{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T08:31:32Z","timestamp":1775637092982,"version":"3.50.1"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,1,20]]},"abstract":"<jats:p>The use of opioids to control pain at the end of life may cause constipation, a symptom that can negatively influence the well-being of patients and caregivers. The main aim of this study was to evaluate the impact of constipation on symptomatic control and patients\u2019 overall quality of life at this stage. A particular focus was placed on opioids. We also intended to investigate whether constipation and caregiver fatigue is related to the place of death (hospital vs home). The approach of 121 patients followed in 2021 in their last week of life by a home team specialized in palliative care was analyzed in an observational, retrospective, non-interventional study. The patients were followed up for an average of 39.7 days. A total of 82.6% wished to die at home, which occurred in 74% of the cases. The constipation prevention protocol reduced constipation by 55.1%. It seems that morphine is more related with constipation and tapentadol seems to reduce constipation induced by opioids. Patients tended to die in hospitals when their caregivers were exhausted; however, it was not possible to determine a cutoff point using the Zarit scale, which was used to assess caregiver burden. Constipation in the last week of life does not seem to influence the well-being of patients or their caregivers significantly and the individualization of intensive treatment of constipation is needed. Different opioids have different probabilities of causing adverse effects such as constipation. Future special support mechanisms can be created and activated for the most tired caregivers to avoid exhaustion and promote death at home, if that is the patient\u2019s will.<\/jats:p>","DOI":"10.1097\/md.0000000000032718","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T21:51:46Z","timestamp":1674769906000},"page":"e32718","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death"],"prefix":"10.1097","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6623-7420","authenticated-orcid":false,"given":"Hugo","family":"Ribeiro","sequence":"first","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"},{"name":"Center for the Study and Development of Continuing and Palliative Care \u2013 Faculty of Medicine, University of Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (ICBR) - Group of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine of the University of Coimbra, Portugal"},{"name":"Doctoral Program in Palliative Care at the Faculty of Medicine of the University of Porto, Portugal"}]},{"given":"J\u00falia","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"}]},{"given":"Tatiana","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"}]},{"given":"Isabel","family":"Chaves-Castro","sequence":"additional","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"}]},{"given":"Carla","family":"Lopes-Mota","sequence":"additional","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"}]},{"given":"Elisabete","family":"Costa","sequence":"additional","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"}]},{"given":"Patr\u00edcia","family":"Rocha","sequence":"additional","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"}]},{"given":"Lu\u00edsa","family":"Lopes","sequence":"additional","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"}]},{"given":"\u00c2ngela","family":"Bou\u00e7a","sequence":"additional","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"}]},{"given":"Cristina","family":"Pereira","sequence":"additional","affiliation":[{"name":"Community Support Team in Palliative Care \u2013 Group of Health Centers Gaia, Portugal"}]},{"given":"Jos\u00e9","family":"Paulo Andrade","sequence":"additional","affiliation":[{"name":"Department of Biomedicine \u2013 Unity of Anatomy, Faculty of Medicine of the University of Porto, Portugal"},{"name":"Center for Health Technology and Services Research (CINTESIS), Porto, Portugal."}]},{"given":"Mar\u00edlia","family":"Dourado","sequence":"additional","affiliation":[{"name":"Center for the Study and Development of Continuing and Palliative Care \u2013 Faculty of Medicine, University of Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (ICBR) - Group of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine of the University of Coimbra, Portugal"}]}],"member":"276","reference":[{"key":"R2-20250504","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1016\/j.mcna.2016.04.020","article-title":"Symptom control at the end of life.","volume":"100","author":"Kreher","year":"2016","journal-title":"Med Clin N Am"},{"key":"R3-20250504","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1056\/NEJMoa0909087","article-title":"Trajectories of disability in the last year of life.","volume":"362","author":"Gill","year":"2010","journal-title":"N Engl J Med"},{"key":"R4-20250504","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12904-019-0416-7","article-title":"Optimal treatment of opioid induced constipation in daily clinical practice \u2013 an observational study.","volume":"18","author":"Neefjes","year":"2019","journal-title":"BMC Palliat Care"},{"key":"R5-20250504","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jpainsymman.2007.10.010","article-title":"Characteristics and quality of life of patients who choose home care at the end of life.","volume":"36","author":"Ahlner-Elmqvist","year":"2008","journal-title":"J Pain Symptom Manage"},{"key":"R6-20250504","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1200\/JCO.2010.31.6752","article-title":"Can this patient be discharged home? 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