Association among rescue neuroleptic use, agitation, and perceived comfort: secondary analysis of a randomized clinical trial on agitated delirium

Tang, Michael; Chen, Minxing; Bruera, Éduardo; Hui, David

doi:10.1007/s00520-021-06384-6

Cited by 5 publications

(4 citation statements)

References 33 publications

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“…The combination group showed reduced agitation scores and decreased need for rescue neuroleptics, although delirium severity scores remained comparable after 24 h of treatment [17]. A pre-planned secondary analysis of the same study population by Tang et al showed a significant difference in the need for rescue medication between the two groups after 8 h (15% in the combination group and 62% for haloperidol only) [18]. Lin et al studied the use of oral olanzapine (mean age 61 years) compared to oral haloperidol (mean age 68 years) in 30 terminal and preterminal cancer patients.…”

Section: Discussionmentioning

confidence: 92%

“…The average age in these studies was below the defined cut-off criteria and age ranges were too wide to be considered for inclusion and to allow for proper representation of the intended geriatric target group. Nevertheless, a part of this population could be considered as older people with some frailty characteristics, yielding potential valuable information for the present study [16][17][18][19][20]. Most of these studies used haloperidol in one of the intervention arms.…”

Section: Discussionmentioning

confidence: 99%

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Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients

Jennes,

Biesbrouck,

De Roo

et al. 2024

Geriatrics

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Context: Psychological distress symptoms in the last days of life often contribute to the overall symptom burden in frail older patients. Good symptom management practices are crucial to ensure high-quality end-of-life care in an aging population, though the best pharmacological approach to treat these psychological symptoms has yet to be established. Objectives: To identify current evidence-based and practice-based knowledge of pharmacological interventions for the treatment of agitation, delirium, and anxiety during the last days of life in frail older patients. Methods: A systematic, mixed methods review was performed through MEDLINE via PubMed and EMBASE from inception until February 2022 and updated through March 2023. National and international guideline databases and grey literature were searched for additional studies and guidelines. Results: Four quantitative studies, two non-randomized and two descriptive, were identified. No randomized controlled trials met inclusion criteria. No qualitative studies were withheld. The three consensus-based protocols that were found through citation searching and screening of grey literature did not meet the standards for inclusion. Haloperidol is recommended in consensus-based guidelines for delirium and is widely used, but high-quality evidence about its efficacy is missing. Better control of agitation or refractory delirium might be achieved with the addition of a benzodiazepine. There is no evidence available about the treatment of anxiety in the last days of life in frail older patients. Conclusions: This mixed methods review demonstrates the lack of good quality evidence that is needed to help clinicians with pharmacological treatment decisions when confronted with psychological symptoms in the last days of life in frail older patients. Population aging will only emphasize the need for further research in this specific population.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients

Jennes,

Biesbrouck,

De Roo

et al. 2024

Geriatrics

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“…During the assessment phase, when contacted, the press office of one of the funders (the American Cancer Society) stated that they neither conduct nor fund clinical trials, though they are listed under grant support for several studies 34 35. Thus, the data from the American Cancer Society’s assessment was removed and they were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

Towards transparency: adoption of WHO best practices in clinical trial registration and reporting among top medical research funders in the USA

