Delirium In ICU Patients With Malignancy: Patient Characteristics, Resource Utilization and Outcomes

Sieber, Mattia; Rudiger, Alain; Schüpbach, Reto; Krüger, Bernard; Schubert, Maria; Béttex, Dominique

doi:10.21203/rs.3.rs-278757/v1

Cited by 2 publications

(5 citation statements)

References 34 publications

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“…Full texts of these studies were retrieved and reviewed for inclusion. Finally, 24 potentially eligible studies were excluded 9,27‐49 , leaving 17 studies for inclusion (Appendix B). Table 1 provides an overview of the included studies.…”

Section: Resultsmentioning

confidence: 99%

The economic cost of delirium: A systematic review and quality assessment

Kinchin

Mitchell

Agar

et al. 2021

Alzheimer's & Dementia

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Introduction: This review aims to systematically identify and appraise the methodological quality of claims on the cost of delirium; and discuss challenges and opportunities for improvements in the precision of the estimates.Methods: Searches of scientific papers and gray literature were performed up until June 2020. The Larg and Moss checklist was used to assess the methodological quality of the included studies.Results: After deduplication, the search identified 317 potentially relevant articles, of which 17 articles were eligible for inclusion. After adjusting for inflation and common currency, the cost of delirium ranged between $806 and $24,509 (in 2019 US$).Discussion: This review found significant variation among the cost estimates and methodological quality. There has been limited focus on dementia as a sequela of delirium in terms of economic implications, but recent evidence suggests cost implications of delirium may be 52% higher when dementia is considered.

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Section: Resultsmentioning

confidence: 99%

The economic cost of delirium: A systematic review and quality assessment

Kinchin

Mitchell

Agar

et al. 2021

Alzheimer's & Dementia

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“…The incidence of delirium in patients diagnosed with cancer is high, although it varies depending on patient characteristics and the stage of cancer. 3,4,8 Delirium that is not diagnosed early and cannot be managed effectively is a factor that negatively affects the care and patient outcomes of cancer patients and increases the care burden. [7][8][9] There are many risk factors that cause delirium development.…”

Section: Discussionmentioning

confidence: 99%

“…3 In a study conducted by Sieber et al, delirium was observed in 36% of the patients with malignancy, and the incidence of delirium development was higher in patients with liver, lung, and colorectal malignancies, respectively. 4 It has been reported that this variance in the incidence of delirium differs according to the delirium assessment method used in studies, education of personnel, and the delirium subtype. 1,5,6 Hyperactive delirium is often associated with agitation and discomfort, and increased psychomotor activity makes delirium easily recognized.…”

Section: Oncology Nurses' Practices On Diagnosis Prevention and Manag...mentioning

confidence: 99%

“…2,6 Delirium is a syndrome that increases morbidity, mortality, and cost of care in patients with cancer and affects the care burden of patients and healthcare professionals. 4,7,8 In a prospective cohort study, it was determined that the presence of delirium in patients with cancer increased the risk of mortality by a factor of six. 9 It was found that 40.2% of palliative care patients receiving inpatient treatment in a tertiary health center in Mexico developed delirium and that the average life expectancy was 11 days in patients with delirium but 21 days in patients with no delirium.…”

Section: Oncology Nurses' Practices On Diagnosis Prevention and Manag...mentioning

confidence: 99%

“…1,15,16 In a study on the characteristics of patients with malignancy who developed delirium in the intensive care unit, it was found that patients were older and had a higher disease severity score, incidence of sepsis and septic shock, and length of stay in the unit. 4 In the European Society for Medical Oncology (ESMO) Clinical Practice Manual, it has been noted that oncology nurses are concerned about how to evaluate delirium and how to manage delirium during evening and night shifts. 6 De la Cruz et al, found that delirium could not be detected in 61% of patients hospitalised in cancer care centers and that delirium findings were evaluated as pain.…”

