{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T16:19:05Z","timestamp":1773332345855,"version":"3.50.1"},"reference-count":29,"publisher":"Royal College of Psychiatrists","issue":"3","license":[{"start":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T00:00:00Z","timestamp":1713398400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec id=\"S2056472424000504_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Constipation is overrepresented in people with intellectual disabilities. Around 40% of people with intellectual disabilities who died prematurely were prescribed laxatives. A quarter of people with intellectual disabilities are said to be on laxatives. There are concerns that prescribing is not always effective and appropriate. There are currently no prescribing guidelines specific to this population.<\/jats:p><\/jats:sec><jats:sec id=\"S2056472424000504_sec_a2\"><jats:title>Aims<\/jats:title><jats:p>To develop guidelines to support clinicians with their decision-making when prescribing laxatives to people with intellectual disabilities.<\/jats:p><\/jats:sec><jats:sec id=\"S2056472424000504_sec_a3\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>A modified Delphi methodology, the RAND\/UCLA Appropriateness Method, was used. Step 1 comprised development of a bespoke six-item, open-ended questionnaire from background literature and its external validation. Relevant stakeholders, including a range of clinical experts and experts by experience covering the full range of intellectual disability and constipation, were invited to participate in an expert panel. Panel members completed the questionnaire. Responses were divided into \u2018negative consensus\u2019 and \u2018positive consensus\u2019. Members were then invited to two panel meetings, 2 weeks apart, held virtually over Microsoft Teams, to build consensus. The expert-by-experience group were included in a separate face-to-face meeting.<\/jats:p><\/jats:sec><jats:sec id=\"S2056472424000504_sec_a4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>A total of 20 people (ten professional experts and ten experts by experience, of whom seven had intellectual disability) took part. There were five main areas of discussion to reach a consensus i.e. importance of diagnosis, the role of prescribing, practicalities of medication administration, importance of reviewing and monitoring, and communication.<\/jats:p><\/jats:sec><jats:sec id=\"S2056472424000504_sec_a5\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Laxative prescribing guidelines were developed by synthesising the knowledge of an expert panel including people with intellectual disabilities with the existing evidence base, to improve patient care.<\/jats:p><\/jats:sec>","DOI":"10.1192\/bjo.2024.50","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T09:11:40Z","timestamp":1713431500000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":6,"title":["Laxative use in adults with intellectual disabilities: development of prescribing guidelines"],"prefix":"10.1192","volume":"10","author":[{"given":"Ruth","family":"Bishop","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9916-343X","authenticated-orcid":false,"given":"Richard","family":"Laugharne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Burrows","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"CHAMPS Team","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Ward","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Eustice","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Branford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Wilcock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsten","family":"Lamb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Tavare","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Annesley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasileios","family":"Voulgaropoulos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faye","family":"Sleeman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beth","family":"Sargent","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1183-6933","authenticated-orcid":false,"given":"Rohit","family":"Shankar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"170","published-online":{"date-parts":[[2024,4,18]]},"reference":[{"key":"S2056472424000504_ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-019-00942-z"},{"key":"S2056472424000504_ref24","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2022.34"},{"key":"S2056472424000504_ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-021-10938-3"},{"key":"S2056472424000504_ref21","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-015-1802-8"},{"key":"S2056472424000504_ref3","doi-asserted-by":"publisher","DOI":"10.3109\/13668250.2017.1310829"},{"key":"S2056472424000504_ref7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2788.1987.tb01355.x"},{"key":"S2056472424000504_ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11701-6"},{"key":"S2056472424000504_ref17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0198261"},{"key":"S2056472424000504_ref12","unstructured":"12 NHS England. Laxatives. NHS England, 2022 (https:\/\/www.nhs.uk\/conditions\/laxatives\/)."