Background Delirium causes severe distress for patients, families, and staff. One-third of people admitted to adult palliative care units have delirium and two-thirds develop delirium during their stay (Watt, Momoli, Ansari, et al., 2019. Palliat Med. 33: 865), yet implementation of clinical guidelines is poor and assessment tools are used infrequently (Boland, Kabir, Bush, et al., 2022. BMJ Support Palliat Care. 12: 73). Strategies are needed to address this gap between knowledge and action (Featherstone, Hosie, Siddiqi, et al., 2021. Palliat Med. 35: 988).

Aim To adapt the Creating Learning Environments for Compassionate Care (CLECC) strategy from acute settings for use in hospice delirium care.

Methods We conducted three 2-hour Experience-Based Co-Design online workshops (Locock, Robert, Boaz, et al., 2014. Health Serv Deliv Res. 2) co-Chaired by a Patient & Public Involvement member. Participants had lived experience of delirium (personally or as a carer) or were hospice clinicians, domestic staff, or management. Workshops used examples of key delirium events to trigger discussion between patients/carers (Workshop 1), staff (Workshop 2), and patients/carers and staff (Workshop 3). Workshops 1 and 2 focused on adaptations to CLECC components (team study day, action learning sets, peer practice observations, mid-shift ‘cluster discussions’ and twice-weekly reflective discussions), whilst Workshop 3 focused on refining CLECC based on initial testing. The final specification of CLECC (‘CLECC-Pal’) for hospices at Workshop 4 will be informed by Process Evaluation findings.

Results The workshops conducted to date prompted changes to CLECC delivery and content to address equity and implementation concerns and to reflect the different circumstances of hospices. Changes included: flexible access to study materials, recognition of staff working relationships, including all staff in reflective discussions, having core and adaptable CLECC components, and identification of hospice leads for each CLECC component.

Conclusions Online Experience-Based Co-Design is a practical and feasible way of involving patients, carers, staff and management in adapting an existing intervention for hospice use. Our ongoing work is assessing signal of benefit of CLECC-Pal on number of patient delirium days.

For more on this study, see also oral presentation (O-13): Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices: The DAMPen-Delirium feasibility study, by Gillian Jackson et al. (Parallel session 4.1 – Patient care perspectives).