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Delirium screening practice in specialist palliative care units: a survey
  1. Rebecca Woodhouse1,2,
  2. Najma Siddiqi2,3,
  3. Jason W Boland4,5,
  4. Imogen Featherstone1 and
  5. Miriam J Johnson4
  1. 1 Department of Health Sciences, University of York, York, UK
  2. 2 Hull York Medical School, University of York, York, North Yorkshire, UK
  3. 3 General Adult Psychiatry, Bradford District Care NHS Foundation Trust, Bradford, UK
  4. 4 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
  5. 5 Care Plus Group and St Andrew’s Hospice, NE Lincolnshire, UK
  1. Correspondence to Mrs Rebecca Woodhouse, Department of Health Sciences, University of York, York YO10 5DD, UK; rebecca.woodhouse{at}york.ac.uk

Abstract

Objectives Delirium is common and distressing in palliative care settings. This survey aims to describe current practice regarding delirium identification in specialist palliative care units (SPCU), such as inpatient hospices, in the UK.

Methods An 18-item anonymous online survey was distributed by Hospice UK to their network of clinical leads (n=223), and to their research mailing list (n=228). The survey was also sent to the chair of the Hospice UK executive clinical leads forum for direct dissemination to forum representatives (n=20). Clinical leads and forum representatives were asked to distribute the survey to healthcare staff in their SPCUs.

Results 220 SPCU staff (48% nurses; 31% doctors; 10% healthcare assistants) completed the survey. Approximately half reported using clinical judgement alone to screen (97/204; 48%) and/or diagnose (124/220; 56%) delirium. Over a third used an assessment tool to screen for delirium (76/204; 37%). The majority (150/220; 68%) reported screening in response to clinical symptoms, while few reported routine on-admission (11/220; 5%) or daily-during-admission (12/220; 6%) screening. Most respondents had received some training on delirium (137/220; 62%). However, 130/220 (59%) said their SPCU did not have a training programme for delirium screening and only 79/220 (36%) reported that their SPCU had delirium clinical guidelines. The main barriers to routine screening included: lack of delirium training, lack of guidelines and complexity of patient’s conditions.

Conclusion There is variation in practice for delirium screening and diagnosis in SPCUs. Clinical guidelines for delirium, including consensus on which screening tools to use, are needed for this setting.

  • delirium
  • hospice care
  • terminal care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bmjspcare-2020-002251

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @MJJohnson_HYMS

    • Contributors All authors (RW, NS, JWB, IF, MJJ) have contributed to the design and development of the survey, the interpretation of the results and the writing of this manuscript.

    • Funding RW is supported by a research fellowship from Hull York Medical School.

    • 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.