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Habib MH, Arnold RM. Fecal Incontinence in Palliative Care Settings #424. J Palliat Med 2021; 24:1570-1571. [PMID: 34596470 DOI: 10.1089/jpm.2021.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Smith N, Rajabali S, Hunter KF, Chambers T, Fasinger R, Wagg A. Bladder and bowel preferences of patients at the end of life: a scoping review. Int J Palliat Nurs 2020; 26:432-442. [PMID: 33331214 DOI: 10.12968/ijpn.2020.26.8.432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Following patient preferences at the end of life should improve outcomes of care, yet patient preferences regarding bladder and bowel care are not often accommodated, as they are not well known in the literature. AIMS This scoping review sought to identify bladder and bowel care preferences of patients at the end of life in published literature. METHODS Papers published in or after 1997 (in English) that focused on adult preferences for bladder and bowel care at the end of life were included. FINDINGS Scant literature exists on preferences for bladder and bowel care for adult patients at end of life. Further investigation is warranted to arrive at a better understanding of preferences regarding bladder and bowel symptom management. CONCLUSIONS Future research should explore if prioritising the symptoms caused by incontinence, among the many symptoms experienced at the end of life, could be achieved through careful questioning and development of a standardised tool focused on improving patient care and incorporating patient preferences for care.
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Affiliation(s)
| | - Saima Rajabali
- Clinical Trials Project Coordinator for Division of Geriatric Medicine, Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Kathleen F Hunter
- Professor, Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Thane Chambers
- Research Impact Librarian, Faculty of Nursing, University of Alberta
| | - Robin Fasinger
- Professor, Faculty of Medicine and Dentistry, University of Alberta
| | - Adrian Wagg
- Professor/Director, Faculty of Medicine and Dentistry, University of Alberta
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Pais R, Lee P, Cross S, Gebski V, Aggarwal R. Bladder Care in Palliative Care Inpatients: A Prospective Dual Site Cohort Study. Palliat Med Rep 2020; 1:251-258. [PMID: 34223485 PMCID: PMC8241358 DOI: 10.1089/pmr.2020.0060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Urinary catheterization is often undertaken to relieve distressing bladder symptoms in palliative care. Objective: The primary aim of this study was to determine the incidence of, and clinical indications that predispose patients admitted to palliative care units to, urinary catheterization. The secondary aims were to determine causal factors, including the type of malignancy, antecedent medications, and duration of admission in these patients. Methods: This was a prospective observational dual site cohort study in palliative care inpatients. Univariate categorical chi-square analysis was performed to compare patients with and without urinary catheterization, and to identify risk factors associated with urinary catheter use. Results: The incidence of catheterization in this cohort was 41% (43/104) and urinary retention (63%) was the most common cause. Agitation (47%) and urinary incontinence (70%) were common symptoms in those catheterized. Medications that were significantly associated with the need for urinary catheterization were benzodiazepines (p < 0.01) and antipsychotics (p = 0.01). All measures that define poor functional status were found to be significant (p < 0.01). Patients with prolonged hospitalization of greater than three weeks were catheterized more frequently (p = 0.017). The majority of patients catheterized (79%) were admitted for terminal care. Conclusions: The high incidence of urinary catheterization highlights the need for good bladder care for all patients in the palliative care setting. Patients with risk factors include the use of antipsychotics and benzodiazepines, declining functional status and prolonged hospital admission are more likely to be catheterized.
