Shirley H Bush1, Eduardo Bruera2, Peter G Lawlor3, Salmaan Kanji4, Daniel H J Davis5, Meera Agar6, David Kenneth Wright7, Michael Hartwick8, David C Currow9, Bruno Gagnon10, Jessica Simon11, José L Pereira12. 1. Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada. Electronic address: sbush@bruyere.org. 2. The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. 3. Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 4. The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada. 5. Institute of Public Health, University of Cambridge, Cambridge, United Kingdom. 6. Discipline, Palliative & Supportive Services, Flinders University, Adelaide, South Australia, Australia; South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia. 7. McGill University, Montreal, Québec, Canada. 8. Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada. 9. Discipline, Palliative & Supportive Services, Flinders University, Adelaide, South Australia, Australia. 10. Département de médecine familiale et de médecine d'urgence, Université Laval, Québec City, Québec, Canada; Centre de recherche du CHU de Québec, Québec City, Québec, Canada. 11. Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada. 12. Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada.
Abstract
CONTEXT: Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. OBJECTIVES: This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. METHODS: We searched PubMed (1990-2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. RESULTS: There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from "expert opinion" for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. CONCLUSION: Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.
CONTEXT: Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. OBJECTIVES: This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. METHODS: We searched PubMed (1990-2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. RESULTS: There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from "expert opinion" for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. CONCLUSION:Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.
Authors: Juliana Barr; Gilles L Fraser; Kathleen Puntillo; E Wesley Ely; Céline Gélinas; Joseph F Dasta; Judy E Davidson; John W Devlin; John P Kress; Aaron M Joffe; Douglas B Coursin; Daniel L Herr; Avery Tung; Bryce R H Robinson; Dorrie K Fontaine; Michael A Ramsay; Richard R Riker; Curtis N Sessler; Brenda Pun; Yoanna Skrobik; Roman Jaeschke Journal: Crit Care Med Date: 2013-01 Impact factor: 7.598
Authors: Peter G Lawlor; Daniel H J Davis; Mohammed Ansari; Annmarie Hosie; Salmaan Kanji; Franco Momoli; Shirley H Bush; Sharon Watanabe; David C Currow; Bruno Gagnon; Meera Agar; Eduardo Bruera; David J Meagher; Sophia E J A de Rooij; Dimitrios Adamis; Augusto Caraceni; Katie Marchington; David J Stewart Journal: J Pain Symptom Manage Date: 2014-04-12 Impact factor: 3.612
Authors: Shirley H Bush; Elise Skinner; Peter G Lawlor; Misha Dhuper; Pamela A Grassau; José L Pereira; Alistair R MacDonald; Henrique A Parsons; Monisha Kabir Journal: BMC Palliat Care Date: 2022-07-16 Impact factor: 3.113
Authors: Shirley H Bush; Katie L Marchington; Meera Agar; Daniel H J Davis; Lindsey Sikora; Tammy W Y Tsang Journal: BMJ Open Date: 2017-03-10 Impact factor: 2.692