Gamertsfelder,

Delgado Figueroa,

Keestra

et al. 2023

BMJ EBM

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ObjectiveTo assess to what extent the clinical trial policies of the largest public and philanthropic funders of clinical research in the United States meet WHO best practices in trial registration and reporting.MethodsPublic and philanthropic funders of clinical trials in the USA with >US$50 million annual spend were selected. The funders were assessed using an 11-item scoring tool based on WHO Joint Statement benchmarks. These 11 items fell into 4 categories, namely: trial registration, academic publication, monitoring and sanctions. An additional item captured whether and how funders referred to Consolidated Standards of Reporting Trials (CONSORT) within their trial policies. Each funder was independently assessed by two or three researchers. Funders were contacted to flag possible errors and omissions. Ambiguous or difficult-to-score items were settled by an independent adjudicator.ResultsFourteen funders were assessed. Our cross-sectional study found that, on average, funders have only implemented 4.1/11 (37%) of WHO best practices in clinical trial transparency. The most frequently adopted requirement was open access publishing (14/14 funders). The least frequently adopted were (1) requiring trial ID to appear in all publications (2/14 funders, 14%) and (2) making compliance reports public (2/14 funders, 14%). Public funders, on average, adopted more policy elements (5.2/11 items, 47%) than philanthropic funders (2.8/11 items, 25%). Only one funder’s policy documents mentioned the CONSORT statement.ConclusionsThere is a significant variation between the number of best practice policy items adopted by medical research funders in the USA. Many funders fell significantly short of WHO Joint Statement benchmarks. Each funder could benefit from policy revision and strengthening.

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“…They found that the addition of lorazepam to haloperidol resulted in a significantly greater reduction in agitation at 8 hours. Secondary analysis showed that the lorazepam plus haloperidol arm was also associated with increased comfort and required fewer rescue doses [ 71 , 72 ].…”

Section: Deliriummentioning

confidence: 99%

Management of Physical Symptoms in Patients with Advanced Cancer during the Last Weeks and Days of Life

Azhar

Hui

2022

Cancer Res Treat

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As patients with advanced cancer approach the end-of-life (EOL) (i.e., last weeks to days), they often suffer from devastating physical and psychological symptoms [1,2]. These may include, but are not limited to, intractable pain, agitated delirium, and severe dyspnea, which can lead to immense suffering in terminally ill patients with cancer. Many symptoms remain under-recognized and under-treated in the last months of life, and often increase in intensity as patients approach death [3][4][5].Symptom control in the last weeks of life requires certain considerations. First, symptom assessment is often complicated by delirium and/or drowsiness. Second, symptom expression may be modulated by many unique factors that have relevance in the last days of life. For example, existential distress may increase symptom expression. Third, treatment decision making is highly dependent on patient survival and their expressed wishes. For example, a patient with depression may benefit from starting methylphenidate rather than antidepressants if they have an expected survival of a few weeks only. Fourth, caregiver distress is closely associated with patient's level of distress [6]. Support for and close coordination with caregivers is paramount to optimizing patient care.Clinicians looking after patients with advanced cancer in the last weeks to days of life need to be skilled in the manage-ment of these complex issues. Availability of a specialized interdisciplinary palliative care team is crucial. The team may provide care in the mobile consultation team setting or in palliative care unit (PCU). PCUs are particularly important because they offer intensive symptom management and care planning by a team of highly skilled palliative care professionals. These units are different from inpatient hospice facilities which are community-based; patients with a prognosis more than 6 months can be admitted to a PCU in a hospital setting for the management of physical, psychosocial, and spiritual distress [7][8][9].In this narrative review, we aim to provide an update on in-patient management of several of the most distressing physical symptoms occurring commonly in the last weeks to days of life, including pain, delirium, dyspnea, bronchial hypersecretions (death rattle) and intractable seizures. Other aspects of EOL care, such as psychosocial and spiritual issues and prognostication are covered in other articles in this issue. It should be recognized that there is a paucity of research studies specifically examining issues in the last weeks and days of life, with one literature review reporting that only 13% of palliative care studies involved patients in the last month of life [10]. This is related to many unique challenges in this setting, such as frailty in dying patients, difficulty with symptom assessment, delirium, rapidly changing health status, limited funding, and few palliative care researchers. Thus, many of the current practice patterns

show abstract

Association among rescue neuroleptic use, agitation, and perceived comfort: secondary analysis of a randomized clinical trial on agitated delirium

Cited by 5 publications

References 33 publications

Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients

Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients

Towards transparency: adoption of WHO best practices in clinical trial registration and reporting among top medical research funders in the USA

Management of Physical Symptoms in Patients with Advanced Cancer during the Last Weeks and Days of Life

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