Docusate not effective at relieving constipation in end-of-life patients: U of A medical research

Standard practice in palliative-care setting no more effective than not taking stool softeners

Raquel Maurier - 19 April 2013

End-of-life patients typically struggle with constipation due to the narcotics they are given to alleviate their pain, so doctors prescribe a stool softener called docusate twice a day to alleviate this uncomfortable problem. But new medical research from the University of Alberta shows this practice isn't effective in dealing with constipation in palliative-care settings.

Faculty of Medicine & Dentistry researchers Rick Spooner, Olga Szafran, Yoko Tarumi and Mitchell Wilson recently published their findings in the peer-reviewed publication, Journal of Pain and Symptom Management. Spooner and Szafran both work in the Department of Family Medicine, while Tarumi works in the Department of Oncology and Wilson is a current medical student.

Spooner said similar evidence published years ago suggested that patients in long-term care facilities didn't benefit from stool softeners, so many such facilities abandoned the practice. Spooner and his colleagues wanted to know if a similar situation existed in palliative-care patients.

"No one ever questioned the effectiveness of administering docusate to palliative-care patients," says Spooner. "Our research demonstrated there was no effectiveness to the practice. How many other things are we commonly doing in palliative medical practice where we are going on belief and tradition, instead of evidence?"

Szafran noted their research showed no difference in stool frequency or volume when comparing palliative-care patients who received the stool softeners and those who didn't.

In total, 74 patients took part in the 10-day randomized, double-blind, placebo-controlled trial in palliative-care settings in Edmonton.

Docusate pills are large and can be difficult to swallow so making gravely ill patients take awkward and ineffective medication that doesn't improve their quality of life doesn't make sense, says Spooner. Because nurses have to administer the medication, reducing or stopping the use of the stool softener could also mean time and cost savings for the health-care system.

The research group noted trying to pinpoint best medical practices in the palliative-care population is challenging, and little research exists in this area, because most patients are only in such facilities for a limited number of days. The patients themselves or their families can be reluctant to take part in research and others pass away before completing studies.

The research was funded by a Janus Research Grant through the Research and Education Foundation of the College of Family Physicians of Canada. Research funding was also provided by the Covenant Health Research Trust Fund.