},{"key":"S2056472424000504_ref25","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2022.182"},{"key":"S2056472424000504_ref9","first-page":"25","article-title":"An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database","volume":"5","author":"Carey","year":"2017","journal-title":"Health Serv Delivery Res"},{"key":"S2056472424000504_ref1","unstructured":"1 National Institute for Health and Care Excellence (NICE). Constipation: What Is It? NICE, 2024 (https:\/\/cks.nice.org.uk\/topics\/constipation\/background-information\/definition\/)."},{"key":"S2056472424000504_ref4","doi-asserted-by":"publisher","DOI":"10.1111\/jar.12426"},{"key":"S2056472424000504_ref16","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp22X720077"},{"key":"S2056472424000504_ref28","unstructured":"28 NHS England. Constipation Campaign Toolkit. NHS England, 2023 (https:\/\/www.england.nhs.uk\/long-read\/constipation-campaign-toolkit\/)."},{"key":"S2056472424000504_ref13","unstructured":"13 NHS Inform. Laxatives. NHS Scotland, 2023 (https:\/\/www.nhsinform.scot\/tests-and-treatments\/medicines-and-medical-aids\/types-of-medicine\/laxatives#:~:text=Considerations-,Introduction,exercise%2C%20haven't%20helped)."},{"key":"S2056472424000504_ref27","unstructured":"27 Learning Disabilities Mortality Review (LeDeR) Team. LeDeR Annual Report 2022: Learning from Lives and Deaths: People with a Learning Disability and Autistic People. King's College London, 2023 (https:\/\/www.kcl.ac.uk\/ioppn\/assets\/fans-dept\/leder-2022-v2.0.pdf)."},{"key":"S2056472424000504_ref6","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2024.12"},{"key":"S2056472424000504_ref10","unstructured":"10 Public Health England. Constipation: Making Reasonable Adjustments. Public Health England, 2016 (https:\/\/www.gov.uk\/government\/publications\/constipation-and-people-with-learning-disabilities\/constipation-making-reasonable-adjustments)."},{"key":"S2056472424000504_ref18","doi-asserted-by":"publisher","DOI":"10.1111\/jir.13097"},{"key":"S2056472424000504_ref5","doi-asserted-by":"publisher","DOI":"10.1111\/jir.13108"},{"key":"S2056472424000504_ref19","unstructured":"19 Fitch, K , Bernstein, SJ , Aguilar, MD , Burnand, B , LaCalle, JR , L\u00e1zaro, P , et al. The RAND\/UCLA Appropriateness Method User's Manual. RAND, 2001 (https:\/\/www.rand.org\/content\/dam\/rand\/pubs\/monograph_reports\/2011\/MR1269.pdf)."},{"key":"S2056472424000504_ref15","unstructured":"15 NHS South, Central and West. Review of Constipation in People with a Learning Disability and Autistic People: Summary Report. NHS South, Central and West, 2022 (https:\/\/www.scwcsu.nhs.uk\/documents\/66-summary-report-review-of-constipation-in-people-with-a-learning-disability-and-autistic-people-v1-1\/file)."},{"key":"S2056472424000504_ref29","doi-asserted-by":"publisher","DOI":"10.1111\/jar.13101"},{"key":"S2056472424000504_ref26","unstructured":"26 Learning Disabilities Mortality Review (LeDeR) Team. LeDeR Annual Report 2019. Healthcare Quality Improvement Partnership, 2020 (https:\/\/leder.nhs.uk\/images\/annual_reports\/LeDeR_2019_annual_report_FINAL2.pdf)."},{"key":"S2056472424000504_ref14","unstructured":"14 Hull and East Riding Prescribing Committee (HERPC). Management of Constipation in Adults. HERPC, 2019 (https:\/\/www.hey.nhs.uk\/wp\/wp-content\/uploads\/2019\/08\/GUIDELINE-Constipation-guidelines-updated-may-19.pdf)."},{"key":"S2056472424000504_ref2","doi-asserted-by":"publisher","DOI":"10.12968\/bjcn.2017.22.4.168"},{"key":"S2056472424000504_ref11","unstructured":"11 National Institute for Health and Care Excellence (NICE). Constipation: Prescribing Information. NICE, 2024 (https:\/\/cks.nice.org.uk\/topics\/constipation\/prescribing-information\/)."},{"key":"S2056472424000504_ref20","doi-asserted-by":"publisher","DOI":"10.2147\/JHL.S352500"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472424000504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T17:31:00Z","timestamp":1739813460000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472424000504\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,18]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["S2056472424000504"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2024.50","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,18]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e84"}}