Palyatif bakım hastalarında konstipasyonun yönetimi ve akupresürün etkinliği

Yıl 2020, Cilt: 7 Sayı: 2, 141 - 148, 30.06.2020

Derya Bıçak Ayık Gülbeyaz Can

Öz

Konstipasyon, palyatif bakım hastalarının yaşadığı en yaygın semptomlardan biridir ve prevalansının yaklaşık olarak %30–90 arasında olduğu tahmin edilmektedir. Konstipasyon tedavi edilmediği takdirde, karın ağrısı, bulantı, kusma, psikolojik rahatsızlıklar, bağırsak tıkanması ve perforasyonu gibi rahatsız edici semptomlara veya yaşamı tehdit edici komplikasyonlara yol açabilmektedir. Konstipasyon için yaygın farmakolojik müdahalelerin kullanımı kısa süreli semptomların hafifletilmesinde etkili olsa da uzun süreli kullanımları ciddi yan etkilere ve sağlık bakım sisteminde yüksek maliyetlere neden olabilmektedir. Bu nedenle palyatif bakım hastalarında görülen konstipasyonu hafifletmek için diğer destekleyici yöntemlere de ihtiyaç duyulmaktadır. Son zamanlarda, tamamlayıcı ve alternatif tıp uygulamaları semptom yönetiminde yaygın olarak kullanılmaktadır. Non-farmakolojik yöntemlerden biri olan akupresürün konstipasyon yönetiminde etkili olduğu yapılan çalışmalarda gösterilmiştir. Akupresür, vücuttaki belirli akupunktur noktalarına el ile uygulanan basınç uygulamasıdır ve bu uygulamanın insan vücudundaki dengeyi geri kazandırdığına inanılmaktadır. Bu terapi, konstipasyon için non-invaziv bir müdahaledir ve herhangi bir ağrı ve yan etki ile sonuçlanmayan etkili bir yöntemdir. Bununla birlikte, palyatif bakım hastalarında konstipasyonun tedavisinde akupresürün etkileri ile ilgili çalışma sayısı oldukça sınırlıdır. Bu açıdan, akupresürün palyatif bakım hastalarında gelişen konstipasyona etkisini tespit etmek için daha fazla çalışmaya ihtiyaç duyulmaktadır.

Anahtar Kelimeler

Akupresür, Konstipasyon, Palyatif bakım

Destekleyen Kurum

YOK

Proje Numarası

YOK

Management of constipation and effectiveness of acupressure in palliative care patients

Öz

Constipation is one of the most common symptoms experienced by palliative care patients, and its prevalence is estimated to be approximately 30–90%. If constipation is not treated, it can lead to uncomfortable symptoms such as abdominal pain, nausea, vomiting, psychological disorders, or life-threatening complications such as bowel obstruction and perforation. Although the use of common pharmacological interventions for constipation is effective in alleviating short-term symptoms, their long-term use can cause serious side effects and high costs in the health care system. Therefore, other supportive methods are needed to alleviate the constipation seen in palliative care patients. Recently, complementary and alternative medicine practices have been widely used in symptom management. Research results reported that acupressure, one of the nonpharmacological methods, is effective in constipation management. Acupressure is the application of pressure applied to certain acupuncture points on the body by hand, and this practice is believed to restore balance in the human body. This therapy is a non-invasive intervention for constipation and is an effective method that does not result in any pain and side effects. However, the number of studies on the effects of acupressure in the treatment of constipation in palliative care patients is very limited. In this regard, more studies are needed to determine the effect of acupressure on constipation developing in palliative care patients.

