Terminal delirium: families' experience

Namba, Miki; Morita, Tatsuya; Imura, Chizuru; Kiyohara, Emi; Ishikawa, Sayuri; Hirai, Kei

doi:10.1177/0269216307081129

Cited by 100 publications

(130 citation statements)

References 21 publications

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“…Delirium increases distress for family members (11,12), especially at the end of life where communication is impaired (73,74,78). In M A N U S C R I P T…”

Section: Pharmacological Intervention With a More Sedating Approach Omentioning

confidence: 99%

“…Families vary in their comfort level of witnessing delirious behavior and express both positive and negative emotions (78). Some families may prefer the patient to be minimally sedated although remaining confused and intermittently agitated, whereas other families may be much more at ease if the patient is more deeply sedated, sleeping peacefully and felt not to be aware of distress.…”

mentioning

confidence: 99%

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End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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“…Delirium increases distress for family members (11,12), especially at the end of life where communication is impaired (73,74,78). In M A N U S C R I P T…”

Section: Pharmacological Intervention With a More Sedating Approach Omentioning

confidence: 99%

mentioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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“…Likewise, witnessing agitation, confusion, moaning, and groaning can cause significant distress in families, caregivers, and health care professionals. [47][48][49][50][51] In dying patients with hyperactive delirium, when the goals are to decrease agitation, relieve muscle tension, ensure amnesia, and minimize the risk of seizures, benzodiazepines appear to be ideal medications to manage and prevent these symptoms. 29,60,68,90,[109][110][111][112][113][114][115][116][117]119 Benzodiazepines.…”

Section: Muscle Relaxation Anticonvulsantmentioning

confidence: 99%

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

Irwin

Pirrello

Hirst

et al. 2013

Journal of Palliative Medicine

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Delirium is highly prevalent in those with serious or advanced medical illnesses. It is associated with many adverse consequences, including significant patient, family, and health care provider distress. This article suggests a novel approach to delirium assessment and management and provides useful, practical guidance for clinicians based on a complete review of the existing literature and the expert clinical opinion of the authors and their colleagues, derived from over a decade of collective bedside experience. Comprehensive assessment includes careful description of observed symptoms, signs, and behaviors; and an understanding of the patient's situation, including primary diagnosis, associated comorbidities, functional status, and prognosis. The importance of incorporating goals of care for the patient and family is discussed. The concepts of potential reversibility versus irreversible delirium and delirium subtype are proffered, with a description of how diagnostic and management strategies follow from these concepts. Pharmacological interventions that provide rapid, effective, and safe relief are presented. Employing both pharmacological and nonpharmacological interventions, including patient and family education, improves symptoms and relieves patient and family distress, whether the delirium is reversible or irreversible, hyperactive or hypoactive. All interventions can be provided in any setting of care, including patients' homes.

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“…8 In the last days or hours of life, hyperactive delirium symptoms-commonly referred to as "terminal agitation" or "terminal restlessness"-cause distress for family members. [9][10][11] Core symptoms for a Diagnostic and Statistical Manual (DSM), Fourth Edition (DSM-IV) diagnosis of delirium include disturbed consciousness, with reduced ability to focus, sustain, or shift attention; altered cognition or a perceptual disturbance, acute onset and fluctuating symptoms, which can be mild and fleeting or severe and persistent; and evidence of an etiological cause. 12 Level of consciousness identifies the three delirium subtypes: hyperactive, hypoactive, or mixed.…”

Section: Introductionmentioning

confidence: 99%

Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review

et al. 2012

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Background: Delirium is a serious neuropsychiatric syndrome frequently experienced by palliative care inpatients. This syndrome is under-recognized by clinicians. While screening increases recognition, it is not a routine practice. Aim and design: This systematic review aims to examine methods, quality, and results of delirium prevalence and incidence studies in palliative care inpatient populations and discuss implications for delirium screening. Data sources: A systematic search of the literature identified prospective studies reporting on delirium prevalence and/or incidence in inpatient palliative care adult populations from 1980 to 2012. Papers not in English or those reporting the occurrence of symptoms not specifically identified as delirium were excluded. Results: Of the eight included studies, the majority (98.9%) involved participants (1079) with advanced cancer. Eight different screening and assessment tools were used. Delirium incidence ranged from 3% to 45%, while delirium prevalence varied, with a range of: 13.3%-42.3% at admission, 26%-62% during admission, and increasing to 58.8%-88% in the weeks or hours preceding death. Studies that used the Diagnostic and Statistical Manual-Fourth Edition reported higher prevalence (42%-88%) and incidence (40.2%-45%), while incidence rates were higher in studies that screened participants at least daily (32.8%-45%). Hypoactive delirium was the most prevalent delirium subtype (68%-86% of cases). Conclusion: The prevalence and incidence of delirium in palliative care inpatient settings supports the need for screening. However, there is limited consensus on assessment measures or knowledge of implications of delirium screening for inpatients and families. Further research is required to develop standardized methods of delirium screening, assessment, and management that are acceptable to inpatients and families.Palliative Medicine 27(6) 486 -498

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Terminal delirium: families' experience

Cited by 100 publications

References 21 publications

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

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

Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review

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