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Title: Identifying contributory factors leading to the suboptimal management of constipation and the development of a nurse-led clinic to improve constipation management in patients with cancer : an action research study
Author: Gale, Sue
ISNI:       0000 0004 2674 9933
Awarding Body: Brunel University
Current Institution: Bucks New University
Date of Award: 2008
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Constipation in cancer and palliative care is frequent, poorly managed and has a profound adverse effect on patients' lives. This qualitative study explores factors contributing to the suboptimal management of constipation and identifies strategies to alleviate it. In a three-staged action research study data were collected from 11 patient interviews, 26 health care professionals (HCPs) during six focus group meetings and a Constipation Management Clinic (CMC), comprising a cohort of 29 patients, which was developed as part of this study. The findings from stage one, patient interviews, confirm that the management of constipation in patients with cancer and palliative care is suboptimal partly due to HCPs’ poor knowledge and ambivalent attitudes, inadequate patient education and a lack of a concordant approach to management. Patients described feeling abandoned, their condition trivialised and many suffered considerable distress and embarrassment. In stage two, focus groups of HCPs were questioned on their understanding of the condition, its impact and their strategies for treatment. Findings from the patient interviews were fed back as a means of education and to facilitate discussion. The focus groups confirmed the findings from the patient interviews. It was therefore possible to postulate that constipation management would be improved by redressing the educational needs of HCPs, imparting knowledge to patients and working to develop a partnership approach. To test this a CMC was developed during stage three. Patients with severe and intractable constipation were recruited to a nurse-led clinic that adopted a patient-focused, education-based management strategy which also encompassed a concordant approach to laxative recommendations. Following attendance there was an immediate improvement in bowel function in all patients who became more autonomous and concordant with their treatment regimens. Aims of the study were to improve the research’s skills and knowledge in research methodology in the cancer and palliative care setting, identify factors leading to the suboptimal management of constipation and to explore ways in which to alleviate the condition in patients with cancer. Throughout the project the action research methodology incorporated concurrent dissemination of findings to HCPs allowing them to discuss and assist with the evolution of the research and to modify their own practices to the benefit of patients generally. This research demonstrates the advantages of adopting an action research approach when identifying strategies to reduce the incidence of constipation in patients with cancer and the importance of paying attention to detail when trying to manage this frequent and distressing problem.
Supervisor: Not available Sponsor: Buckinghamshire New University
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available