Pharmacological and non-pharmacological treatment of delirium in an oncological hospital service: an integrative review

Louro, Luciana Aparecida Vieira; Possari, João Francisco; Lima, Antônio Fernandes Costa

doi:10.1590/0034-7167-2020-0200

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…38 The goal in delirium management is; It includes presenting preventive approaches, identifying delirium risk factors and eliminating them if possible, and in the final stage, pharmacological and non-pharmacological management of delirium. 39 The use of non-pharmacological approaches is recommended as the first line of treatment in the management of delirium. 6,18 In the study, it was detected that only 17.5% of the nurses first used a non-pharmacological approach to delirium treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In a review study evaluating the pharmacological and non-pharmacological management of delirium in oncology hospitals; It was found that in 80% of the ten studies analysed, delirium was managed with a pharmacological agent and haloperidol was used especially frequently in advanced stage cancer patients. 39 In a study evaluating the attitudes, beliefs and opinions of certified palliative care specialists and liaison psychiatrists towards hypoactive delirium in the last days of life; 62% of physicians stated that pharmacological drugs should be used in the management of hypoactive delirium. 40 In a study evaluating the practices of clinicians regarding delirium treatment in Australia; It has been interpreted that 79% of palliative care providers use antipsychotics in delirium management, and this is mainly due to distress and safety concerns for the patient and others nearby.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Öztürk Birge,

KUTLUTÜRKAN

2024

Aust J Adv Nurs

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“…It also interferes with the patient's decision-making capacity, making shared decision-making significantly more complex [57]. The main treatment consists of non-pharmacological interventions focused on prevention [58,59]. However, when non-pharmacological interventions are insufficient, treatment with psychotropic drugs such as antipsychotics medications may be necessary [56].…”

Section: Deliriummentioning

confidence: 99%

Delivering Palliative and Supportive Care for Older Adults with Cancer: Interactions between Palliative Medicine and Geriatrics

Castelo-Loureiro,

Perez-de-Acha,

Torres-Perez

et al. 2023

Cancers

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The world’s population is aging rapidly, with projections indicating that by 2050 one in six people will be aged ≥65 years. As a result, the number of cancer cases in older people is expected to increase significantly. Palliative care is an essential component of cancer care with a direct impact on quality of life. However, older adults with cancer often suffer from multiple comorbidities, cognitive impairment, and frailty, posing unique challenges in the delivery of palliative care. The complex healthcare needs of older patients with cancer therefore require a comprehensive assessment, including a geriatric evaluation. Collaboration between geriatrics and palliative care can offer a solution to the challenges faced by older people with cancer, since this is a population with overlapping concerns for both disciplines. This review highlights the importance of palliative care for older adults with cancer and the benefits of a multidisciplinary approach. It also addresses the coordination of palliative care and geriatrics for specific symptom management and decision making.

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Pharmacological and non-pharmacological treatment of delirium in an oncological hospital service: an integrative review

Cited by 2 publications

References 23 publications

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

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

Delivering Palliative and Supportive Care for Older Adults with Cancer: Interactions between Palliative Medicine and Geriatrics

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