Background The diagnosis, assessment and management of malignant bowel obstruction (MBO) varies across organisations. Different levels of emphasis are placed on resolution of the obstruction or symptomatic management. Yet there is currently a lack of comprehensive guidance or clinical pathways to ensure an equivalent high-standard level of care is offered to all patients.
To determine current practice in the management of MBO.
To inform future guidance and direct the emphasis placed on specific management strategies.
To improve future patient care and experience through more effective symptomatic management.
Methods Patients with an inpatient diagnosis of MBO were identified from the specialist palliative care (SPC) multi-disciplinary [MDT] lists from March 2019-January 2020. Data collected included: demographics, admission length/outcome, diagnosis, symptomatic reviews and treatment methods. Data was tabulated and analysed in Microsoft Excel.
Results Fifteen inpatients were identified. Seven patients (47%) died in hospital on average 22 days after admission. Nine (60%) had known colorectal malignancies. Fifteen (100%) had nausea and vomiting or colic on admission. Of the nine (60%) who had colic on admission five (34%) still had colic on day 4.
Only five (45%) had a daily review of symptoms. By day four, 10(67%) had PRN anti-emetics prescribed and 5(34%) had regular anti-emetics prescribed. The most commonly used agents were cyclizine (PO/IM/IV) and ondansetron (PO/IM/IV). Ten (77%) had naso-gastric [NG] tubes inserted and none underwent surgical procedures. All were reviewed by the inpatient SPC team at least once during their admission.
Conclusions Surgical management of MBO is uncommon and so emphasis should be placed on symptomatic relief and conservative therapy options. This would enable greater patient autonomy to decide preferred place of death. Assessment of symptoms of MBO should be clearly documented on assessment and daily. Assessment of colic is often missed and prompt commencement of anti-colic therapy would benefit patient care. Standardisation of anti-emetic choice in MBO would be beneficial, leading to reduced inappropriate prescribing.
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