Health-Care Workers’ Judgments About Pain in Older Palliative Care Patients With and Without Delirium

Mah, Kenneth; Rodin, Rebecca; Chan, Vincent; Stevens, Bonnie; Zimmermann, Camilla; Gagliese, Lucia

doi:10.1177/1049909116672641

Cited by 6 publications

(8 citation statements)

References 23 publications

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“…Given that delirium is perceived as a very distressing condition by those who have experienced it and recovered (Kuusisto-Gussmann et al, 2021), it is possible that the dying patient with an altered level of consciousness is equally distressed. The findings of this integrative review agree with the previously reported findings regarding the lack of available guidance, and the difficulty in assessing the care needs of the voiceless and vulnerable dying patient with delirium (Gao et al, 2013; Lawlor et al, 2014; Blinderman and Billings, 2015; Mah et al, 2017).…”

Section: Discussionsupporting

confidence: 89%

The conscious state of the dying patient: An integrative review

et al. 2021

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Objectives The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs. Methods An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach. Results Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying. Significance of results In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.

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Section: Discussionsupporting

confidence: 89%

The conscious state of the dying patient: An integrative review

et al. 2021

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“…In this study, only one patient in the persistent‐delirium group was treated with pregabalin. The relationship between pain and delirium has been pointed out in areas such as palliative treatment and ICU, with an emphasis on assessment and management in these areas 29,30 . In addition, there is a report about elderly patients with dementia who have a fractured hip joint, in which a comparison is made between those elderly whose pain is controlled appropriately and whose pain is not well controlled.…”

Section: Discussionmentioning

confidence: 99%

“…The relationship between pain and delirium has been pointed out in areas such as palliative treatment and ICU, with an emphasis on assessment and management in these areas. 29,30 In addition, there is a report about elderly patients with dementia who have a fractured hip joint, in which a comparison is made between those elderly whose pain is controlled appropriately and whose pain is not well controlled. The report shows that the latter group had a nine times higher occurrence of complications from delirium, implying that pain is a cause of delirium.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of factors associated with persistent delirium

et al. 2021

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Background It has been reported that delirium causes various problems. Many researchers have reported the risk factors associated with the onset of delirium; however, there are few reports focused on persistent delirium. This study aimed to identify the risk factors associated with persistent delirium. Methods A total of 573 patients hospitalised in Nara Prefecture General Medical Centre from October 2014 through September 2017 who were referred to the psychiatry consultation service were included in this study. Persistent delirium was defined as delirium lasting for 14 days or more. A retrospective study was carried out based on the patients' records. The relationship between various background factors and persistent delirium was statistically analysed. Results Of the 573 hospitalised patients, 295 were diagnosed as having delirium. Forty‐six patients with persistent delirium and 181 patients with nonpersistent delirium were included in this study. Multivariable logistic regression analyses revealed that male gender, opioid analgesics use, non‐opioid analgesics use, and low serum sodium were significantly and independently associated with persistent delirium. Ramelteon or trazodone was used significantly more in persistent delirium, although each use was not significant. Conclusion This is the first study to reveal that male gender and use of analgesics were associated with persistent delirium in general hospital. However, as this is a case–control study and may contain bias, future cohort studies and intervention studies are needed. It is also necessary to investigate the relevance of the ‘degree of pain’ behind the use of analgesics.

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“…We found that patients with HD experienced higher levels of distress associated with pain compared with their counterparts without HD. Previous research showed that pain was substantially less well managed for patients with palliative care cancer with HD than for those without HD (Mah et al., 2017). Health professionals also observed that patients with HD tended to experience more intense and intractable pain (Mah et al., 2017).…”

Section: Discussionmentioning

confidence: 99%

Symptom trajectories for palliative care inpatients with and without hyperactive delirium in the last week of life

Dai

Walpole

Ding

et al. 2021

Journal of Advanced Nursing

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Aims: Hyperactive delirium (HD) is a common and distressing symptom among palliative care patients. This study aimed to describe the characteristics of HD and associated symptoms among palliative care inpatients and evaluate relationships between HD development and symptom trajectories in this population.Design: A retrospective study was conducted.Methods: A retrospective review of medical records was conducted for all patients who died in a large Australian specialist palliative care unit between 1 January and 31 December 2019. Patients were assessed daily using the Symptoms Assessment Scale (SAS) and Palliative Care Problem Severity Scale (PCPSS). Multilevel models were used to estimate the differences in symptoms trajectories in the last 7 days of life between the two groups.Results: Of the 501 included patients, 64.5% (323) had an episode of HD. For 30% (95) of patients, HD occurred prior to admission. Compared with patients without HD, those with HD had significantly higher odds ratios (ORs) for four of the seven SAS symptoms (sleep problems, appetite, fatigue and pain; OR range: 1.94-4.48, p < .05), and all four PCPSS items (OR range: 2.00-3.00, p < .05) in the last week of life. Conclusions:Palliative care inpatients commonly experience HD in their last week of life. There are higher levels of symptom distress, complexity, psychological concerns and family/carer concerns among patients with HD compared with those without HD. Impact:The high prevalence of HD, and its association with higher levels of symptom distress, highlights the importance of routine screening and optimal management for HD among palliative care patients. Given the widely recognized challenges facing palliative care professionals in assessment and management of delirium, provision of relevant training among these professionals is recommended.

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Health-Care Workers’ Judgments About Pain in Older Palliative Care Patients With and Without Delirium

Cited by 6 publications

References 23 publications

The conscious state of the dying patient: An integrative review

The conscious state of the dying patient: An integrative review

A retrospective study of factors associated with persistent delirium

Symptom trajectories for palliative care inpatients with and without hyperactive delirium in the last week of life

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