Hosie, A., Agar, M., Caplan, G. A., Draper, B., Hedger, S., Rowett, D., Tuffin, P., Cheah, S. L., Phillips, J. L., Brown, L., Sidhu, M., & Currow, D. C. (2021). Clinicians' delirium treatment practice, practice change, and influences: A national online survey. Palliative Medicine, 35 (8), 1553-1563.
Background: Recent studies cast doubt on the net effect of antipsychotics for delirium.
Aim: To investigate the influence of these studies and other factors on clinicians’ delirium treatment practice and practice change in palliative care and other specialties using the Theoretical Domains Framework.
Design: Australia-wide online survey of relevant clinicians.
Setting/participants: Registered nurses (72%), doctors (16%), nurse practitioners (6%) and pharmacists (5%) who cared for patients with delirium in diverse settings, recruited through health professionals’ organisations.
Results: Most of the sample (n=475): worked in geriatrics/aged (31%) or palliative care (30%); in hospitals (64%); and saw a new patient with delirium at least weekly (61%). More (59%) reported delirium practice change since 2016, mostly by increased non-pharmacological interventions (53%). Fifty-five percent reported current antipsychotic use for delirium, primarily for patient distress (79%) and unsafe behaviour (67%). Common Theoretical Domains Framework categories of influences on respondents’ delirium practice were: emotion (54%); knowledge (53%) and physical (43%) and social (21%) opportunities. Palliative care respondents more often reported: awareness of any named key study of antipsychotics for delirium (73% vs 39%, p<0.001); decreased pharmacological interventions (60% vs 15%, p<0.001); off-label medication use (86% vs 51%, p<0.001); antipsychotics 79% vs 44%, p<0.001); benzodiazepines 61% vs 26%, p<0.001); and emotion as an influence (82% vs 39%, p<0.001).
Conclusion: Clinicians’ use of antipsychotic during delirium remains common and is primarily motivated by distress and safety concerns for the patient and others nearby. Supporting clinicians to achieve evidence-based delirium practice requires further work.
antipsychotic agents, delirium, implementation science, palliative care, psychological distress, surveys and questionnaires