Anahtar Kelimeler

Acupressure, Constipation, Palliative Care

Proje Numarası

YOK

Kaynakça

• 1. WHO Definition of Palliative Care [Internet]. World Health Organization. 2019 [cited 2019 Oct 17]. Available from: https://www.who.int/cancer/palliative/definition/en/
• 2. Danış, M. Z., & Özhan, E. (2019). Sağlık Hizmetlerinde Palyatif Bakım, Kanser ve Sosyal Destek: Bir Vaka Örneğinde Güçlendirme Yaklaşımının Uygulanması. Kesit Akademi Dergisi, 5(18), 305–320.
• 3. Elçigil, A. (2012). Palyatif bakım hemşireliği. Gülhane Tıp Derg, 54(4), 329–334. https://doi.org/10.5455/gulhane.30582
• 4. Li, B., Mah, K., Swami, N., Pope, A., Hannon, B., Lo, C., Rodin, G., Le, L. W., & Zimmermann, C. (2019). Symptom Assessment in Patients with Advanced Cancer: Are the Most Severe Symptoms the Most Bothersome? Journal of Palliative Medicine, jpm.2018.0622. https://doi.org/10.1089/jpm.2018.0622
• 5. Özcelik, H., Fadiloglu, C., Karabulut, B., Uyar, M., Elbi, H., Eyigor, S., Sertoz, O. O., Eyigor, C., Hophanci Bicakli, D., Caliskan, Z., Ozaydemir, G., Guzel, Y., & Kuzeyli Yildirim, Y. (2014). Case Management Based Multidisciplinary Care Protocol In The Palliative Care Of Cancer Patients. Ağrı - The Journal of The Turkish Society of Algology, 26(2), 47–56. https://doi.org/10.5505/agri.2014.93585
• 6. Dionne-Odom, J. N., Hull, J. G., Martin, M. Y., Lyons, K. D., Prescott, A. T., Tosteson, T., Li, Z., Akyar, I., Raju, D., & Bakitas, M. A. (2016). Associations between advanced cancer patients’ survival and family caregiver presence and burden. Cancer Medicine, 5(5), 853–862. https://doi.org/10.1002/cam4.653
• 7. Hui, D., & Bruera, E. (2017). The Edmonton Symptom Assessment System 25 Years Later: Past, Present and Future Developments. Journal of Pain and Symptom Management, 53(3), 630–643. https://doi.org/10.1016/j.jpainsymman.2016.10.370
• 8. Shoemaker, L. K., Estfan, B., Induru, R., & Walsh, T. D. (2011). Symptom management: An important part of cancer care. Cleveland Clinic Journal of Medicine, 78(1), 25–34. https://doi.org/10.3949/ccjm.78a.10053
• 9. Clark, K., & Currow, D. C. (2013). Constipation in palliative care: What do we use as definitions and outcome measures? Journal of Pain and Symptom Management, 45(4), 753–762.
• 10. Erichsén, E., Milberg, A., Jaarsma, T., & Friedrichsen, M. (2016). Constipation in specialized palliative care: Factors related to constipation when applying different definitions. Supportive Care in Cancer, 24(2), 691–698.
• 11. Zhe, H. (2016). The assessment and management of constipation among patients with advanced cancer in a palliative care ward in China: A best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports, 14(5), 295–309. https://doi.org/10.11124/JBISRIR-2016-002631
• 12. Larkin, P., Sykes, N., Centeno, C., Ellershaw, J., Elsner, F., Eugene, B., Gootjes, J., Nabal, M., Noguera, A., Ripamonti, C., Zucco, F., & Zuurmond, W. (2008). The management of constipation in palliative care: Clinical practice recommendations. Palliative Medicine, 22(7), 796–807. https://doi.org/10.1177/0269216308096908
• 13. Andrews, A., & Morgan, G. (2012). Constipation management in palliative care: Treatments and the potential of independent nurse prescribing. International Journal of Palliative Nursing, 18(1), 17–22.
• 14. Muldrew, D. H., Hasson, F., Carduff, E., Clarke, M., Coast, J., Finucane, A., Graham, L., Larkin, P., McCorry, N. K., Slater, P., Watson, M., Wright, E., & McIlfatrick, S. (2018). Assessment and management of constipation for patients receiving palliative care in specialist palliative care settings: A systematic review of the literature. Palliative Medicine, 32(5), 930–938. https://doi.org/10.1177/0269216317752515
• 15. Lee, E. J. (2010). The effect of acupressure on constipation, quality of life, and depressive symptoms in cancer patients with constipation.
• 16. Olgun, S. (2016). Konstipasyon Yönetiminde Abdominal Masaj Uygulaması. Ege Üniversitesi Hemşirelik Fakültesi Dergisi, 32(3), 118–126.
