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ONS Guidelines Article

ONS Guidelines™ for Opioid-Induced and Non–Opioid-Related Cancer Constipation

Barbara B. Rogers
Pamela K. Ginex
Allison Anbari
Brian J. Hanson
Kristine B. LeFebvre
Rachael Lopez
Deborah M. Thorpe
Brenda Wolles
Kerri A. Moriarty
Christine Maloney
Mark Vrabel
Rebecca L. Morgan
ONF 2020, 47(6), 671-691 DOI: 10.1188/20.ONF.671-691

Purpose: This evidence-based guideline intends to support clinicians, patients, and others in decisions regarding the treatment of constipation in patients with cancer.

Methodologic Approach: An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of cancer-related constipation. Systematic reviews of the literature were conducted. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the evidence and make recommendations.

Findings: The panel agreed on 13 recommendations for the management of opioid-induced and non–opioid-related constipation in patients with cancer.

Implications for Nursing: The panel conditionally recommended a bowel regimen in addition to lifestyle education as first-line treatment for constipation. For patients starting opioids, the panel suggests a bowel regimen as prophylaxis. Pharmaceutical interventions are available and recommended if a bowel regimen has failed. Acupuncture and electroacupuncture for non–opioid-related constipation are recommended in the context of a clinical trial.

Supplementary material can be found at

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