A qualitative study to explore psychological distress and illness burden associated with opioid-induced constipation in cancer patients with advanced disease.
BACKGROUND
Constipation affects many patients receiving long-term opioid therapy for cancer pain. Little is known about the nature of psychological distress and the burden associated with this problem. This information may inform the development of effective treatment strategies and ameliorate distress.


OBJECTIVE
The objective was to use qualitative research methods to better understand psychological distress and the burden associated with opioid-induced constipation and its treatment in advanced cancer patients.


METHODS
In this qualitative study, semi-structured interviews explored perceptions of psychological distress and burden from opioid-induced constipation. Interviews were analyzed using a thematic content analysis approach involving descriptive and interpretive coding and identification of recurring themes.


METHODS
Twelve advanced cancer patients with opioid-induced constipation were recruited from a large urban hospital.


RESULTS
Patients experienced various types of negative affect and cognitions associated with opioid-induced constipation. Analyses indicated three major themes: (1) irrational thoughts and educational needs; (2) psychological distress from constipation and (3) the effects of constipation on the decision to use opioid analgesics. Irrational thoughts and educational needs included beliefs that nutrition could improve constipation, the supposition that constipation indicated deteriorating health, and catastrophic beliefs. Psychological distress included depressive symptoms and anticipatory anxiety related to constipation. Decision-making revealed cognitive dissonance about using opioids and conflicting preferences about continuing use.


CONCLUSIONS
Future investigation of the multiple components of cognitive and affective burden from opioid-induced constipation is warranted. Understanding the varied nature of this burden may improve clinical recognition and assessment and promote more intensive management consistent with the distress it produces.
Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY 10003, USA. Ldhingra@chpnet.org
Lara
L
Dhingra
Elyse
E
Shuk
Bella
B
Grossman
Alessandra
A
Strada
Emily
E
Wald
Allison
A
Portenoy
Helena
H
Knotkova
Russell
R
Portenoy
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D003248:Constipation / Q000139:chemically induced / Q000523:psychology*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D036301:Qualitative Research; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid