Opioid-induced constipation (OIC) is a common adverse effect of opioid therapy. We aim to identify the main barriers hindering clinical recommendations implementation and propose consensus solutions to improve OIC control in cancer patients. Following collaborative and prioritization techniques, a scientific committee generated statements addressing possible barriers to optimal OIC management (related to patients, health providers and health care system), and potential interventions to overcome these barriers. An expert panel of 36 oncologists assessed the statements to reach a consensus. The survey consisted of 70 statements. Consensus was reached on 12/45 items related to barriers (26.6%) and on 19/25 items about corrective interventions (76%). The panel considered that patients are unaware of the existence of a specific OIC treatment, and their information sources are highly variable and unreliable. Regarding health providers, the panel considered that the oncologists prioritize symptoms such as diarrhea, pain, anxiety, or other treatment toxicities, over constipation. Work overload and bureaucratic requirements were the main barriers related to health care system. Regarding potential interventions, best-rated proposals included specific training programs development for primary care physicians and nurses, and multiplatform informative resources development for patients and caregivers, including precisely written instructions about OIC recognition and management. Oncologists assessed positively measures aiming to improve coordination between primary care physicians and oncologists, and nursing consultations implementation. The panel considered useful the OIC treatment algorithms simplification. The expert panel identified the main barriers to optimal OIC management and suggested some feasible approaches to overcome these barriers.

中文翻译：

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克服癌症患者阿片类药物引起的便秘管理障碍

阿片类药物引起的便秘（OIC）是阿片类药物治疗的常见不良反应。我们的目标是找出阻碍临床建议实施的主要障碍，并提出共识解决方案，以改善癌症患者的 OIC 控制。根据协作和优先顺序技术，一个科学委员会生成了声明，解决了最佳 OIC 管理（与患者、卫生服务提供者和卫生保健系统相关）可能遇到的障碍，以及克服这些障碍的潜在干预措施。由 36 名肿瘤学家组成的专家小组评估了这些声明并达成了共识。该调查包含 70 份陈述。 12/45 个与障碍相关的项目（26.6%）和 19/25 个与纠正干预相关的项目（76%）达成了共识。专家组认为，患者不知道特定 OIC 治疗的存在，而且他们的信息来源变化很大且不可靠。关于医疗服务提供者，专家组认为肿瘤学家优先考虑腹泻、疼痛、焦虑或其他治疗毒性等症状，而不是便秘。工作负担过重和官僚要求是医疗保健系统的主要障碍。关于潜在的干预措施，评价最高的建议包括为初级保健医生和护士制定具体培训计划，为患者和护理人员开发多平台信息资源，包括关于 OIC 认可和管理的精确书面说明。肿瘤科医生对旨在改善初级保健医生和肿瘤科医生之间的协调以及护理咨询实施的措施进行了积极评估。专家组认为 OIC 治疗算法的简化很有用。专家小组确定了伊斯兰会议组织最佳管理的主要障碍，并提出了一些克服这些障碍的可行方法。