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Affiliation(s)
- Riona Pais
- Department of Palliative Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Supportive and Palliative Medicine, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Philip Lee
- Department of Supportive and Palliative Medicine, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Shamira Cross
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Val Gebski
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Rajesh Aggarwal
- Department of Palliative Medicine, Bankstown Hospital, Sydney, New South Wales, Australia
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Affiliation(s)
- Anne Marie Kelly
- Clinical Nurse Specialist-Continence, Continence Promotion Unit, Dr. Steeven's Hospital, Dublin
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Chughtai B, Thomas D, Russell D, Phongtankuel V, Bowles K, Prigerson H. Prevalence and Risk Factors for Fecal Incontinence in Home Hospice. Am J Hosp Palliat Care 2018; 36:33-37. [DOI: 10.1177/1049909118784891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: We sought to determine the prevalence and risk factors associated with fecal incontinence (FI) in the home hospice setting. Methods: We conducted a retrospective cohort study of patients served by a hospice agency. Data on patient characteristics were extracted from hospice medical records. The primary outcome, FI, was assessed routinely during clinical visits to the patient’s home. Descriptive statistics were used to summarize patient characteristics. A Cox proportional hazards regression model was estimated for FI to examine associations with sociodemographic and clinical characteristics of patients. Results: A total of 15 432 patients were eligible. Patients were female (59.0%) and 75 years or older (23.5% were 75-84; 39.9% were 85+). Most patients with FI indicated incontinence at the time of hospice admission (64.5%; n = 4314), with the average onset period being approximately 18 days from admission (mean = 17.9, standard deviation = 50.6). Increasing age represented a risk factor for FI (hazard ratio [HR] = 1.01 [confidence interval, CI = 1.01-1.01]). The absence of a health-care proxy was associated with an increased risk of FI (HR = 1.11 [CI = 1.04-1.19]). Greater risk of FI was observed among patients with dementia (HR = 1.34 [1.24-1.46]) and stroke (HR = 1.42 [1.26-1.60]) compared to patients with cancer. Patients referred to hospice from settings other than the hospital also had a greater risk of FI compared to those referred from the hospital (HR = 1.17 [1.11-1.23]). Conclusion: Fecal incontinence is a highly prevalent condition among home hospice patients and most patients indicated FI upon admission (median time to detection = 18 days). Further studies are needed to identify modifiable risk factors for FI detection and its symptom management in this patient population.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York– Presbyterian Hospital, New York, NY, USA
| | - Dominique Thomas
- Department of Urology, Weill Cornell Medical College, New York– Presbyterian Hospital, New York, NY, USA
| | - David Russell
- Visiting Nurse Service of New York (VNSNY), New York, NY, USA
| | - Veerawat Phongtankuel
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine/New York–Presbyterian Hospital, New York, NY, USA
| | - Kathryn Bowles
- Visiting Nurse Service of New York (VNSNY), New York, NY, USA
- The University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Holly Prigerson
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine/New York–Presbyterian Hospital, New York, NY, USA
- Center for Research on End of Life Care, Weill Cornell Medicine/New York–Presbyterian Hospital, New York, NY, USA
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Gutmanis I, Hay M, Shadd J, Byrne J, McCallum S, Bishop K, Whitfield P, Faulds C. Understanding bladder management on a palliative care unit: a grounded theory study. Int J Palliat Nurs 2017; 23:144-151. [PMID: 28345475 DOI: 10.12968/ijpn.2017.23.3.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research regarding factors associated with nursing-initiated changes to bladder management at end-of-life is sparse. OBJECTIVES To explore the process of Palliative Care Unit (PCU) nurses' approach to bladder management changes. METHODS Nursing staff from one PCU in London, Canada were interviewed regarding bladder management care practices. A constructivist grounded theory was generated. RESULTS Four interconnected themes emerged: humanity (compassionate support of patients); journey (making the most of a finite timeline); health condition (illness, functional decline); and context (orders, policies, supplies). These overlapping themes must be considered in light of ongoing changes which prompt recycling through the framework. While bladder management necessitates shared decision-making and individualised care, nurses' phronetic experience may serve to detect the presence of change and the need to consider other alternatives. CONCLUSION End-of-life bladder management requires nurses to continually reconsider the significance of humanity, journey, health condition and context in light of ongoing changes.
