Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-25T18:36:46.877Z Has data issue: false hasContentIssue false
  • English
  • Français

Goals of care and treatment in terminal delirium: A qualitative study of the views and experiences of healthcare professionals caring for patients with cancer

Published online by Cambridge University Press:  23 November 2018

Megumi Uchida Open the ORCID record for Megumi Uchida [Opens in a new window] ,
Tatsuya Morita ,
Yoshinori Ito ,
Kazuko Koga  and
Tatsuo Akechi
Megumi Uchida*
Affiliation:
Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Tatsuya Morita
Affiliation:
Department of Palliative & Supportive Care, Seirei Mikatahara Hospital, Shizuoka, Japan
Yoshinori Ito
Affiliation:
Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan
Kazuko Koga
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Tatsuo Akechi
Affiliation:
Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
*
Author for correspondence: Megumi Uchida, MD, PhD, Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601Japan. E-mail: ucmegumi@na.rim.or.jp
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This study explores the views of healthcare professionals regarding care and treatment goals in irreversible terminal delirium and their effect on patients and caregivers.

Method

We conducted a qualitative interview study of healthcare professionals (palliative care physician, oncologist, psycho-oncologist, and clinical psychologist) engaged in the treatment of terminally ill cancer patients. We assessed the views of healthcare workers regarding treatment goals in terminal delirium and their effect on patients and their families.

Result

Of the 21 eligible healthcare professionals, 20 agreed to participate in this study. Three of the professionals had experience with treating terminal delirium as family caregivers. We identified five important aspects of treatment goals in terminal delirium based on the views of healthcare professionals: (1) adequate management of symptoms/distress, (2) ability to communicate, (3) continuity of self, (4) provision of care and support to families, and (5) considering a balance (between symptom alleviation and maintaining communication; between symptom alleviation and family preparations for the death of patients; balance between specific treatment goals for delirium and general treatment goals).

Significance of results

According to the views of healthcare workers questioned in this study, goals of care and treatment in terminal delirium are multidimensional and extend beyond simply controlling patient symptoms.

