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Abstract: Context: There is a lack of evidence to guide constipation management in patients receiving palliative care. Data collection requires the systematic use of validated assessment tools. Objectives: The objective of this study was to assess the usefulness of the Victoria Bowel Performance Scale (BPS) as an audit tool. Methods: Charts were reviewed before and after the implementation of a program to monitor constipation through repeated use of the Victoria Bowel Scale. The program was initiated at three oncology pain and symptom management clinics, four palliative care units, and four residential hospices. An additional “control” palliative care unit introduced new nursing assessment tools without the new scale. Results: The Victoria BPS was recorded at 86% of 192 postimplementation outpatient clinic visits and was easy to use in this setting. Documentation of bowel performance at comparable visits improved from 44% to 66% (P <0.001), and the frequency of changes to laxatives increased from 14% to 39% of visits (P <0.001). The scale was completed on 21%–55% of inpatient days, and variations in the proportion of recordings being rated as satisfactory between −1 and +1 (possible range from −4 to +4) revealed important deficiencies in bowel care, which led to change in management. Conclusion: The Victoria BPS was found to be an acceptable and a useful bowel function assessment tool, uniquely incorporating the patient’s usual bowel function. Modifications to the scale have been made to improve clarity and allow for the expected drop in bowel activity seen in end-of-life care. Considerable educational effort and appropriate organization of the charts are required for optimal implementation. The proportion of revised BPS scores ranging from −1 to +1 is proposed as an indicator of satisfactory bowel management for clinical, audit, and research purposes. [Copyright &y& Elsevier]

Context The goal of end-of-life (EOL) communication and decision making is to create a shared understanding about a person’s values and treatment preferences that will lead to a plan of care that is consistent with these values and preferences. Improvements in communication and decision making at the EOL have been identified as a high priority from a patient and family point of view. Objectives The purpose of this study was to develop quality indicators related to EOL communication and decision making. Methods We convened a multidisciplinary panel of experts to develop definitions, a conceptual framework of EOL communication and decision making, and quality indicators using a modified Delphi method. We generated a list of potential items based on literature review and input from panel members. Panel members rated the items using a seven-point Likert scale (1 = very little importance to 7 = extremely important) over four rounds of review until consensus was achieved. Results About 24 of the 28 panel members participated in all four rounds of the Delphi process. The final list of quality indicators comprised 34 items, divided into the four categories of our conceptual framework: Advance care planning (eight items), Goals of care discussions (13 items), Documentation (five items), and Organization/System aspects (eight items). Eleven items were rated “extremely important” (median score). All items had a median score of five (moderately important) or greater. Conclusion We have developed definitions, a conceptual framework, and quality indicators that researchers and health care decision makers can use to evaluate and improve the quality of EOL communication and decision making. [ABSTRACT FROM AUTHOR]