ONS Guidelines Article

ONS Guidelines™ for Opioid-Induced and Non–Opioid-Related Cancer Constipation

Barbara B. Rogers

Pamela K. Ginex

Allison Anbari

Brian J. Hanson

Kristine B. LeFebvre

Rachael Lopez

Deborah M. Thorpe

Brenda Wolles

Kerri Moriarty

Christine Maloney

Mark Vrabel

Rebecca L. Morgan

opioid-induced constipation, cancer, constipation, acupuncture, guideline, GRADE
ONF 2020, 47(6), 671-691. DOI: 10.1188/20.ONF.671-691

Purpose: This evidence-based guideline intends to support clinicians, patients, and others in decisions regarding the treatment of constipation in patients with cancer.

Methodologic Approach: An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of cancer-related constipation. Systematic reviews of the literature were conducted. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the evidence and make recommendations.

Findings: The panel agreed on 13 recommendations for the management of opioid-induced and non–opioid-related constipation in patients with cancer.

Implications for Nursing: The panel conditionally recommended a bowel regimen in addition to lifestyle education as first-line treatment for constipation. For patients starting opioids, the panel suggests a bowel regimen as prophylaxis. Pharmaceutical interventions are available and recommended if a bowel regimen has failed. Acupuncture and electroacupuncture for non–opioid-related constipation are recommended in the context of a clinical trial.

Supplementary material can be found at https://bit.ly/30y29sI

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