Section: What This Paper Addsmentioning

confidence: 99%

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Oncology nurses' practices on diagnosis, prevention, and management of delirium

Öztürk Birge,

KUTLUTÜRKAN

2024

Aust J Adv Nurs

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Objective: To determine oncology nurses’ practices about the diagnosis, prevention, and management of delirium. Background: Delirium can occur at any stage of the disease process of patients with cancer, or it can develop when the first diagnosis is learned. Study Design and Methods: A cross-sectional design was used. The study was conducted between May 10 and July 16, 2021 in Turkey with 181 nurses who worked in the oncology units of public and private hospitals and were reached by using the snowball sampling method. Data were statically analysed. Results: Of the nurses, 48.6% have a bachelor's degree and the average working years in oncology is 6.61+ 5.47, 38.1% had been making routine delirium assessments, and only 5.5% of these nurses had prior experience using a screening tool. Also, 38.1% of the nurses had difficulty diagnosing delirium, with the patient group they had difficulty diagnosing most often being patients with dementia, hypoactive delirium, and those who were sedated, respectively. The rate of nurses who worked with a patient with delirium in the last month was 31.5%, and 40.3% could not determine the type of delirium. While the nurses' definition of hyperactive delirium findings was high, their definition of hypoactive delirium findings such as lethargy (48.8%), decreased psychomotor activity (47.7%) and withdrawal (56.1%) was low. In the study, it was found that being male, having an undergraduate degree in nursing, having professional work experience, having a lower patient-to-nurse ratio, using a screening tool, having experience working with patients diagnosed with delirium, and having positive views on delirium treatment had a significant impact on nurses' routine follow-up of delirium (p<0.05). In addition, it was determined that those who had experience working with patients diagnosed with delirium had less difficulty diagnosing delirium (p<0.05). Also, 82.4% of the nurses stated that they first applied pharmacological treatment after the diagnosis of delirium and that they most frequently used haloperidol (35%), benzodiazepine (29.8%) and dexmedetomidine (22.8%). Although nurses were self-confident about the management of delirium, they thought that it was difficult to prevent and treat delirium in patients with cancer. Conclusions: Although approximately one-third of the nurses had cared for patients diagnosed with delirium in the last month, the rate of using a measurement tool for routine delirium screening and diagnosis was low. Implications for research, policy, and practice: It was concluded that it was important to support the education of nurses with case examples in in-service or certificate programs, workforce planning should be made according to patient/nurse ratios, and evidence-based care procedures should be prepared and implemented so that oncology nurses could do routine follow-up of delirium in patients diagnosed with cancer, use a valid and reliable screening tool, and manage effectively and appropriately delirium. What is already known about this topic? Although the incidence of delirium is high in cancer patients, it is not always diagnosed appropriately or managed effectively. Despite the factors limiting diagnosis and treatment in cancer patients, 40% of delirium cases can be prevented. Delirium is a syndrome that can be managed with pharmacological and non-pharmacological applications. What this paper adds: In the diagnosis and management of delirium, whether nurses use screening tools and do routine follow-up, the level of their education, their experience working with patients diagnosed with delirium, the number of patients they provide care for, their self-confidence, and their positive attitudes towards delirium are factors that impact on the diagnosis and outcomes. Nurses should be supported with case-based education that will increase their knowledge and skills regarding the diagnosis and management of delirium in patients diagnosed with cancer. This approach will increase nurses' experience before they encounter a patient with delirium. For effective diagnosis and management of delirium, workforce planning should consider patient/nurse ratios in oncology units as a workload management and patient safety measure. It is recommended to prepare and implement institutional care procedures for the diagnosis, management and follow-up of delirium in oncology units.

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Delirium In ICU Patients With Malignancy: Patient Characteristics, Resource Utilization and Outcomes

Cited by 2 publications

References 34 publications

The economic cost of delirium: A systematic review and quality assessment

The economic cost of delirium: A systematic review and quality assessment

Oncology nurses' practices on diagnosis, prevention, and management of delirium

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