• 17. Hanai, A., Ishiguro, H., Sozu, T., Tsuda, M., Arai, H., Mitani, A., & Tsuboyama, T. (2016). Effects of a self-management program on antiemetic-induced constipation during chemotherapy among breast cancer patients: A randomized controlled clinical trial. Breast Cancer Research and Treatment, 155(1), 99–107.
• 18. Wong, W. K., Chien, W. T., & Lee, W. M. (2015). Self-administered acupressure for treating adult psychiatric patients with constipation: A randomized controlled trial. Chinese Medicine, 10(1), 32. https://doi.org/10.1186/s13020-015-0064-7
• 19. McIlfatrick, S., Muldrew, D. H. L., Beck, E., Carduff, E., Clarke, M., Finucane, A., Graham-Wisener, L., Larkin, P., McCorry, N. K., Slater, P., & Hasson, F. (2019). 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, 18(1), 57. https://doi.org/10.1186/s12904-019-0436-3
• 20. Wang, P.-M., Hsu, C.-W., Liu, C.-T., Lai, T.-Y., Tzeng, F.-L., & Huang, C.-F. (2019). Effect of acupressure on constipation in patients with advanced cancer. Supportive Care in Cancer. https://doi.org/10.1007/s00520-019-4655-1
• 21. Clark, K., Smith, J. M., & Currow, D. C. (2012). The prevalence of bowel problems reported in a palliative care population. Journal of Pain and Symptom Management, 43(6), 993–1000.
• 22. Mercadante, S., Masedu, F., Maltoni, M., Giovanni, D. D., Montanari, L., Pittureri, C., Bertè, R., Ursini, L., Marinangeli, F., & Aielli, F. (2018). The prevalence of constipation at admission and after 1 week of palliative care: A multi-center study. Current Medical Research and Opinion, 34(7), 1187–1192. https://doi.org/10.1080/03007995.2017.1358702
• 23. Hagmann, C., Cramer, A., Kestenbaum, A., Durazo, C., Downey, A., Russell, M., Geluz, J., Ma, J. D., & Roeland, E. J. (2018). Evidence-based Palliative Care Approaches to Non-pain Physical Symptom Management in Cancer Patients. Seminars in Oncology Nursing, 34(3), 227–240. https://doi.org/10.1016/j.soncn.2018.06.004
• 24. Davies, A., Leach, C., Caponero, R., Dickman, A., Fuchs, D., & Paice, J. (2020). MASCC recommendations on the management of constipation in patients with advanced cancer. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 28(1), 23–33. https://doi.org/10.1007/s00520-019-05016-4
• 25. Dhingra, L., Shuk, E., Grossman, B., Strada, A., Wald, E., Portenoy, A., Knotkova, H., & Portenoy, R. (2013). A qualitative study to explore psychological distress and illness burden associated with opioid-induced constipation in cancer patients with advanced disease. Palliative Medicine, 27(5), 447–456.
• 26. Larkin, Philip J., Sykes, N. P., Centeno, C., Ellershaw, J. E., Elsner, F., Eugene, B., Gootjes, J. R. G., Nabal, M., Noguera, A., & Ripamonti, C. (2008). The management of constipation in palliative care: Clinical practice recommendations. Palliative Medicine, 22(7), 796–807.
• 27. Miller, D., & Nevadunsky, N. (2018). Palliative Care and Symptom Management for Women with Advanced Ovarian Cancer. Hematology/Oncology Clinics of North America, 32(6), 1087–1102. https://doi.org/10.1016/j.hoc.2018.07.012
• 28. Farmer, A. D., Drewes, A. M., Chiarioni, G., De Giorgio, R., O’Brien, T., Morlion, B., & Tack, J. (2019). Pathophysiology and management of opioid-induced constipation: European expert consensus statement. United European Gastroenterology Journal, 7(1), 7–20. https://doi.org/10.1177/2050640618818305
• 29. Larkin, P J, Cherny, N. I., La Carpia, D., Guglielmo, M., Ostgathe, C., Scotté, F., Ripamonti, C. I., & ESMO Guidelines Committee. (2018). Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines. Annals of Oncology, 29(Supplement_4), iv111–iv125. https://doi.org/10.1093/annonc/mdy148
• 30. Tian, H., Ding, C., Gong, J., Ge, X., McFarland, L. V., Gu, L., Chen, Q., Ma, C., Zhu, W., Li, J., & Li, N. (2016). An appraisal of clinical practice guidelines for constipation: A right attitude towards to guidelines. BMC Gastroenterology, 16(1), 52. https://doi.org/10.1186/s12876-016-0466-8
• 31. Librach, S. L., Bouvette, M., Angelis, C. D., Farley, J., Oneschuk, D., Pereira, J. L., & Syme, A. (2010). Consensus Recommendations for the Management of Constipation in Patients with Advanced, Progressive Illness. Journal of Pain and Symptom Management, 40(5), 761–773. https://doi.org/10.1016/j.jpainsymman.2010.03.026
