A Retrospective Chart Review of Terminal Patients with Cancer with Agitation and Their Risk Factors

Nagase, Mie; Okamoto, Yoshiaki; Tsuneto, Satoru; Tanimukai, Hitoshi; Matsuda, Yoichi; Okishiro, Nao; Oono, Yumiko; Tsugane, Mamiko; Takagi, Tatsuya; Uejima, Etsuko

doi:10.1089/jpm.2012.0114

Cited by 12 publications

(11 citation statements)

References 14 publications

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“…Apart from “subsyndromal” delirium and other potential prodromal clinical predictors, 64,65 a prediction model might explore the potential predictive role for biomarkers such as cytokines, insulin-like growth factor-1, cortisol, and C-reactive protein, though inconsistent findings have been noted to date. 61,66–70 Such studies will need careful attention to how putative biomarkers otherwise correlate with disease stage if their associations with delirium (over and above disease stage) are to be understood. A fundamental construct of predictive models in delirium is the understanding that predisposing factors (baseline risk) and precipitating factors (illness severity) interact in a reciprocal fashion.…”

Section: Resultsmentioning

confidence: 99%

An Analytical Framework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives

Lawlor

Davis

Ansari

et al. 2014

Journal of Pain and Symptom Management

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Context Delirium often presents difficult management challenges in the context of goals of care in palliative care settings. Objectives The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research. Methods We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions. Results Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of “very” or “extremely” important confirmed their priority. Conclusion Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework’s research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings.

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Section: Resultsmentioning

confidence: 99%

An Analytical Framework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives

Lawlor

Davis

Ansari

et al. 2014

Journal of Pain and Symptom Management

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“…This was concordant with previous reports that identified age and male sex as the major risk factors for the development of delirium. 10 , 11 , 34 Age and sex, which are unmodifiable through medical intervention, are demographic risk factors for delirium. However, this study was designed to identify the significant risk factors for delirium across a wide range of clinical settings and to evaluate the OR of each risk factor.…”

Section: Discussionmentioning

confidence: 99%

“…The most important aspect in the treatment and management of delirium is identifying and correcting the underlying causes. The causes of delirium are old age, male sex, underlying cognitive impairment, 10 , 11 infection, fever, 12 , 13 hypoxia, hypoglycemia, electrolyte imbalance, general medical conditions such as cardiovascular, renal, and hepatic diseases, 14 use of drugs such as benzodiazepine and narcotic analgesics, 15 , 16 metabolic disorders such as encephalopathy, and central nervous system diseases such as stroke, traumatic brain injury, and epilepsy. 17 , 18 In addition, major surgical procedures such as orthopedic and cardiovascular surgeries, conditions associated with major surgeries such as somatic pain and cobalamin deficiency, 19 , 20 and treatment environments such as ICUs are known risk factors.…”

Section: Introductionmentioning

confidence: 99%

The major risk factors for delirium in a clinical setting

Kim¹,

Chung²,

Joo³

et al. 2016

NDT

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ObjectiveWe aimed to determine the major risk factors for the development of delirium in patients at a single general hospital by comparison with a control group.Subjects and methodsWe reviewed the medical records of 260 delirium patients and 77 control patients. We investigated age, sex, and risk factors for delirium in the total delirium group (n=260), the delirium medical subgroup (n=142), and the delirium surgical subgroup (n=118). Logistic regression analysis adjusting for age and sex was performed to identify the odds ratio.ResultsThe mean age and the percentage of males were significantly higher in the delirium group compared with the control group (68.9 vs 54.3 years and 70% vs 41.6%, respectively). Risk factors for the delirium group were lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use. Plasma sodium level and hypertension were important risk factors for the delirium medical subgroup. Stroke history, hypertension, ICU care, and medication were important risk factors for the delirium surgical subgroup.ConclusionLower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use are important risk factors for delirium.

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“…An agitated delirium frequently occurs in the last week of life (26). In the last hours and days of life, delirium is often a visible manifestation of a culmination of significant multiorgan failure compounded by other irreversible factors.…”

Section: Exploring the "Terminal Delirium" Paradigm: Recognition Issumentioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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A Retrospective Chart Review of Terminal Patients with Cancer with Agitation and Their Risk Factors

Abstract: It is necessary to consider risk factors in order to categorize terminal patients with cancer into high- and low-risk groups and undertake possible counter-measures.

Cited by 12 publications

References 14 publications

An Analytical Framework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives

An Analytical Framework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives

The major risk factors for delirium in a clinical setting

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

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