End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase
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. To review delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and manag...
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| Published in | Journal of pain and symptom management Vol. 48; no. 2; pp. 215 - 230 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article Conference Proceeding |
| Language | English |
| Published |
New York, NY
Elsevier Inc
01.08.2014
Elsevier |
| Subjects | |
| Online Access | Get full text |
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| Abstract | 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.
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.
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.
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.
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 is needed in this patient population. |
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| AbstractList | 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 is needed in this patient population. 121 references AbstractContextIn 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. ObjectivesTo 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. MethodsWe 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. ResultsThe 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. ConclusionFurther 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 is needed in this patient population. 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. 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. 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. 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. 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 is needed in this patient population. 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.CONTEXTIn 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.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.OBJECTIVESTo 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.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.METHODSWe 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.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.RESULTSThe 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.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 is needed in this patient population.CONCLUSIONFurther 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 is needed in this patient population. |
| Author | Currow, David C. Spiller, Juliet A. Hosie, Annmarie Lawlor, Peter G. Agar, Meera Wright, David Kenneth Leonard, Maeve M. Meagher, David J. Bruera, Eduardo Bush, Shirley H. |
| Author_xml | – sequence: 1 givenname: Shirley H. surname: Bush fullname: Bush, Shirley H. email: sbush@bruyere.org organization: Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada – sequence: 2 givenname: Maeve M. surname: Leonard fullname: Leonard, Maeve M. organization: Graduate Entry Medical School, University of Limerick, Limerick, Ireland – sequence: 3 givenname: Meera surname: Agar fullname: Agar, Meera organization: Discipline, Palliative & Supportive Services, Flinders University, Adelaide, South Australia, Australia – sequence: 4 givenname: Juliet A. surname: Spiller fullname: Spiller, Juliet A. organization: Palliative Medicine, Marie Curie Hospice, Edinburgh, United Kingdom – sequence: 5 givenname: Annmarie surname: Hosie fullname: Hosie, Annmarie organization: Faculty of Nursing, University of Notre Dame, Sydney, New South Wales, Australia – sequence: 6 givenname: David Kenneth surname: Wright fullname: Wright, David Kenneth organization: McGill University, Montreal, Québec, Canada – sequence: 7 givenname: David J. surname: Meagher fullname: Meagher, David J. organization: Graduate Entry Medical School, University of Limerick, Limerick, Ireland – sequence: 8 givenname: David C. surname: Currow fullname: Currow, David C. organization: Discipline, Palliative & Supportive Services, Flinders University, Adelaide, South Australia, Australia – sequence: 9 givenname: Eduardo surname: Bruera fullname: Bruera, Eduardo organization: The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA – sequence: 10 givenname: Peter G. surname: Lawlor fullname: Lawlor, Peter G. organization: Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada |
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| Copyright | 2014 American Academy of Hospice and Palliative Medicine American Academy of Hospice and Palliative Medicine 2015 INIST-CNRS Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. |
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| Snippet | 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... AbstractContextIn end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in... 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... |
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| SubjectTerms | Adult and adolescent clinical studies Anesthesia Biological and medical sciences delirium Delirium - diagnosis Delirium - drug therapy end of life hospice Humans Hypnotics and Sedatives - therapeutic use Medical sciences Organic mental disorders. Neuropsychology Pain Medicine Palliative care Pharmacology. Drug treatments Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry sedation terminal Terminal Care - methods Terminology as Topic |
| Title | End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase |
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