title: A retrospective pilot study to explore the timing of cessation of laxatives before death in a palliative care unit.
abstract: Constipation is common and sometimes distressing in palliative care patients. Laxatives are often prescribed, but there is little guidance as to the most appropriate time to cease these medications as death approaches.
  
  
  OBJECTIVE
  To conduct a retrospective pilot review of usual prescribing of laxatives toward the end of life in a specialist palliative care unit.
  
  
  METHODS
  The notes of all 92 inpatients who died over a 2-month period were reviewed, with the main outcomes of interest being the number and types of laxatives prescribed and the documentation of bowel movements in relation to time of death.
  
  
  RESULTS
  On admission 70% of the patients were receiving laxatives, with a mean of two different types per person. The mean number of days before death that people had a bowel movement recorded by nursing staff was 3.8 (standard deviation (SD) 3.55). No differences were identified between those who had not received laxatives at any point, those who received laxatives until death, and those who ceased laxatives at distinct time points. However, differences were found between those who were commenced on an end-of-life care pathway (mean 4.30 days; SD 3.84) and those who were not (mean 2.50 days; SD 2.31) (P=0.01).
  
  
  CONCLUSIONS
  The correct timing for cessation of laxatives as death approaches remains unclear. Further work is needed to understand how bowel function changes with disease progression and the subjective experiences of patients.
authors.affiliation: Department of Palliative Care, Calvary Mater Newcastle, Australia. Katherine.clark@calvarymater.org.au
authors.forename: K
authors.initials: K
authors.lastname: Clark
authors.forename: A
authors.initials: A
authors.lastname: Hipwell
authors.forename: N
authors.initials: N
authors.lastname: Byfieldt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000188:drug therapy*; D006801:Humans; D007297:Inpatients; D054368:Laxatives / Q000008:administration & dosage*; D008875:Middle Aged; D009517:New South Wales; D010166:Palliative Care; D010865:Pilot Projects; D012189:Retrospective Studies; D013727:Terminal Care; D013997:Time Factors
chemical_list: D054368:Laxatives