ORCID
- Rohit Shankar: 0000-0002-1183-6933
Abstract
Background Constipation is overrepresented in people with intellectual disabilities. Around 40% of people with intellectual disabilities who died prematurely were prescribed laxatives. A quarter of people with intellectual disabilities are said to be on laxatives. There are concerns that prescribing is not always effective and appropriate. There are currently no prescribing guidelines specific to this population. Aims To develop guidelines to support clinicians with their decision-making when prescribing laxatives to people with intellectual disabilities. Method A modified Delphi methodology, the RAND/UCLA Appropriateness Method, was used. Step 1 comprised development of a bespoke six-item, open-ended questionnaire from background literature and its external validation. Relevant stakeholders, including a range of clinical experts and experts by experience covering the full range of intellectual disability and constipation, were invited to participate in an expert panel. Panel members completed the questionnaire. Responses were divided into 'negative consensus' and 'positive consensus'. Members were then invited to two panel meetings, 2 weeks apart, held virtually over Microsoft Teams, to build consensus. The expert-by-experience group were included in a separate face-to-face meeting. Results A total of 20 people (ten professional experts and ten experts by experience, of whom seven had intellectual disability) took part. There were five main areas of discussion to reach a consensus i.e. importance of diagnosis, the role of prescribing, practicalities of medication administration, importance of reviewing and monitoring, and communication. Conclusions Laxative prescribing guidelines were developed by synthesising the knowledge of an expert panel including people with intellectual disabilities with the existing evidence base, to improve patient care.
DOI
10.1192/bjo.2024.50
Publication Date
2024-04-18
Publication Title
BJPsych Open
Volume
10
Issue
3
ISSN
2056-4724
Keywords
Carers, comorbidity, education and training, intellectual disability, patients
Recommended Citation
Shankar, R., Bishop, R., Laugharne, R., Burrows, L., Ward, S., Eustice, S., Branford, D., Wilcock, M., Lamb, K., Tavare, A., Annesley, C., Lewis, S., Voulgaropoulos, V., Sleeman, F., & Sargent, B. (2024) 'Laxative use in adults with intellectual disabilities: development of prescribing guidelines', BJPsych Open, 10(3). Available at: https://doi.org/10.1192/bjo.2024.50
