Cancer patients with delirium in the emergency department: A frequent and distressing problem that calls for better assessment

Lawlor, Peter G.

doi:10.1002/cncr.30132

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…However, MDAS is not validated in the ED setting, and it is significantly longer than the CAM. Further research is needed to compare the two tools in the ED setting, probably in addition to evaluation of all patients with suspected delirium by a psychiatrist, as suggested by Lawlor . A short sensitive tool is needed to detect delirium in the ED.…”

Section: Discussionmentioning

confidence: 99%

Advance Directives, Hospitalization, and Survival Among Advanced Cancer Patients with Delirium Presenting to the Emergency Department: A Prospective Study

et al. 2017

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Delirium is a devastating condition among advanced cancer patients. Early diagnosis in the emergency department (ED) should improve management of this life-threatening condition. However, delirium is frequently missed by ED clinicians, and the outcome of patients with delirium is unknown. This study finds that delirium assessed by the Confusion Assessment Method or the Memorial Delirium Assessment Scale is associated with poor survival and more hospitalization among advanced cancer patients visiting the ED of a major cancer center, many of whom lack advance directives. Therefore, delirium in ED patients with cancer should trigger discussion about advance directives.

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Section: Discussionmentioning

confidence: 99%

Advance Directives, Hospitalization, and Survival Among Advanced Cancer Patients with Delirium Presenting to the Emergency Department: A Prospective Study

et al. 2017

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“…Alternatively, the lower rate of delirium in the community may suggest that delirium prompts a crisis admission to hospital or inpatient hospice and that increasing care burdens and behavioral challenges make staying at home a less viable option for delirious patients and their caregivers. 74…”

Section: Main Findings Of the Studymentioning

confidence: 99%

The incidence and prevalence of delirium across palliative care settings: A systematic review

et al. 2019

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Background: Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed. Aim: Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings. Design: This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment. Data sources: Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included. Results: Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer ( n = 34) and mixed diagnoses ( n = 8) were represented. Delirium point prevalence estimates were 4%–12% in the community, 9%–57% across hospital palliative care consultative services, and 6%–74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings ( n = 8) was 42%–88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29–0.40, n = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used. Conclusion: Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.

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Section: Introductionmentioning

confidence: 99%

“…21 The ideal delirium screening tool should have a high level of sensitivity, be validated against a diagnostic reference standard, and be brief and easy to use with minimal training. 10,22 Currently, the use of delirium screening tools in palliative care is varied and their utility is unclear. 1,23 A recent survey of UK and Irish palliative care physicians reported that 59% do not use a formal screening tool on patients admitted to inpatient palliative care units.…”

Section: Introductionmentioning

confidence: 99%

Delirium screening tools validated in the context of palliative care: A systematic review

et al. 2021

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Background: Delirium is a distressing neuropsychiatric disorder affecting patients in palliative care. Although many delirium screening tools exist, their utility, and validation within palliative care settings has not undergone systematic review. Aim: To systematically review studies that validate delirium screening tools conducted in palliative care settings. Design: Systematic review with narrative synthesis (PROSPERO ID: CRD42019125481). A risk of bias assessment via Quality Assessment Tool for Diagnostic Accuracy Studies-2 was performed. Data sources: Five electronic databases were systematically searched (January 1, 1982–May 3, 2020). Quantitative studies validating a screening tool in adult palliative care patient populations were included. Studies involving alcohol withdrawal, critical or perioperative care were excluded. Results: Dual-reviewer screening of 3749 unique titles and abstracts identified 95 studies for full-text review and of these, 17 studies of 14 screening tools were included ( n = 3496 patients). Data analyses revealed substantial heterogeneity in patient demographics and variability in screening and diagnostic practices that limited generalizability between study populations and care settings. A risk of bias assessment revealed methodological and reporting deficits, with only 3/17 studies at low risk of bias. Conclusions: The processes of selecting a delirium screening tool and determining optimal screening practices in palliative care are complex. One tool is unlikely to fit the needs of the entire palliative care population across all palliative care settings. Further research should be directed at evaluating and/or adapting screening tools and practices to fit the needs of specific palliative care settings and populations.

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Cancer patients with delirium in the emergency department: A frequent and distressing problem that calls for better assessment

Cited by 6 publications

References 21 publications

Advance Directives, Hospitalization, and Survival Among Advanced Cancer Patients with Delirium Presenting to the Emergency Department: A Prospective Study

Advance Directives, Hospitalization, and Survival Among Advanced Cancer Patients with Delirium Presenting to the Emergency Department: A Prospective Study

The incidence and prevalence of delirium across palliative care settings: A systematic review

Delirium screening tools validated in the context of palliative care: A systematic review

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