title: Delirium, agitation, and symptom distress within the final seven days of life among cancer patients receiving hospice care.
abstract: OBJECTIVE
  Knowledge of symptom prevalence and adequate assessment of such symptoms at the end of life is important in clinical practice. We determined the frequency and severity of symptom distress and delirium using the Edmonton Assessment Scale (ESAS) and the Memorial Delirium Assessment Scale (MDAS) and evaluated the clinical utility of the Nursing Delirium Screening Scale (Nu-DESC) as scored by a caregiver as a screening tool for delirium.
  
  
  METHODS
  We conducted a secondary analysis of the data from a previous randomized controlled trial on parenteral hydration at the end of life of patients admitted to home hospice. Only patients that had assessments within the last week of life were included. We collected the ESAS, MDAS, Nu-DESC, and Richmond Agitation Sedation Scale (RASS) results. The sensitivity and specificity of the Nu-DESC were then calculated.
  
  
  RESULTS
  Some 78 of 261 patients were included in our study, 62 (80%) of which had moderate-to-severe symptoms corresponding to an ESAS score >4. These symptoms include: 73 (94%) anorexia, 63 (81%) fatigue, 56 (73%) drowsiness, 58 (75%) decreased well-being, and 39 (51%) pain. Delirium was diagnosed in 34 (44%) of patients using the MDAS. The Nu-DESC was found to have a sensitivity of 35%, a specificity of 80%, a positive predictive value (PPV) of 58%, and an negative predictive value (NPV) of 61% when used by caregivers.
  
  
  CONCLUSIONS
  Hospice patients at the end of life have a high rate of symptom distress and delirium. The Nu-DESC is not a reliable tool for screening delirium when scoring is conducted by a caregiver. Our study illustrates the need for routine use of assessment tools to improve care.
authors.affiliation: The University of Texas MD Anderson Cancer Center,Department of Palliative and Rehabilitation Medicine. Houston, Texas.
authors.forename: Maxine
authors.initials: M
authors.lastname: de la Cruz
authors.affiliation: Laguna Hospital Centro de Cuidados,Palliative Care, Madrid,Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Noguera
authors.affiliation: The University of Texas MD Anderson Cancer Center,Department of Palliative and Rehabilitation Medicine. Houston, Texas.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: San Miguel-Arregui
authors.affiliation: The University of Texas MD Anderson Cancer Center,Department of Palliative and Rehabilitation Medicine. Houston, Texas.
authors.forename: Janet
authors.initials: J
authors.lastname: Williams
authors.affiliation: The University of Texas MD Anderson Cancer Center,Department of Palliative and Rehabilitation Medicine. Houston, Texas.
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.affiliation: The University of Texas MD Anderson Cancer Center,Department of Palliative and Rehabilitation Medicine. Houston, Texas.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006701:Home Nursing; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D011237:Predictive Value of Tests; D011595:Psychomotor Agitation / Q000453:epidemiology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013727:Terminal Care
keywords: Symptom distress