Keywords

Advanced cancerPalliative careQualitative researchTerminal deliriumTreatment goal
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 4 , August 2019 , pp. 403 - 408
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ando, M, Morita, T, Ahn, SH, et al. (2009). International comparison study on the primary concerns of terminally ill cancer patients in short-term life review interviews among Japanese, Koreans, and Americans. Palliative and Supportive Care 7(3), 349–355. doi: 10.1017/S1478951509990289Google Scholar
Bell, ML, Olivier, J, and King, MT (2013) Scientific rigour in psycho-oncology trials: Why and how to avoid common statistical errors. Psychooncology 22(3), 499–505. doi: 10.1002/pon.3046Google Scholar
Brajtman, S, Higuchi, K, and McPherson, C (2006) Caring for patients with terminal delirium: Palliative care unit and home care nurses' experiences. International Journal of Palliative Nursing 12(4), 150–156. doi: 10.12968/ijpn.2006.12.4.21010Google Scholar
Breitbart, W, Gibson, C, and Tremblay, A (2002) The delirium experience: Delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics 43(3), 183–194. doi: 10.1176/appi.psy.43.3.183Google Scholar
Breitbart, W, Rosenfeld, B, Roth, A, et al. (1997) The Memorial Delirium Assessment Scale. Journal of Pain and Symptom Management, 13(3), 128–137.Google Scholar
Bruera, E, Bush, SH, Willey, J, et al. (2009). Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer, 115(9), 2004–2012. doi: 10.1002/cncr.24215Google Scholar
Bruera, E, Fainsinger, RL, Miller, MJ, et al. (1992). The assessment of pain intensity in patients with cognitive failure: a preliminary report. Journal of Pain and Symptom Management 7(5), 267–270.Google Scholar
Bush, SH, Leonard, MM, Aga, M, et al. (2014) End-of-life delirium: Issues regarding recognition, optimal management, and the role of sedation in the dying phase. Journal of Pain and Symptom Management 48(2), 215–230. doi: 10.1016/j.jpainsymman.2014.05.009Google Scholar
Cohen, MZ, Pace, EA, Kaur, G, et al. (2009) Delirium in advanced cancer leading to distress in patients and family caregivers. Journal of Palliative Care 25(3), 164–171.Google Scholar
Finucane, AM, Lugton, J, Kennedy, C, et al. (2017) The experiences of caregivers of patients with delirium, and their role in its management in palliative care settings: An integrative literature review. Psychooncology 26(3), 291–300. doi: 10.1002/pon.4140Google Scholar
Fuller, V (2016) Delirium recall - an integrative review. Journal of Clinical Nursing 25(11–12), 1515–1527. doi: 10.1111/jocn.13155Google Scholar
Gaudreau, JD, Gagnon, P, Harel, F, et al. (2005) Fast, systematic, and continuous delirium assessment in hospitalized patients: The nursing delirium screening scale. Journal of Pain and Symptom Management 29(4), 368–375. doi: 10.1016/j.jpainsymman.2004.07.009Google Scholar
Grover, S, Ghosh, A, and Ghormode, D (2015) Experience in delirium: Is it distressing? Journal of Neuropsychiatry and Clinical Neurosciences 27(2), 139–146. doi: 10.1176/appi.neuropsych.13110329Google Scholar
Grover, S and Shah, R (2011) Distress due to delirium experience. General Hospital Psychiatry 33(6), 637–639. doi: 10.1016/j.genhosppsych.2011.07.009Google Scholar
Hirai, K, Miyashita, M, Morita, T, et al. (2006) Good death in Japanese cancer care: a qualitative study. Journal of Pain and Symptom Management 31(2), 140–147. doi: 10.1016/j.jpainsymman.2005.06.012Google Scholar
Inouye, SK, van Dyck, CH, Alessi, CA, et al. (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine 113(12), 941–948.Google Scholar
Kerr, CW, Donnelly, JP, Wright, ST, et al. (2013) Progression of delirium in advanced illness: A multivariate model of caregiver and clinician perspectives. Journal of Palliative Medicine 16(7), 768–773. doi: 10.1089/jpm.2012.0561Google Scholar
Lawlor, PG, Gagnon, B, Mancini, IL, et al. (2000) Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine 160(6), 786–794.Google Scholar
Milisen, K, Steeman, E, and Foreman, MD (2004) Early detection and prevention of delirium in older patients with cancer. European Journal of Cancer Care (England) 13(5), 494–500. doi: 10.1111/j.1365-2354.2004.00545.xGoogle Scholar
Miyashita, M, Morita, T, Sato, K, et al. (2008) Good death inventory: A measure for evaluating good death from the bereaved family member's perspective. Journal of Pain and Symptom Management 35(5), 486–498. doi: 10.1016/j.jpainsymman.2007.07.009Google Scholar
Morita, T, Akechi, T, Ikenaga, M, et al. (2007). Terminal delirium: Recommendations from bereaved families' experiences. Journal of Pain and Symptom Management 34(6), 579–589. doi: 10.1016/j.jpainsymman.2007.01.012Google Scholar
Morita, T, Tei, Y, Tsunoda, J, et al. (2001) Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. Journal of Pain and Symptom Management 22(6), 997–1006.Google Scholar
Namba, M, Morita, T, Imura, C, et al. (2007) Terminal delirium: Families' experience. Palliative Medicine 21(7), 587–594. doi: 10.1177/0269216307081129Google Scholar
Partridge, JS, Martin, FC, Harari, D, et al. (2013) The delirium experience: What is the effect on patients, relatives and staff and what can be done to modify this? International Journal of Geriatric Psychiatry 28(8), 804–812. doi: 10.1002/gps.3900Google Scholar
Tong, A, Sainsbury, P, and Craig, J (2007) Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19(6), 349–357. doi: 10.1093/intqhc/mzm042Google Scholar
Trzepacz, PT, Mittal, D, Torres, R, et al. (2001). Validation of the Delirium Rating Scale-revised-98: Comparison with the delirium rating scale and the cognitive test for delirium. Journal of Neuropsychiatry and Clinical Neurosciences 13(2), 229–242. doi: 10.1176/jnp.13.2.229Google Scholar
World Health Organization (2018) WHO definition of palliative care. Available at http://www.who.int/cancer/palliative/definition/en/. Retrieved July 10, 2018.Google Scholar