Bladder Care in Palliative Care Inpatients: A Prospective Dual Site Cohort Study

Abstract

Background: Urinary catheterization is often undertaken to relieve distressing bladder symptoms in palliative care. Objective: The primary aim of this study was to determine the incidence of, and clinical indications that predispose patients admitted to palliative care units to, urinary catheterization. The secondary aims were to determine causal factors, including the type of malignancy, antecedent medications, and duration of admission in these patients. Methods: This was a prospective observational dual site cohort study in palliative care inpatients. Univariate categorical chi-square analysis was performed to compare patients with and without urinary catheterization, and to identify risk factors associated with urinary catheter use. Results: The incidence of catheterization in this cohort was 41% (43/104) and urinary retention (63%) was the most common cause. Agitation (47%) and urinary incontinence (70%) were common symptoms in those catheterized. Medications that were significantly associated with the need for urinary catheterization were benzodiazepines (p < 0.01) and antipsychotics (p = 0.01). All measures that define poor functional status were found to be significant (p < 0.01). Patients with prolonged hospitalization of greater than three weeks were catheterized more frequently (p = 0.017). The majority of patients catheterized (79%) were admitted for terminal care. Conclusions: The high incidence of urinary catheterization highlights the need for good bladder care for all patients in the palliative care setting. Patients with risk factors include the use of antipsychotics and benzodiazepines, declining functional status and prolonged hospital admission are more likely to be catheterized.

Keywords: bladder care; palliative care; urinary catheterization; urinary symptoms.

FIG. 1.

Oral morphine equivalent doses in noncatheterized versus catheterized (%).

FIG. 2.

Total anticholinergic risk score in those noncatheterized versus catheterized (%).

FIG. 3.

Local factors identified in the catheterized (%).

FIG. 4.

Malignancies in the noncatheterized versus catheterized (%). CNS, central nervous system; CR, colorectal; GU, genitourinary; H&N, head and neck; Haem, hematological; UGI, upper gastrointestinal.