Associations between Caregiver-Perceived Delirium in Patients with Cancer and Generalized Anxiety in their Caregivers

Abstract

Background: Delirium, a common complication of advanced cancer, may put caregivers at risk for poor mental health outcomes. We looked for a relationship between caregiver-perceived delirium in a patient with advanced cancer and rates of caregiver psychiatric disorders.Methods: Using cross-sectional data from 200 caregivers of patients with cancer with a life expectancy of less than 6 months, we determined the frequency of caregiver-perceived delirium, which was defined as caregivers who reported witnessing the patient "confused, delirious" on the Stressful Caregiving Response to Experiences of Dying (SCARED) weekly or more often. We tested for associations between caregiver-reported delirium and presence of caregiver mental disorders, using the Structured Clinical Interview for the DSM-IV to diagnose mental disorders and caregiver burden, as measured by the caregiver burden scale (CBS).Results: Of the 200 caregivers who completed the SCARED, 38 (19.0%) reported seeing the patient "confused, delirious" at least once per week in the month prior to study enrollment and 7 (3.5%) met criteria for generalized anxiety (GA). Caregivers of patients with caregiver-perceived delirium were 12 times more likely to have GA (odds ratio [OR] ‫؍‬ 12.12; p Ͻ 0.01). The relationship between caregiver-perceived delirium and caregiver GA persisted after adjusting for caregiver burden and exposure to other stressful patient experiences (OR ‫؍‬ 9.99; p ‫؍‬ 0.04).Conclusions: This is the first report of an association between caregiver-perceived delirium and a caregiver mental health outcome. Further studies, using improved measures of delirium, are needed.

Delirium in patients with head and neck cancer in the outpatient treatment setting

“…Studies of delirium recall and distress have shown that delirium is highly distressing for patients and their caregivers [26,27]. Buss et al [30] found that caregivers for patients with cancer who reported witnessing the patient as "confused, delirious" weekly or more often on the Stressful Caregiving Response to Experiences of Dying (SCARED) were almost ten times more likely to meet criteria for generalized anxiety disorder, after adjusting for caregiver burden and exposure to other stressful patient experiences.…”

Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

“…49,51 In addition to general distress, caregivers of delirious patients have 12 times the risk for being diagnosed with a generalized anxiety disorder. 133 Supporting caregivers through education about delirium has been shown to help reduce these negative impacts. 83 Verbal and written education provides caregivers with a better understanding of delirium, feelings of empowerment, and an enhanced ability to make decisions on behalf of the delirious patient.…”

We can Do it: Nursing Educational Intervention to Increase Delirium Documentation

“…Complications of delirium include longer hospital stays, prolonged cognitive impairment and significant emotional distress to the patient and caregivers [7]. The financial burden of delirium is staggering, totalling more than $16,303 to $64,421 per patient, with direct 1-year health costs estimated to exceed $143 to $152 billion [8,9].…”