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Stool softener ineffective for hospice patients with constipation
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Hospice patients with constipation did not benefit from treatment with stool softener docusate compared with patients who received placebo in a recent study.
In a prospective, double blind trial, 74 hospice patients with constipation were randomly assigned either 100 mg docusate (n=35) or placebo (n=39) twice daily for 10 days. All participants also received one to three 8.6-mg doses of sennosides daily. Evaluated factors included frequency, volume and consistency of stool, as well as patient perceptions of the difficulty and completeness of their bowel movements and symptoms potentially related to constipation.
Among the 56 patients who completed the study (25 treated patients and 31 receiving placebo), no statistically significant differences were observed between groups in frequency of stools (mean movements per day=0.74 in treated patients, 0.69 in those receiving placebo).
Stool volume also was not significantly different (P=.06) between groups, but slightly more patients in the treated group reported larger bowel movements compared with placebo patients. Investigators also noted that more treated patients had Type 3 and Type 6 stool according to the Bristol Stool Form Scale, while patients receiving placebo more frequently had Type 4 and Type 5 (P=.01).
Patients’ reports of difficulty and completeness also were similar between groups. Participants indicated experiencing difficulty during 25.0% of movements and a sense of complete evacuation in 78.6% of cases in the placebo group, compared with 32.5% (P=.57 for difference) and 73.5% (P=.77), respectively, in the treated group.
No significant differences were observed between groups regarding change to symptoms as measured by Edmonton Symptom Assessment System score, or incidence of additional bowel care interventions (required in 68.6% of treated patients compared with 74.4% receiving placebo, P=.77).
“General standing orders/policies for the use of docusate in the management of constipation on hospice units should be reviewed,” the researchers wrote. “Future randomized clinical trials assessing the efficacy of docusate in a broader range of palliative care patients, including palliative home care, would be beneficial. Research into finding a more effective bowel management protocol/medication is warranted.”
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