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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*
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

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.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2018 

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