title: Detection of delirium in palliative care unit patients: a prospective descriptive study of the Delirium Observation Screening Scale administered by bedside nurses.
abstract: BACKGROUND
  The Delirium Observation Screening Scale (DOS) is designed to detect delirium by nurses' observations and has shown good psychometric properties. Its use in palliative care unit patients has not been studied.
  
  
  OBJECTIVE
  To determine diagnostic and concurrent validity, internal consistency, and user-friendliness of the Delirium Observation Screening Scale administered by bedside nurses in palliative care unit patients.
  
  
  METHODS
  In this descriptive study, psychometric properties of the Delirium Observation Screening Scale were tested by comparing the performance on the Delirium Observation Screening Scale (bedside nurses) to the algorithm of the Confusion Assessment Method and the Delirium Index (DI) (researchers). Paired observations were collected on three time points. Afterward, the user-friendliness of the Delirium Observation Screening Scale was determined by bedside nurses using a questionnaire.
  
  
  METHODS
  In total, 48 patients were recruited from one palliative care unit (PCU) of a university hospital. Of the 14 eligible bedside nurses of the palliative care unit, 10 participated in the study.
  
  
  RESULTS
  Delirium was present in 22.9% of patients. Diagnostic validity of the Delirium Observation Screening Scale was very good (area under the curve = 0.933), with 81.8% sensitivity, 96.1% specificity, 69.2% positive, and 98% negative predictive value. Concurrent validity of the Delirium Observation Screening Scale with the Delirium Index was moderate (rSpearman = 0.53, p = 0.001). The Cronbach's alpha for all Delirium Observation Screening Scale shift scores was 0.772. Generally, bedside nurses experienced the Delirium Observation Screening Scale as user-friendly. However, most Delirium Observation Screening Scale items (n = 11/13 items) need verbally active patients to perform the observations correctly.
  
  
  CONCLUSIONS
  The Delirium Observation Screening Scale can be used for delirium screening in verbally active palliative care unit patients. The scale was rated as easy to use and relevant. Further validation studies in this population are required.
authors.affiliation: 1Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
authors.forename: Elke
authors.initials: E
authors.lastname: Detroyer
authors.forename: Paul M
authors.initials: PM
authors.lastname: Clement
authors.forename: Nele
authors.initials: N
authors.lastname: Baeten
authors.forename: Michèle
authors.initials: M
authors.lastname: Pennemans
authors.forename: Marleen
authors.initials: M
authors.lastname: Decruyenaere
authors.forename: Joris
authors.initials: J
authors.lastname: Vandenberghe
authors.forename: Johan
authors.initials: J
authors.lastname: Menten
authors.forename: Etienne
authors.initials: E
authors.lastname: Joosten
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
mesh_terms: D000368:Aged; D000465:Algorithms; D016022:Case-Control Studies; D002908:Chronic Disease / Q000453:epidemiology; D003693:Delirium / Q000175:diagnosis* / Q000451:nursing; D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008609:Mental Status Schedule / Q000592:standards; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D019370:Observation; D017063:Outcome Assessment, Health Care / Q000379:methods; D010166:Palliative Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011594:Psychometrics; D015203:Reproducibility of Results; D012923:Social Class; D011795:Surveys and Questionnaires
keywords: Delirium; Delirium Observation Screening Scale; palliative care; psychometrics; sensitivity and specificity; validation studies