A National Study to Compare Effective Management of Constipation in Children Receiving Concurrent Versus Standard Hospice Care

Abstract

Constipation is a distressing and uncomfortable symptom children experience at end of life. There is a gap in knowledge about how different approaches to hospice care delivery might improve pediatric symptom management of constipation. The purpose of this study was to evaluate the effectiveness of pediatric concurrent hospice versus standard hospice care to manage constipation. Medicaid data (2011-2013) were analyzed. Children who were younger than 21 years enrolled in hospice care and had a hospice enrollment between January 1, 2011, and December 31, 2013, were included. Instrumental variable analysis was used to test the effectiveness of concurrent versus standard hospice care. Among the 18 152 children, approximately 14% of participants were diagnosed or treated for constipation from a nonhospice provider during hospice enrollment. A higher proportion of children received nonhospice care for constipation in concurrent hospice care, compared with standard hospice (19.5% vs 13.2%), although this was not significant (β = .22, P < .05) after adjusting for covariates. The findings demonstrated that concurrent care was no more effective than standard hospice care in managing pediatric constipation. Hospice and nonhospice providers may be doing a sufficient job ordering bowel regimens before constipation becomes a serious problem for children at end of life.

A Rapid Review on the Management of Constipation for Hospice and Palliative Care Patients

“…Four studies were retrospective-observational and conducted in Portugal, 20 the United States, 13,19 and the United Kingdom 2,12 . One study focused specifically on the management of constipation in children in concurrent care management versus standard hospice care 19 . Eight of the 11 studies focused on cancer, or advanced cancer, and constipation 2,8,12-15,18,21 …”

“…2,12 One study focused specifically on the management of constipation in children in concurrent care management versus standard hospice care. 19 Eight of the 11 studies focused on cancer, or advanced cancer, and constipation. 2,8,[12][13][14][15]18,21 Three studies, a case report, 12 a systematic review of international randomized controlled trials, 8 and a systematic review and meta-analysis 16 examined peripherally acting μ-opioid receptor antagonists (PAMORAs).…”

“…Limitations to the study included the use of administrative claims data to identify patients and considered only those enrolled in Medicaid. 19…”

“…In another retrospective study using Medicaid data from 2011 through 2013 in children younger 12 years, Lindley et al 19 examined the effectiveness of pediatric concurrent care hospice to standard hospice in managing constipation. Symptom management for constipation was operationalized using data points of fecal impaction, enema administration, and radiographs.…”

“…The study did not find any difference between concurrent care and standard hospice care in the management of constipation. Limitations to the study included the use of administrative claims data to identify patients and considered only those enrolled in Medicaid 19 …”