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The recognition and documentation of delirium in hospital palliative care inpatients

Published online by Cambridge University Press:  23 March 2010

Julia Barnes ,
Suzanne Kite  and
Manoj Kumar
Julia Barnes*
Affiliation:
Specialist Registrar in Palliative Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, England
Suzanne Kite
Affiliation:
Consultant in Palliative Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, England
Manoj Kumar
Affiliation:
Consultant in Psycho-oncology and Community Psychiatry, Mehac Foundation, Institute of Palliative Medicine, Calicut, Kerala, India
*
Address correspondence and reprint requests to: J. Barnes, Palliative Care Team, Robert Ogden Centre, St. James' University Hospital, Leeds, England. E-mail: jebarnes@doctors.org.uk
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Abstract

Objective:

Delirium is a clinical syndrome that is known to be under recognized by palliative care teams. A wide variation in reported prevalence may reflect differences in definitions and assessment methods, patient characteristics, and study design. The aim of this study was to test an intervention to improve recognition of delirium in the inpatient palliative care setting.

Method:

We conducted a retrospective palliative care notes review of documented prevalence of delirium among 61 patients referred to the Specialist Palliative Care Advisory Team (SPCT). Subsequently, training in the use of the Confusion Assessment Method (CAM) was provided to the SPCT and a prospective survey of the prevalence of delirium measured by the CAM was undertaken with the next 59 patients referred.

Results:

In the retrospective chart review, the term “delirium” was not used, and synonyms were identified and used to establish a delirium prevalence of 11.5%. In the intervention utilizing the CAM in a prospective sample of 59 referred patients, a prevalence rate of 8.5–15.2% for delirium was found. Use of the CAM was received favorably by the SPCT.

Significance of Results:

The institution of the use of the CAM as a screening and assessment tool in the inpatient palliative care setting did not significantly increase the recognition of delirium. Reasons for the low prevalence of delirium are discussed.

Keywords

Palliative careDeliriumHospitalAssessmentConfusion Assessment Method
Type
Original Articles
Information
Palliative & Supportive Care , Volume 8 , Issue 2 , June 2010 , pp. 133 - 136
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

Breitbart, W., Gibson, C. & Tremblay, A. (2002). The delirium experience: Delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers and their nurses. Psychosomatics, 43, 183–194.CrossRefGoogle ScholarPubMed
British Geriatrics Society and Royal College of Physicians. (2006). Guidelines for the prevention, diagnosis and management of delirium in older people. Concise guidance to good practice series, No 6. London: Royal College of Physicians.Google Scholar
Burns, A., Gallagley, A. & Byrne, J. (2004). Delirium. Journal of Neurology, Neurosurgery and Psychiatry, 75, 362–367.CrossRefGoogle ScholarPubMed
Fang, C.-K., Chen, H.-W., Liu, S.-I., et al. (2008). Prevalence, detection and treatment of delirium in terminal cancer inpatients: A prospective survey. Japanese Journal of Clinical Oncology, 38, 56–63.CrossRefGoogle ScholarPubMed
Hjermstad, M., Loge, J. & Kaasa, S. (2004). Methods for assessment of cognitive failure and delirium in palliative care patients: Implications for practice and research. Palliative Medicine, 18, 494–506.CrossRefGoogle ScholarPubMed
Inouye, S., van Dyck, C., Alessi, C., et al. (1990). Clarifying confusion: The Confusion Assessment Method. Annals of Internal Medicine, 113, 941–948.CrossRefGoogle ScholarPubMed
Inouye, S. (2003). The Confusion Assessment Method (CAM): Training Manual and Coding Guide. New Haven: Yale University School of Medicine.Google Scholar
Irwin, S., Rao, S., Bower, K., et al. (2008). Psychiatric issues in palliative care: Recognition of delirium in patients enrolled in hospice care. Palliative & Supportive Care, 6, 159–164.CrossRefGoogle ScholarPubMed
Lawlor, P., Gagnon, B., Mancini, I., et al. (2000). Occurrence, causes and outcome of delirium in patients with advanced cancer. Archives of Internal Medicine, 160, 786–794.CrossRefGoogle ScholarPubMed
Morita, T., Hirai, K., Sakaguchi, Y., et al. (2004). Family-perceived distress from delirium-related symptoms of terminally ill cancer patients. Psychosomatics, 45, 107–113.CrossRefGoogle ScholarPubMed
Ryan, K., Leonard, M., Guerin, S., et al. (2009). Validation of the confusion assessment method in the palliative care setting. Palliative Medicine, 23, 40–45.CrossRefGoogle ScholarPubMed
Spiller, J. & Keen, J. (2006). Hypoactive delirium: Assessing the extent of the problem for inpatient specialist palliative care. Palliative Medicine, 20, 17–23.CrossRefGoogle ScholarPubMed
Tabet, N., Hudson, S., Sweeney, V., et al. (2005). An educational intervention can prevent delirium on acute medical wards. Age and Ageing, 34, 152–156.CrossRefGoogle ScholarPubMed