Differing management of people with advanced cancer and delirium by four sub-specialties.
BACKGROUND
Delirium in advanced cancer is prevalent, with limited prospective data to guide management. The aim was to survey current practice of specialists using two contrasting cases of delirium in cancer.


METHODS
A questionnaire was designed to identify investigations and treatment used, in relation to two cases.


RESULTS
Overall response rate (n = 270) was 30%. Place of care: Only 35% of medical oncologists would consider care at home for a patient with reversible delirium compared with 66% of other specialists.


METHODS
85% specialists would order basic bloods, however, medical oncologists were more likely to use oxygen saturation and head computed tomography, psychogeriatricians more likely to order thyroid function and palliative medicine specialists less likely to order chest X-ray and urine culture. Greater than 40% of specialists would do no investigations for terminal delirium.


METHODS
Medical oncologists use more pre-emptive therapies and more likely to use a benzodiazepine as agent of choice, and Palliative medicine specialists used significantly more neuroleptics to treat hypoactive symptoms of delirium.


CONCLUSIONS
The survey emphasise significant areas of variability in the management of delirium in advanced cancer. Furthermore, evidence to guide management in ways that draw on the strengths and knowledge of each specialty is urgently needed.
Agar
M
M
Sydney South West (western zone) Area Palliative Care Service, Braeside Hospital, Prairiewood, New South Wales, Australia. meera.agar@sswahs.nsw.gov.au
Currow
Dc
D
Plummer
J
J
Chye
R
R
Draper
B
B
D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001315:Australia; D001943:Breast Neoplasms / Q000523:psychology; D003693:Delirium / Q000209:etiology; D003695:Delivery of Health Care / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration*; D013727:Terminal Care / Q000379:methods* / Q000458:organization & administration; D019452:Terminally Ill