Delirium management by palliative medicine specialists: a survey from the association for palliative medicine of Great Britain and Ireland

Boland, Jason W.; Kabir, Monisha; Bush, Shirley H; Spiller, Juliet Anne; Johnson, Miriam J.; Agar, Meera; Lawlor, Peter

Abstract

Objectives Delirium is common in palliative care settings. Management includes detection, treatment of cause(s), non-pharmacological interventions and family support; strategies which are supported with varying levels of evidence. Emerging evidence suggests that antipsychotic use should be minimised in managing mild to moderate severity delirium, but the integration of this evidence into clinical practice is unknown.

Methods A 21-question online anonymous survey was emailed to Association for Palliative Medicine members in current clinical practice (n=859), asking about delirium assessment, management and research priorities.

Results Response rate was 39%: 70% of respondents were palliative medicine consultants. Delirium guidelines were used by some: 42% used local guidelines but 38% used none. On inpatient admission, 59% never use a delirium screening tool. Respondents would use non-pharmacological interventions to manage delirium, either alone (39%) or with an antipsychotic (58%). Most respondents (91%) would prescribe an antipsychotic and 6% a benzodiazepine, for distressing hallucinations unresponsive to non-pharmacological measures. Inpatient (57%) and community teams (60%) do not formally support family carers. Research priorities were delirium prevention, management and prediction of reversibility.

Conclusion This survey of UK and Irish Palliative Medicine specialists shows that delirium screening at inpatient admission is suboptimal. Most specialists continue to use antipsychotics in combination with non-pharmacological interventions to manage delirium. More support for family carers should be routinely provided by clinical teams. Further rigorously designed clinical trials are urgently needed in view of management variability, emerging evidence and perceived priorities for research.

Citation

Boland, J. W., Kabir, M., Bush, S. H., Spiller, J. A., Johnson, M. J., Agar, M., & Lawlor, P. (in press). Delirium management by palliative medicine specialists: a survey from the association for palliative medicine of Great Britain and Ireland. BMJ supportive & palliative care, bmjspcare-2018-001586. https://doi.org/10.1136/bmjspcare-2018-001586

• Journal Article Type: Article
• Acceptance Date: Feb 11, 2019
• Online Publication Date: Mar 4, 2019
• Deposit Date: Mar 14, 2019
• Publicly Available Date: Apr 29, 2019
• Journal: BMJ Supportive and Palliative Care
• Print ISSN: 2045-435X
• Electronic ISSN: 2045-4368
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Pages: bmjspcare-2018-001586
• DOI: https://doi.org/10.1136/bmjspcare-2018-001586
• Keywords: Palliative medicine; Palliative care; Delirium management; Cognition; Assessment; Research
• Public URL: https://hull-repository.worktribe.com/output/1364238
• Publisher URL: https://spcare.bmj.com/content/bmjspcare/early/2019/03/04/bmjspcare-2018-001586.full.pdf