Renee Holder

Novel Oral Therapies for Opioid‐induced Bowel Dysfunction in Patients with Chronic Noncancer Pain

Opioid analgesics are frequently prescribed and play an important role in chronic pain management. Opioid‐induced bowel dysfunction, which includes constipation, hardened stool, incomplete evacuation, gas, and nausea and vomiting, is the most common adverse event associated with opioid use. Mu‐opioid receptors are specifically responsible for opioid‐induced bowel dysfunction, resulting in reduced peristaltic and secretory actions. Agents that reverse these actions in the bowel without reversing pain control in the central nervous system may be preferred over traditional laxatives. The efficacy and safety of these agents in chronic noncancer pain were assessed from publications identified through Ovid and PubMed database searches. Trials that evaluated the safety and efficacy of oral agents for opioid‐induced constipation or opioid‐induced bowel dysfunction, excluding laxatives, were reviewed. Lubiprostone and naloxegol are approved in the United States by the Food and Drug Administration for use in opioid‐induced constipation. Axelopran (TD‐1211) and sustained‐release naloxone have undergone phase 2 and phase 1 studies, respectively, for the same indication. Naloxegol and axelopran are peripherally acting μ‐opioid receptor antagonists. Naloxone essentially functions as a peripherally acting μ‐opioid receptor antagonist when administered orally in a sustained‐release formulation. Lubiprostone is a locally acting chloride channel (CIC‐2) activator that increases secretions and peristalsis. All agents increase spontaneous bowel movements and reduce other bowel symptoms compared with placebo in patients with noncancer pain who are chronic opioid users. The most common adverse events were gastrointestinal in nature, and none of the drugs were associated with severe adverse or cardiovascular events. Investigations comparing these agents to regimens using standard laxative and combination therapy and trials in special populations and patients with active cancer are needed to further define their role in therapy.

Palliative Care Integration for Patients Receiving Left-Ventricular Assist Device (LVAD) as Destination Therapy (SR) (TH310D)

5-point Likert scale was used. Responses

Expanding Practice: Pharmacist and Social Worker Led Palliative Consults (S797)

4 (agree, strongly agree) were considered positive. Results. Survey response rate was 31% (MD/DO 31%, RN 60%, APP 9%). Experiences in providing palliative care was variable. Routine symptom management was reported by 89%, while goals of care conversations (55%) and emotional support to other clinicians were less routine (53%). The majority of respondents (95%) believed palliative care was an important part of their patients’ care; 79% felt they could personally provide this care; and 84% felt they could ask for PCC. The most commonly perceived barriers to PCC were patient/family reluctance or uncertainty, disagreement within or between teams, and inadequate comfort level. Active stage IV malignancy, patient/family support, or request and decision to forgo life-sustaining treatment were the most commonly reported PCC triggers. Conclusion. While a majority of ICU clinicians report PCC is important, experiences, attitudes, and barriers in providing such care vary widely. Implications for Research, Policy, and Practice. This survey involving key stakeholders identified barriers to target for interventions, including development of a PCC trigger tool, tailored to needs of ICUs in this health system.