Research may improve quality of life for palliative care patients with delirium
The University of Notre Dame Australia
As part of a larger PhD study, researchers at The University of Notre Dame Australia have recently reported on the prevalence of delirium experienced by palliative care inpatients. This systematic review has been published in Palliative Medicine, a highly ranked peer reviewed journal dedicated to improving the knowledge and clinical practice in the care of patients with advanced disease.
The systematic review was undertaken by PhD student Annmarie Hosie, under the supervision of Professor Jane Phillips, Professor of Palliative Nursing at Notre Dame and The Cunningham Centre for Palliative Care. It examines the prevalence of delirium in palliative care inpatients and will be used to inform work being undertaken as part of the DePAC Study, which is exploring the capacity of palliative care nurses to recognise and respond to symptoms of delirium and facilitators and barriers that impact on the delivery of best delirium care. Professor Phillips said Ms Hosie's research, and its scholarly publication, would result in the better recognition of delirium in the palliative care population and this would have a positive impact on patient dignity, safety and quality of life.
This study is particularly important as although palliative care patients can suffer from a range of clinical conditions, this systematic review suggests that a larger proportion of them are affected by delirium than originally anticipated. Delirium is an acute neuropsychiatric syndrome related to a physical cause, where fluctuating changes to levels of consciousness or alertness, cognition and/or perception occur. Patients may experience a wide range of symptoms, including inattention, altered alertness (hypoactive, hyperactive or both), impaired memory, language, behavior changes, hallucinations, illusions or delusions, mood changes and altered sleep wake cycle.
Ms Hosie, a palliative care nurse with 20 years' experience in clinical settings, said delirium is under-recognised by clinicians, including nurses, but its effects have a significant impact on quality of life for patients and their families.
"Most patients will remember their experience of delirium and report it as being frightening, humiliating and distressing," Ms Hosie said.
"Patients who experience delirium in hospital are more likely to fall, stay in hospital longer and be discharged to a nursing home. These patients also have increased mortality, compared to those patients who did not experience delirium."
As patients with delirium may not be able to make their own decisions and become more dependent, family members may feel the burden of their increased care needs and of having to make decisions on their behalf. Added to this, family members report distress and sometimes embarrassment at seeing their loved one acting in uncharacteristic ways or being unable to communicate effectively.
Research indicates that between one third and one half of palliative care patients' delirium is reversible, so a comprehensive screening process may be crucial in efforts to reduce the distress of patients and families, as well as reducing the risk of other negative outcomes.
"Recognising patients' delirium early may provide clinicians with the opportunity to treat the underlying physical cause and reverse the delirium," Ms Hosie said.
"Even if the delirium cannot be reversed, patients and families will need information and support about what is happening, and there are interventions that may reduce the severity of the symptoms."
Professor Phillips said Ms Hosie's research is working to improve patient care with a new pilot program.
"Annmarie's continuing study in this area will lead to the development and testing of a pilot intervention, aimed at improving nursing practice in delirium prevention, recognition and assessment, with the aim of strengthening the system and improving patients' health experiences," Professor Phillips said.
For further information please contact: Communications Officer, Elizabeth Fenech The University of Notre Dame Australia, Sydney Campus
T: 02 8204 4407
Fenech, Elizabeth, "Research may improve quality of life for palliative care patients with delirium" (2012). Media Release Archive. 907.