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Development and validation of the Terminal Delirium-Related Distress Scale to assess irreversible terminal delirium

Published online by Cambridge University Press:  05 January 2021

Megumi Uchida Open the ORCID record for Megumi Uchida [Opens in a new window] ,
Tatsuo Akechi ,
Tatsuya Morita ,
Yasuo Shima ,
Naoko Igarashi Open the ORCID record for Naoko Igarashi [Opens in a new window] ,
Mitsunori Miyashita  and
J-HOPE group
Megumi Uchida*
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan
Tatsuo Akechi
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan
Tatsuya Morita
Affiliation:
Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
Yasuo Shima
Affiliation:
Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
Naoko Igarashi
Affiliation:
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
Mitsunori Miyashita
Affiliation:
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
J-HOPE group
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
*
Author for correspondence: Megumi Uchida, Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan. E-mail: ucmegumi@na.rim.or.jp
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Abstract

Objective

There is no tool to appropriately assess terminal delirium, including the natural terminal course. The objective of this study was to develop an evaluation scale to assess distress from irreversible terminal delirium and to examine the validity of the scale.

Method

Based on previous qualitative analysis and systematic literature searches, we carried out a survey regarding the views of bereaved families and developed a questionnaire. We extracted items that bereaved families regarded as important and constructed an evaluation scale of terminal delirium. Then, we applied the questionnaire in a cross-sectional questionnaire survey of bereaved relatives of cancer patients who were admitted to a hospice or a palliative care unit.

Results

We developed the Terminal Delirium-Related Distress Scale (TDDS), a 24 item questionnaire consisting of five subscales (support for families and respect for a patient, ability to communicate, hallucinations and delusions, adequate information about the treatment of delirium, and agitation and restlessness). Two hundred and eighty-one bereaved relatives participated in the validation phase. The construct validity was shown to be good by repeated factor analysis. Convergent validity, confirmed by the correlation between the TDDS and the Care Evaluation Scale (r = 0.651, P < 0.001), was also good. The TDDS had good internal consistency (Cronbach's alpha coefficient for all 24 items = 0.84).

Significance of results

This study showed that the TDDS is a valid and feasible measure of irreversible terminal delirium.

Keywords

CancerDeliriumEnd of lifePalliative careTerminal delirium
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 3 , June 2021 , pp. 287 - 293
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

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