• 32. Lindberg, G., Hamid, S. S., Thomsen, O. O., Thomson, A., Goh, K.-L., Tandon, R., Wong, B. C. Y., & LeMair, A. (2011). World Gastroenterology Organisation Global Guideline. J Clin Gastroenterol, 45(6), 5.
• 33. Forootan, M., Bagheri, N., & Darvishi, M. (2018). Chronic constipation: A review of literature. Medicine, 97(20), e10631. https://doi.org/10.1097/MD.0000000000010631
• 34. Jani, B., & Marsicano, E. (2018). Constipation: Evaluation and Management. Missouri Medicine, 115(3), 236.
• 35. Vazquez Roque, M., & Bouras, E. P. (2015). Epidemiology and management of chronic constipation in elderly patients. Clinical Interventions in Aging, 10, 919–930. https://doi.org/10.2147/CIA.S54304
• 36. Bengi̇, G., Yalçin, M., & Akpinar, H. (2014). Kronik Konstipasyona Güncel Yaklaşım. Güncel Gastroenteroloji, 18(2), 181–197.
• 37. Rao, S. S. C., Rattanakovit, K., & Patcharatrakul, T. (2016). Diagnosis and management of chronic constipation in adults. Nature Reviews. Gastroenterology & Hepatology, 13(5), 295–305. https://doi.org/10.1038/nrgastro.2016.53
• 38. Management of Constipation in Adult Patients Receiving Palliative Care National Clinical Guideline No. 10 [Internet]. National Clinical Effectiveness Committee. 2015 [cited 2019 Sep 24]. Available from: https://health.gov.ie/wp-content/uploads/2015/11/Mgmt-of-Constipation-Guideline.pdf
• 39. Can, G. (2018). Kanser hastasında kanıta dayalı palyatif bakım. Nobel Tıp Kitabevleri. 19–41 p.
• 40. Kabalak, A. A., Öztürk, H., & Çağil, H. (2013). Yaşam Sonu Bakım Organizasyonu; Palyatif Bakım. Yoğun Bakım Dergisi, 11(2), 56–70.
• 41. NCCN Clinical Practice Gıidelines in Oncology Palliative Care Versiyon 2.2019 [Internet]. National Comprehensive Cancer Network. 2019. Available from: https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf
• 42. Özçelik, H., Fadıloğlu, Ç., Uyar, M., & Karabulur, B. (2010). Kanser Hastaları ve Aileleri için Palyatif Bakım. Üniversiteliler Ofset.
• 43. Jing, X., Liu, J., Wang, C., Ji, M., Chen, X., Mei, Y., & Zhu, Q. rong. (2018). Auricular acupressure is an alternative in treating constipation in leukemia patients undergoing chemotherapy: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 31, 282–289. https://doi.org/10.1016/j.ctcp.2018.03.005
• 44. Robinson, N., Lorenc, A., & Liao, X. (2011). The evidence for Shiatsu: A systematic review of Shiatsu and acupressure. BMC Complementary and Alternative Medicine, 11(1), 88. https://doi.org/10.1186/1472-6882-11-88
• 45. Ren, K., Qiu, J., Wang, X., Niu, F., & Jiang, T. (2012). The Effect of a Sweet Potato, Footbath, and Acupressure Intervention in Preventing Constipation in Hospitalized Patients With Acute Coronary Syndromes: Gastroenterology Nursing, 35(4), 271–277. https://doi.org/10.1097/SGA.0b013e31825ed7bc
• 46. Shin, J., & Park, H. (2018). Effects of Auricular Acupressure on Constipation in Patients With Breast Cancer Receiving Chemotherapy: A Randomized Control Trial. Western Journal of Nursing Research, 40(1), 67–83. https://doi.org/10.1177/0193945916680362
• 47. Lee, E. J., & Frazier, S. K. (2011). The Efficacy of Acupressure for Symptom Management: A Systematic Review. Journal of Pain and Symptom Management, 42(4), 589–603. https://doi.org/10.1016/j.jpainsymman.2011.01.007
• 48. Li, M. K., Lee, T. F. D., & Suen, K. P. L. (2014). Complementary effects of auricular acupressure in relieving constipation symptoms and promoting disease-specific health-related quality of life: A randomized placebo-controlled trial. Complementary Therapies in Medicine, 22(2), 266–277. https://doi.org/10.1016/j.ctim.2014.01.010
• 49. Abbasi, P., Mojalli, M., Kianmehr, M., & Zamani, S. (2019). Effect of acupressure on constipation in patients undergoing hemodialysis: A randomized double-blind controlled clinical trial. Avicenna Journal of Phytomedicine, 9(1), 84–91.
• 50. Abbott, R., Ayres, I., Hui, E., & Hui, K.-K. (2015). Effect of Perineal Self-Acupressure on Constipation: A Randomized Controlled Trial. Journal of General Internal Medicine, 30(4), 434–439. https://doi.org/10.1007/s11606-014-3084-6