Many randomized trials in specialist palliative care (SPC) have failed to recruit sufficient numbers of patients. A questionnaire was designed to assess the attitudes of inpatients of a SPC unit to taking part in research. Only 50% of patients were considered physically and mentally fit for interview. Forty patients and 13 nurses were asked to indicate their willingness to take part, or for their patients to take part, in research in general and then in three hypothetical trials. Reasons for their responses were analysed. The patients were generally agreeable to trial participation (66% 'quite happy' or 'very happy'). The nurses were strongly in favour of research participation for the same group of patients (92% 'quite happy' or 'very happy'). The most invasive study involving venepuncture and random drug allocation had the least favourable response (46% of patients and 54% of nurses 'quite happy' or 'very happy'). A trial of reflexology attracted 77% of patients, while 62% were happy to take part in a study involving mood assessment and interview. Factors deterring willingness to participate included the need for record keeping by the patient and concern about potential emotional strain. The nurses correctly identified some of the factors deterring patients, but often their willingness for trial participation did not match that of the patient. Although there is support for research among the small number of potential trial entrants in specialist palliative care units, their limited physical and emotional reserves make careful attention to appropriate trial design essential to the success of future studies.

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To the Editor:Constipation is the third most common symptom in palliative medicine, with prevalence ranging from 32% to 87%. 1 Palliative care patients may have many risk factors for constipation, including the use of opioid analgesics. Opioids slow bowel transit time by acting on mu receptors in the gut. Newer treatments for opioid-induced constipation (OIC), such as prolonged-release oxycodone/naloxone (OXN) and methylnaltrexone, have focused on blocking this action on mu receptors to directly relieve OIC.OXN has been shown to improve bowel function without compromising analgesic efficacy. 2 It is a fixed combination preparation, with prolonged-release oxycodone providing systemic analgesia, whereas naloxone improves gut motility by antagonizing mu receptors in the gut. Because of extensive first-pass metabolism, oral naloxone is reported to have less than 3% bioavailability, allowing antagonism of gastrointestinal, but not central, opioid receptors, thus allowing adequate analgesia to be maintained. The case presented here suggests that naloxone bioavailability in OXN may be increased in some patients.

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