Librach, S.L., Bouvette, M., De Angelis, C., Farley, J., Oneschuk, D., Pereira, J.L., . . . Canadian Consensus Development Group for Constipation in Patients With Advanced Progressive Illness. (2010). Consensus recommendations for the management of constipation in patients with advanced, progressive illness. Journal of Pain and Symptom Management, 40, 761-773.

To identify best practices for the management of constipation in patients with advanced progressive disease.

In this consensus-based guideline, the literature was reviewed and a multidisciplinary group met to develop the consensus statement. The guideline was revised and reviewed several times prior to publication.

Databases searched were PubMed and the Cochrane Library.

Search keywords were constipation, palliative care, advanced illness, laxatives, management, guidelines, and recommendations.

Inclusion and exclusion criteria were not provided.

• Patients were undergoing the end-of-life or palliative phase of care.
• The study has clinical applicability for palliative care.

This information was not provided. The consensus statement included only 20 references.

The consensus statement included information on the components of patient assessment, history, rectal and abdominal examination, management, goal development, and pharmacologic and nonpharmacologic interventions, as well as a best practice summary. Nonpharmacologic recommendations included maintaining adequate fluid and fiber intake, mobility, optimizing toileting with privacy, and positioning. Pharmacologic recommendations included selection of laxatives based on patient symptoms and preferences, as well as use of methylnaltrexone with opioid-induced constipation for patients who fail to respond to optimal laxative therapy. Osmotic laxatives, polyethylene glycol (PEG), and lactulose are supported by high-level evidence. Docusates and mineral oil should not be used.

• Patients with cancer were not identified as a specific target of the review.
• The number of articles reviewed to develop the consensus statement was not provided.

The consensus statement included a summary in outline format that reviewed the information provided in the body of the article. The summary is the most useful section of the document as the information is concise but contains adequate detail. No new information is provided. In addition, a decision tree was included that may be useful. Regular assessment is needed for the management of patients with constipation.