Evaluation of the memorial delirium assessment scale (MDAS) for the screening of delirium by means of simulated cases by palliative care health professionals.
BACKGROUND
Delirium is among the most common neuropsychiatric complications of advanced cancer. The Memorial Delirium Assessment Scale (MDAS) is a widely used and validated screening tool for delirium in cancer patients.


OBJECTIVE
The purpose of this study was to assess the use of the MDAS by different palliative care health professionals after receiving formal training and a guiding manual for administration and scoring.


METHODS
Thirty-one palliative care health professionals received a training session on the MDAS, including description of the tool, validation, and scoring. Participants also received copies of a proposed standardized manual for completion of the MDAS. Two of the investigators presented three simulated cases to the participants, who independently completed a scoring sheet for each case. The data were then analyzed according to the cases and the profession of the operators.


RESULTS
Thirty-one scoring sheets were analyzed (11 physicians, 12 nurses, and 8 others). A correct diagnosis was achieved by 30 (96.8%) of the 31 participants in case 1 (nondelirious, true score = 5, median = 5, range = 2-15), 28 of 31 (90.3%) in case 2 (severe mixed delirium, true score = 20, median = 18, range = 10-26), and 31 of 31 in case 3 (mild hypoactive delirium, true score = 14, median = 19, range = 13-25). Overall percentage of error was 31% for items 2, 3, and 4 (cognitive) and 45% for all other items (observational) (p < 0.001). The percentage of error did not differ between physicians and nurses and other palliative care professionals (p > 0.99).


CONCLUSIONS
Our preliminary results suggest that adequate training and a guiding manual can enhance the application of MDAS by palliative care health professionals in the teaching settings. Clinical studies to assess the utility of the MDAS as a screening tool are justified to further confirm these findings.
Fadul
Nada
N
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Unit 008, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
Kaur
Guddi
G
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Unit 008, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
Zhang
Tao
T
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Unit 008, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
Palmer
J Lynn
JL
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Unit 008, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
Bruera
Eduardo
E
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Unit 008, 1515 Holcombe Blvd., Houston, TX, 77030, USA. ebruera@mdanderson.org.
D003693:Delirium / Q000175:diagnosis*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007318:Inservice Training / Q000379:methods; D008403:Mass Screening / Q000295:instrumentation*; D010166:Palliative Care; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D014481:United States