Maeve M Leonard1, Cheryl Nekolaichuk2, David J Meagher3, Christopher Barnes4, Jean-David Gaudreau5, Sharon Watanabe6, Meera Agar7, Shirley H Bush8, Peter G Lawlor9. 1. University of Limerick, Limerick, Ireland. 2. Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Alberta, Canada; Tertiary Palliative Care Unit, Covenant Health, Grey Nuns Hospital, Edmonton, Alberta, Canada. 3. University of Limerick, Limerick, Ireland; Department of Adult Psychiatry, Limerick Regional Hospital, Limerick, Ireland. 4. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 5. Centre de recherche du CHU de Québec and Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada. 6. Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Alberta, Canada; Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton, Alberta, Canada. 7. Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia; South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia. 8. Bruyère and Ottawa Hospital Research Institutes, Ottawa, Ontario, Canada; Division of Palliative Care, Departments of Medicine, Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. 9. Bruyère and Ottawa Hospital Research Institutes, Ottawa, Ontario, Canada; Division of Palliative Care, Departments of Medicine, Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: pglawlor@gmail.com.
Abstract
CONTEXT: Delirium is a common, distressing neuropsychiatric complication for patients in palliative care settings, where the need to minimize burden yet accurately assess delirium is hugely challenging. OBJECTIVES: This review focused on the optimal clinical and research application of delirium assessment tools and methods in palliative care settings. METHODS: In addition to multidisciplinary input from delirium researchers and other relevant stakeholders at an international meeting, we searched PubMed (1990-2012) and relevant reference lists to identify delirium assessment tools used either exclusively or partly in the context of palliative care. RESULTS: Of the 26 delirium scales identified, we selected six for in-depth review: three screening tools, two severity measures, and one research tool for neuropsychological assessment of delirium. These tools differed regarding intended use, ease of use, training requirements, psychometric properties, and validation in or suitability for palliative care populations. The Nursing Delirium Screening Scale, Single Question in Delirium, or Confusion Assessment Method, ideally with a brief attention test, can effectively screen for delirium. Favoring inclusivity, use of Diagnostic and Statistical Manual of Mental Disorders-IV criteria gives the best results for delirium diagnosis. The Revised Delirium Rating Scale and the Memorial Delirium Assessment Scale are the best available options for monitoring severity, and the Cognitive Test for Delirium provides detailed neuropsychological assessment for research purposes. CONCLUSION: Given the unique characteristics of patients in palliative care settings, further contextually sensitive studies of delirium assessment are required in this population.
CONTEXT: Delirium is a common, distressing neuropsychiatric complication for patients in palliative care settings, where the need to minimize burden yet accurately assess delirium is hugely challenging. OBJECTIVES: This review focused on the optimal clinical and research application of delirium assessment tools and methods in palliative care settings. METHODS: In addition to multidisciplinary input from delirium researchers and other relevant stakeholders at an international meeting, we searched PubMed (1990-2012) and relevant reference lists to identify delirium assessment tools used either exclusively or partly in the context of palliative care. RESULTS: Of the 26 delirium scales identified, we selected six for in-depth review: three screening tools, two severity measures, and one research tool for neuropsychological assessment of delirium. These tools differed regarding intended use, ease of use, training requirements, psychometric properties, and validation in or suitability for palliative care populations. The Nursing Delirium Screening Scale, Single Question in Delirium, or Confusion Assessment Method, ideally with a brief attention test, can effectively screen for delirium. Favoring inclusivity, use of Diagnostic and Statistical Manual of Mental Disorders-IV criteria gives the best results for delirium diagnosis. The Revised Delirium Rating Scale and the Memorial Delirium Assessment Scale are the best available options for monitoring severity, and the Cognitive Test for Delirium provides detailed neuropsychological assessment for research purposes. CONCLUSION: Given the unique characteristics of patients in palliative care settings, further contextually sensitive studies of delirium assessment are required in this population.
Authors: Jo Ellen Wilson; Leanne Boehm; Lauren R Samuels; Deborah Unger; Martha Leonard; Christianne Roumie; E Wesley Ely; Robert S Dittus; Sumi Misra; Jin H Han Journal: Palliat Support Care Date: 2019-10
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: Anne M Finucane; Louise Jones; Baptiste Leurent; Elizabeth L Sampson; Patrick Stone; Adrian Tookman; Bridget Candy Journal: Cochrane Database Syst Rev Date: 2020-01-21