Background Patients with subacute malignant bowel obstruction (MBO) not amenable to surgical or interventional procedures are often highly symptomatic of pain, bloating, nausea and vomiting. Diet often exacerbates symptoms so intake is limited. UK medical treatment of MBO includes medicines and interventions to improve bowel transit and to manage symptoms (Ahmad, Jeffries, Longford, et al., 2015; Scottish Palliative Care Guidelines, 2020) but often little specific advice is given on low fibre diet compared to approaches worldwide (Lee, Jivraj, Wang, et al., 2019; British Columbia Cancer Agency, 2019).

Aim To develop a low fibre staged diet plan for patients with subacute or resolving MBO. To offer patients choice and taste variety within the limitations of a clear fluid or low residue diet in order to improve symptom control, chance of resolution and quality of life.

Methods A review of literature was undertaken to better understand diet in MBO. A UK hospital’s oncology dietician team use a phased model on which, with permissions, our diet is based. A collaborative approach was taken including input from the local trust dieticians and hospice multi-disciplinary team including catering and hospitality.

Results A four staged diet plan was created for our inpatient unit. Stage one, clear fluids; Stage two, liquid low fibre; Stage three, soft low fibre; Stage four, normal texture low fibre. MBO patients often start with bowel rest and move up or down the stages as tolerated. Stage four may also be used prophylactically for those at risk of developing MBO symptoms.

Conclusion Most patients have welcomed specific guidance on diet. The menu provides variety despite the restrictions and many patients report significant relief of their symptoms. Patients may choose to eat off plan, as part of our ‘Eat for Comfort’ policy. A community MBO diet advice booklet has subsequently been created for those living with or at risk of MBO, enabling patients to stay at home longer and be more in control of their symptoms.