eLearning course to help you assess and treat people with palliative care needs experiencing constipation

Author: Dr Deborah Muldrew, Ulster University

Date of publication: April 2021

Twitter: @DrDebMuldrew | #DEMCon
 

Do you want to develop your knowledge and skills to learn how to improve the quality of life of people receiving palliative care and experiencing constipation? If yes, our free eLearning course is for you.

From 2016 to 2019, I was part of a research group in Ulster University that identified that there was no standard approach to assess, manage, and treat constipation for people with palliative care needs.  Nor was there a current training resource that could highlight the experience of patients and improve health and social care professionals’ skills and knowledge. So we decided to make one!

24 health and social care professionals in 5 hospices have already used the new eLearning course, increasing their knowledge and improving their clinical practice. We’d like for you to benefit from it too and share it with colleagues. Read on if you’d like to learn about our eLearning course and research into a suggested standard approach or watch a 90-second video summarising the research.

Why this eLearning course matters

In Ireland, 85 people die every day, and about 3 in every 4 of these people could benefit from palliative care. Palliative care aims to improve the quality of life for people and their families living with any terminal illness, and managing symptoms like constipation is a vital part of this.

Constipation is a common and distressing symptom for many people with palliative care needs. However, due to the private and sometimes embarrassing nature of the topic, it is often not discussed. One man in a hospice told us:

“Healthcare professionals need to realise the impact it [constipation] has. Most people think it will pass, but when you’re living with it, day in and day out, it is so distressing.”

We believe that by supporting health and social care professionals to manage this symptom, many other symptoms may improve, leading to a better quality of life for people with palliative care needs.

What we aimed to do

We aimed to develop and test an eLearning course for health and social care professionals to help them assess, manage, and treat constipation experienced by people with palliative care needs in the hospice. We wanted the eLearning to help develop a standard approach.

What we did
 

Getting started

We first wanted to gather evidence on how constipation is currently assessed, managed, and treated. These are the steps we took to achieve this.

(1) Literature review

In our review, we analysed 13 articles about how constipation was assessed, managed, and treated for people in a hospice. We found no standard approach to assessing people with palliative care needs. Laxatives were the most common treatment for the physical symptoms of constipation. However, the psychological and social symptoms were not considered.

(2) Clinical note review

We reviewed the clinical notes of 150 people receiving palliative care in hospices across England, Scotland, and Northern Ireland. We found that very few people had received treatment that did not include medicine. There was little or no mention of advice on diet, exercise, massage, and reflexology.

(3) Interviews and Focus Groups

We spoke to 6 groups of health and social care professionals working in hospices, 13 people with palliative care needs, and 5 family caregivers. People with palliative care needs and their families explained how constipation had affected their physical, psychological, and social wellbeing. However, they felt staff did not see it as important.

Everyone reported the use of medicine to manage the symptom. Unfortunately, people with palliative care needs and their families felt the lifestyle changes they did at home were not being included in their care plan while in the hospice. For example, staff did not know what food might help patients’ bowel movements.

Develop the eLearning course with expert input

To help us develop the eLearning course, we wanted input from experts in the area. We organised a workshop with 39 people. They included:

  • Health and social care professionals
  • academics
  • educators
  • clinical managers
  • people with palliative care needs who had experienced constipation
  • family members
  • members of the public

We set up an online Clinical Expert Review group with nurses, doctors, pharmacists, and other health and social care professionals. This group reviewed and edited the content and layout of the course.

The eLearning course

As a result of these steps, we developed a six-week, eLearning course and delivered it to 24 health and social care professionals across 5 hospices. To find out if the eLearning course made a difference to participants’ knowledge and skills, we asked them to complete an online questionnaire before and after completing the eLearning course. We also followed up with 4 focus groups to understand their experience of completing the eLearning course.

The eLearning course is now freely available on The Palliative Hub - Learning Platform. It contains 6 short modules, videos, quizzes, case studies, and links to further resources. It takes at least 3 hours to complete and learners can progress through the contents and materials at their own pace.

What we found, learned, and achieved

By completing the eLearning course, health and social care professionals improved their knowledge, skills, and ability to assess, manage, and treat constipation. Their feedback about the eLearning course has been very positive. Everyone viewed the content as relevant to clinical practice, believing that it would help to inform and change practice. While some reported a lack of time for training and technological concerns as barriers, these could be overcome with planning and resources. Overall, most participants saw the training as a valuable resource to help care for someone with constipation and contributed to their Continuing Professional Development (CPD).

By completing this research, we understand better how constipation is assessed, managed, and treated in hospices. We highlighted the broader impact of constipation on people with palliative care needs and their families. By developing an educational online eLearning course that provides tailored information to health and social care professionals, we hope to contribute to improving clinical practice and give a voice to the people with palliative care needs and their families receiving this care.

Find out more

Funding:

Marie Curie UK and HSC R&D Office (PI: Professor Sonja McIlfatrick)

References

  • Hasson F, Muldrew D, Carduff E, Finucane A, Graham-Wisener L, Larkin P, McCorry N, Slater P, McIlfatrick S. ‘Take more laxatives was their answer to everything’: A qualitative exploration of the patient, carer and healthcare professional experience of constipation in specialist palliative care. Palliative Medicine. 2020 Sep;34(8):1057-66.
  • McIlfatrick S, Muldrew DH, Beck E, Carduff E, Clarke M, Finucane A, Graham-Wisener L, Larkin P, McCorry NK, Slater P, Hasson F. Examining constipation assessment and management of patients with advanced cancer receiving specialist palliative care: a multi-site retrospective case note review of clinical practice. BMC palliative care. 2019 Dec;18(1):1-0.
  • Muldrew DH, Hasson F, Carduff E, Clarke M, Coast J, Finucane A, Graham L, Larkin P, McCorry NK, Slater P, Watson M. Assessment and management of constipation for patients receiving palliative care in specialist palliative care settings: a systematic review of the literature. Palliative medicine. 2018 May;32(5):930-8.

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