patients, nurses, and providers might be the key to solving this problem and will be our next ste.
Author Disclosure:
M. Abougergi, none; K. Cole, none; R. Hess, none; A. Boueiz, none; S. Eid, none; J. Kwon, none.