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Original research
Delirium management by palliative medicine specialists: a survey from the association for palliative medicine of Great Britain and Ireland
  1. Jason W Boland1,
  2. Monisha Kabir2,
  3. Shirley H Bush2,3,4,
  4. Juliet Anne Spiller5,6,
  5. Miriam J Johnson1,
  6. Meera Agar6 and
  7. Peter Lawlor2,3,4
  1. 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
  2. 2 Division of Palliative Care, Bruyère Research Institute; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  3. 3 Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
  4. 4 Department of Palliative Care, Bruyère Continuing Care, Ottawa, Ontario, Canada
  5. 5 Palliative Medicine, Marie Curie Hospice, Edinburgh, UK
  6. 6 IMPACCT (Improving Palliative, Chronic and Aged Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, Broadway NSW, Australia
  1. Correspondence to Dr Jason W Boland, Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine, Hull York Medical School, Hull HU6 7RX, UK; Jason.Boland{at}hyms.ac.uk

Abstract

Objectives Delirium is common in palliative care settings. Management includes detection, treatment of cause(s), non-pharmacological interventions and family support; strategies which are supported with varying levels of evidence. Emerging evidence suggests that antipsychotic use should be minimised in managing mild to moderate severity delirium, but the integration of this evidence into clinical practice is unknown.

Methods A 21-question online anonymous survey was emailed to Association for Palliative Medicine members in current clinical practice (n=859), asking about delirium assessment, management and research priorities.

Results Response rate was 39%: 70% of respondents were palliative medicine consultants. Delirium guidelines were used by some: 42% used local guidelines but 38% used none. On inpatient admission, 59% never use a delirium screening tool. Respondents would use non-pharmacological interventions to manage delirium, either alone (39%) or with an antipsychotic (58%). Most respondents (91%) would prescribe an antipsychotic and 6% a benzodiazepine, for distressing hallucinations unresponsive to non-pharmacological measures. Inpatient (57%) and community teams (60%) do not formally support family carers. Research priorities were delirium prevention, management and prediction of reversibility.

Conclusion This survey of UK and Irish Palliative Medicine specialists shows that delirium screening at inpatient admission is suboptimal. Most specialists continue to use antipsychotics in combination with non-pharmacological interventions to manage delirium. More support for family carers should be routinely provided by clinical teams. Further rigorously designed clinical trials are urgently needed in view of management variability, emerging evidence and perceived priorities for research.

  • palliative medicine
  • palliative care
  • delirium management
  • cognition
  • assessment
  • research

https://doi.org/10.1136/bmjspcare-2018-001586

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    Footnotes

    • JWB and MK are joint first authors.

    • JWB and MK contributed equally.

    • Contributors JWB, JS and PGL conceptualised, planned and constructed the study. JWB and MK led on data collection and analysis. All authors were involved in data interpretation. JWB and MK drafted the manuscript. All authors edited the manuscript and approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.