Introduction
Constipation is a common symptom in palliative care, resulting in physical, psychological, social and existential problems affecting quality of life. The lack of a clear definition of constipation can contribute to difficulties in reaching a diagnosis. Contributory factors to developing constipation may include poor dietary intake, physical inactivity, underlying disease and its treatment. As not all of these are reversible in this population, laxative prescribing practice is highly variable, depending on prescriber preference and trial and error.
Aims 
To develop evidence-based guidance on the diagnosis and management of constipation in palliative care patients.
Methods
A regional audit of clinical practice was combined with a systematic literature review in July 2017. Databases searched included Medline, Embase, CINAHL and Cochrane. Evidence was compiled to form the strongest evidence to support new guideline construction.
Results
148 clinical audit forms and 91 professional surveys were returned. Assessment for reversible factors was inconsistent, with the commonest factor assessed being reduced mobility in 70%. Prescribing practice was highly variable. Professional opinions varied greatly in approach to management and most respondents felt unconfident using peripheral mu opioid receptor antagonists to treat opioid induced constipation.
The literature review revealed 11 original research articles applicable to this population and clinical question. These revealed strong evidence for senna and lactulose (both as monotherapy and in combination). In addition strong evidence for naloxegol for opioid induced constipation was found. Evidence of non-efficacy was found for sodium docusate, although in the audit it was the joint most commonly used medication.
Conclusions
These findings combined with patient representatives’ input led to the construction of a new NICE accredited regional guideline to support standardised assessment and management of constipation in palliative care.

The Management of Constipation in Palliative Care