Background & Aims
Joy Hospice Mbale is a private not for profit health facility. It was started in 2001 by Dr. JB
White on a foundation of providing palliative care to enormous number of patients and their
families who were having chronic illnesses and suffering from uncontrolled pain in the Bugisu
sub region and surrounding districts in the sub regions of Teso and Bukedi.
Palliative care requires the application of the concept of total pain. This concept of total pain is
the suffering that encompasses all of a person’s physical, psychological, social, spiritual, and
practical struggles (Dame Cicely Saunders, 1967).
Thus, pain assessment and management is an important component of palliative care provision.
The International Association for Study of Pain (IASP) defines pain as “an unpleasant sensory
and emotional experience associated with actual or potential tissue damage, or described in terms
of such damage.”
Methods
3.0. Methodology
3.1. Study site
The audit was carried out at Joy Hospice Mbale located in Hospital cell, north central ward,
Northern Division, Mbale municipality, Mbale City.
3.2. Study Population
The study population included all cancer patients enrolled for palliative care program that were
prescribed oral liquid morphine in a period of July, 2020 to July, 2021.
3.3. Audit Design
A retrospective study design was employed for this audit. Here the files of all cancer patients
enrolled for palliative care program that were prescribed oral liquid morphine in July, 2020 to
July, 2021 were considered for only one visit.
3.4.Sampling size
This included a record of only one visit of 74 cancer patients enrolled for palliative care program
that were prescribed oral liquid morphine in the period of July, 2020 to July, 2021.
3.5. Data collection procedure: Patient chart review
The audit data was collected from patient files at Joy Hospice Mbale and then entered into checlist
Results
Data analysis was done manually by tallying using tally sheets. Almost all patients received
concurrent prescription of oral morphine and a laxative as recommended in the standard of this
audit; 73 (99%) and 74 (100%) were scored for pain before pain medicine prescription.
Bisacodyl 70 (96%) and lactulose 03 (04%) were the prescribe laxatives. See table.5 and figures
5 and 6. The patients involved presented with different cancer types like breast cancer 03 (4%),
cervical cancer 21 (28%), cancer of oesophagus 05 (7%), prostate cancer 22 (30%), and others
23 (31%). See table.4. and figure. 4. The data was also analysed by age group,0-9 01 (1%), 15-24
02 (03%), 25-49 20 (27%), 50+ 51 (69%), also by sex; female 38 (51%), male 36 (49%), and by
care model; OPD 53 (72%), IPD 21 (28%),
Conclusions
There was concurrent prescription of morphine with laxatives for a substantial number of cancer
patients that are prescribed with oral liquid morphine, 73 (99%). moreover 74 (100%) had been
scored for pain before morphine prescription. bisacodyl 70 (96%) and lactulose 03 (04%) were
the prescribed laxatives. The patients involved presented with different cancer types like breast
cancer 03 (4%), cervical cancer 21 (28%), cancer of oesophagus 05 (7%), prostate cancer 22
(30%), and others 23 (31%). The patients that presented at the audit site represented all age
groups with progressive increase with age. Cancer distribution by sex was almost equal with
female 38 (51%), male 36 (49%). Cancer distribution by OPD care model was twice more than
of IPD, OPD 53 (72%), IPD 21 (28%). This audit site demonstrates an adherence to concurrent
prescription of morphine with laxatives. These good practices should be replicated to similar
sites that offer palliative care services.
References
Beck D,Kettler D. Obstipationsbehandlung und differenzierter Laxanzieneinsatz in der
Palliativmedizin [Treatment of constipation and different laxative requirements in palliative
medicine]. Z Arztl Fortbild Qualitatssich. 2000 Sep;94(7):563-7. German. PMID:
11048340.).
Bell T , Annunziata K, Leslie JB. Opioid-induced constipation negatively impacts pain
management, productivity, and health- related quality of life: Findings from the National
Health and Wellness Survey. J Opioid Manag 2009;5;137–44.
Cancer Institute, N. (2021). Age and Cancer Risk was originally published by the National
Cancer Institute.”. USA.gov: National Cancer Institute at the National Institutes of Health.
https://www.cancer.gov/about-cancer/causes
prevention/risk/age#:~:text=Age%20and%20Cancer%20Risk&text=The%20incidence%20ra
tes%20for%20cancer,groups%2060%20years%20and%20olderPalliative-Care-Pain-andSymptom-Control-Guidelines, 2020. (https://www.england.nhs.uk/north-west/wp-
https://journals.sagepub.com/doi/pdf/10.1177/1078155218801066.
Presenting Author
Mawogole John
Poster Authors
John Mawogole
Palliative care medicine
Institute of hospice and palliative care in Africa
Lead Author
Topics
- Access to Care