Experiences of patients with cancer and healthcare professionals with opioid-induced constipation: A qualitative study

OBJECTIVES: Opioids are frequently prescribed for cancer-related pain, with opioid-induced constipation (OIC) being the most commonly reported side-effect. OIC in patients with cancer can be difficult to treat, underlining the importance of adequate prevention. The primary aim of this study was to explore the experiences and beliefs of patients with advanced cancer, and of healthcare professionals (HCPs) regarding the prevention of OIC. As a secondary aim, we investigated patients' and HCPs' experiences and perceptions of education and communication around prevention of OIC.

METHODS: A qualitative, explorative study using semi-structured, in-depth interviews with both patients and HCPs (physicians, nurse practitioners, nurses and pharmacy assistants). Data were analyzed using thematic analysis.

RESULTS: Eleven patients with cancer and twenty-seven HCPs were recruited from a single, academic hospital in Amsterdam. The mean duration of the interviews was 22 min (range 12-32 min) among patients and 15 min (range 9-29 min) among HCPs. Four main themes were identified: (1) Patient education on prevention of OIC; (2) Levels of knowledge of patients and HCPs; (3) Discussing constipation; (4) Beliefs of HCPs regarding prevention. Patients often do not recall the information professionals believe they have provided, prefer to receive information from their physician, demonstrate more knowledge about bowel function than HCPs assume, and lack clear guidance on when to contact their physician or how to manage their laxative use.

CONCLUSION: Our findings reveal gaps in patient education and HCP-patient communication on the prevention of OIC. Future research should focus on the use of educational tools, structured communication and monitoring of bowel movements.

PRACTICE IMPLICATIONS: There is a need for improved explanation about opioid-related side-effects through clear and repeated informing to the patients. Educational tools may support clear and consistent communication in helping patients better understand these side effects.