EFFECT OF ABDOMINAL MASSAGE TRAINING PROVIDED TO CAREGIVERS ON CONSTIPATION MANAGEMENT

Constipation is an important symptom management concern in palliative care. Patients may experience constipation in association with their underlying illnesses, medication use, reduced mobility, and changes in food and fluid intake. Individualized nursing assessment and care are therefore important components of constipation management.

Abdominal massage is a nonpharmacological approach that may complement routine constipation management. Training primary caregivers to perform abdominal massage may support their active participation in care. This randomized controlled study aims to evaluate the effects of caregiver abdominal massage training and caregiver-delivered abdominal massage on constipation severity and stool form in palliative care patients, and on caregiver burden and self-efficacy in contributing to patient self-care.

The study will use a randomized controlled experimental design and will be conducted in the palliative care unit of Sultanbeyli State Hospital in Istanbul, Türkiye. Eligible patients and their primary caregivers will participate as patient-caregiver pairs. Pairs will be randomly assigned to the intervention or control group using a random number table.

Researcher Preparation and Baseline Assessment Before delivering the intervention, the researcher will complete certified abdominal massage training. The researcher will be present in the palliative care unit during study procedures to maintain communication with caregivers and support accurate completion of the data collection instruments.

After informed consent, caregivers in both groups will complete a structured information form. Baseline assessments will include the Constipation Assessment Scale (CAS) and Bristol Stool Form Scale (BSFS) for patients, and the Zarit Burden Interview and Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC) for caregivers. Completion of the data collection instruments is expected to take approximately 20 minutes.

Intervention Group Caregivers will receive one 45-minute abdominal massage training session, consisting of theoretical instruction followed by practical demonstration. The training will cover four topics: the role and importance of abdominal massage in constipation management in palliative care; its relevance to caregivers; the potential effects of abdominal massage; and the steps of the massage procedure. A training booklet will be provided at the end of the session.

Following training, caregivers will perform abdominal massage on the patient over a two-week period. Massage will be performed three days per week, twice on each scheduled day, for 15 minutes in the morning and 15 minutes in the evening. Sessions will be scheduled to avoid interference with treatment times and routine clinical activities. Baby oil will be used as a lubricant during massage. Routine treatment and nursing care will continue throughout the study.

Control Group Patients in the control group will receive routine treatment and nursing care without the study-specific abdominal massage intervention during the two-week follow-up period. After completion of study procedures, control-group caregivers will be offered abdominal massage training.

Outcome Assessment Assessments will be repeated in both groups on Days 7 and 14. Patient outcomes will include constipation severity assessed using the CAS and stool form assessed using the BSFS. Caregiver outcomes will include caregiver burden assessed using the Zarit Burden Interview and self-efficacy in contributing to patient self-care assessed using the CSE-CSC. Changes from baseline will be compared between the intervention and control groups.

Discontinuation Criteria Study participation will be discontinued if a participant requests withdrawal, the patient is discharged from hospital, the patient dies, or the data collection process cannot be completed.

Ethical Considerations Ethical approval has been obtained from the University of Health Sciences Hamidiye Ethics Committee for Interventional Research Not Involving Drugs or Medical Devices. Institutional permission has been obtained from the study hospital before data collection begins.

Eligible patients and caregivers will be informed about the study purpose, procedures, voluntary participation, confidentiality, and protection of privacy. Written informed consent will be obtained from patients and caregivers before study procedures. Personal information will be kept confidential, and participants' privacy will be protected throughout the research.