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Affiliation(s)
- Iris Gutmanis
- Associate Scientist, Lawson Health Research Institute in London, ON Canada
| | - Melissa Hay
- PhD Candidate, Health and Rehabilitation Sciences, Western University in London, ON Canada
| | - Joshua Shadd
- Assistant Professor, Department of Family Medicine, McMaster University, Hamilton, ON in London, ON Canada
| | - Janette Byrne
- Palliative Pain and Symptom Management Consultation Program, St Joseph's Health Care in London, ON Canada
| | - Sarah McCallum
- Forensic Rehabilitation Unit, St Joseph's Health Care in London, ON Canada
| | - Kristen Bishop
- PhD Candidate, Health and Rehabilitation Sciences, Western University in London, ON Canada
| | - Patricia Whitfield
- Palliative Pain and Symptom Management Consultation Program, St. Joseph's Health Care in London, ON Canada
| | - Cathy Faulds
- Family Physician and Practicing in Palliative Care, Adjunct Professor, Department of Family Medicine, Western University in London, ON Canada
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Farrington N, Fader M, Richardson A, Sartain S. Exploring the role of practical nursing wisdom in the care of patients with urinary problems at the end of life: a qualitative interview study. J Clin Nurs 2015; 24:2745-56. [DOI: 10.1111/jocn.12829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Naomi Farrington
- Southampton General Hospital; Clinical Academic Facility; University of Southampton & University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Mandy Fader
- Southampton General Hospital; Clinical Academic Facility; University of Southampton; Southampton UK
| | - Alison Richardson
- Southampton General Hospital; Clinical Academic Facility; University of Southampton & University Hospital Southampton NHS Foundation Trust; Southampton UK
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Samantha Sartain
- Southampton General Hospital; Clinical Academic Facility; University of Southampton; Southampton UK
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Farrington N, Fader M, Richardson A, Prieto J, Bush H. Indwelling urinary catheter use at the end of life: a retrospective audit. ACTA ACUST UNITED AC 2014; 23:S4, S6-10. [PMID: 24820513 DOI: 10.12968/bjon.2014.23.sup9.s4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This audit aimed to measure: the prevalence of indwelling urinary catheters in patients at the end of life; the use of nursing documentation relating to catheter insertion and care; and prevalence of continence screening on admission. The audit involved a retrospective examination of case notes of patients who died on two oncology wards and a hospice at a large teaching hospital in the south of England. The audit showed that 63% of patients had an indwelling catheter during their admission. Documentation relating to urinary catheter insertion and care was present in 75% of cases, and 75% of patients received continence screening on admission. The findings confirm that indwelling urinary catheters are frequently used as a tool to manage urinary difficulties at the end of life, but that the indications for insertion and continued use can be unclear. Research is needed to establish appropriate use.
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Affiliation(s)
- Naomi Farrington
- Clinical Academic Fellow and Staff Nurse at the University of Southampton and University Hospital Southampton NHS Foundation Trust
| | - Mandy Fader
- Professor of Continence Technology at the University of Southampton and University Hospital Southampton NHS Foundation Trust
| | - Alison Richardson
- Clinical Professor in Cancer Nursing and End of Life Care at the University of Southampton and University Hospital Southampton NHS Foundation Trust
| | - Jacqui Prieto
- Senior Clinical Academic Research Fellow at the University of Southampton and University Hospital Southampton NHS Foundation Trust
| | - Harriet Bush
- Consultant in Palliative Medicine at the University of Southampton and University Hospital Southampton NHS Foundation Trust
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Farrington N, Fader M, Richardson A. Managing urinary incontinence at the end of life: an examination of the evidence that informs practice. Int J Palliat Nurs 2014; 19:449-56. [PMID: 24071836 DOI: 10.12968/ijpn.2013.19.9.449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To achieve a 'good' death, management of urinary incontinence at the end of life arguably should be as much a priority for nursing attention as managing symptoms such as pain and nausea. To understand how contemporary best practice is described and the nature of interventions prescribed for managing this issue, this article reviews the content of 16 seminal palliative care textbooks and 10 journal articles (retrieved through systematic search techniques) that discuss the management of urinary incontinence for patients at the end of life. The findings depict an area of nursing that has been governed by 'common sense' and precedent rather than evidence-based research, particularly regarding the use of indwelling urinary catheters. There is very little robust research evidence on this topic. Further research is required to ascertain the current state of practice in settings where patients who are approaching the end of life are cared for and the needs and preferences of patients and families.
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Affiliation(s)
- Naomi Farrington
- Clinical Academic Fellow and Staff Nurse, University of Southampton and University Hospital Southampton NHS Foundation Trust
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Heaney F. Nurse decision to insert a urinary catheter in a female patient in orthopaedic speciality: The development of a protocol to guide care. Int J Orthop Trauma Nurs 2011. [DOI: 10.1016/j.ijotn.2011.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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