Practical Assessment of Delirium in Palliative Care

被引:35
作者
Leonard, Maeve M. [1 ]
Nekolaichuk, Cheryl [2 ,3 ]
Meagher, David J. [1 ,4 ]
Barnes, Christopher [5 ]
Gaudreau, Jean-David [6 ,7 ]
Watanabe, Sharon [2 ,8 ]
Agar, Meera [9 ,10 ,11 ]
Bush, Shirley H. [12 ,13 ,14 ,15 ]
Lawlor, Peter G. [12 ,13 ,14 ,15 ,16 ]
机构
[1] Univ Limerick, Limerick, Ireland
[2] Univ Alberta, Dept Oncol, Div Palliat Care Med, Edmonton, AB, Canada
[3] Grey Nuns Hosp, Covenant Hlth, Tertiary Palliat Care Unit, Edmonton, AB, Canada
[4] Limerick Reg Hosp, Dept Adult Psychiat, Limerick, Ireland
[5] Univ Ottawa, Dept Med, Div Palliat Care, Ottawa, ON, Canada
[6] Univ Laval, Ctr Rech, CHU Quebec, Quebec City, PQ, Canada
[7] Univ Laval, Fac Pharm, Quebec City, PQ, Canada
[8] Cross Canc Inst, Dept Symptom Control & Palliat Care, Edmonton, AB T6G 1Z2, Canada
[9] Flinders Univ S Australia, Discipline Palliat & Support Serv, Adelaide, SA 5001, Australia
[10] Univ New S Wales, Braeside Hosp, Dept Palliat Care, Sydney, NSW, Australia
[11] Univ New S Wales, HammondCare & South West Sydney Clin Sch, Sydney, NSW, Australia
[12] Univ Ottawa, Bruyere Hosp Res Inst, Ottawa, ON, Canada
[13] Univ Ottawa, Ottawa Hosp Res Inst, Ottawa, ON, Canada
[14] Univ Ottawa, Div Palliat Care, Ottawa, ON, Canada
[15] Univ Ottawa, Dept Med, Ottawa, ON, Canada
[16] Univ Ottawa, Dept Epidemiol & Community Med, Ottawa, ON, Canada
关键词
Delirium; assessment; screening; diagnosis; rating scales; palliative care; CONFUSION ASSESSMENT METHOD; ASSESSMENT SCALE; TERMINAL CANCER; COGNITIVE TEST; RATING-SCALE; HOSPITALIZED-PATIENTS; CLINICAL UTILITY; MOTOR SUBTYPES; VALIDATION; PHENOMENOLOGY;
D O I
10.1016/j.jpainsymman.2013.10.024
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Context. Delirium is a common, distressing neuropsychiatric complication for patients in palliative care settings, where the need to minimize burden yet accurately assess delirium is hugely challenging. Objectives. This review focused on the optimal clinical and research application of delirium assessment tools and methods in palliative care settings. Methods. In addition to multidisciplinary input from delirium researchers and other relevant stakeholders at an international meeting, we searched PubMed (1990-2012) and relevant reference lists to identify delirium assessment tools used either exclusively or partly in the context of palliative care. Results. Of the 26 delirium scales identified, we selected six for in-depth review: three screening tools, two severity measures, and one research tool for neuropsychological assessment of delirium. These tools differed regarding intended use, ease of use, training requirements, psychometric properties, and validation in or suitability for palliative care populations. The Nursing Delirium Screening Scale, Single Question in Delirium, or Confusion Assessment Method, ideally with a brief attention test, can effectively screen for delirium. Favoring inclusivity, use of Diagnostic and Statistical Manual of Mental Disorders-IV criteria gives the best results for delirium diagnosis. The Revised Delirium Rating Scale and the Memorial Delirium Assessment Scale are the best available options for monitoring severity, and the Cognitive Test for Delirium provides detailed neuropsychological assessment for research purposes. Conclusion. Given the unique characteristics of patients in palliative care settings, further contextually sensitive studies of delirium assessment are required in this population. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:176 / 190
页数:15
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