Practical assessment of delirium in palliative care.
BACKGROUND
Delirium is a common, distressing neuropsychiatric complication for patients in palliative care settings, where the need to minimize burden yet accurately assess delirium is hugely challenging.


OBJECTIVE
This review focused on the optimal clinical and research application of delirium assessment tools and methods in palliative care settings.


METHODS
In addition to multidisciplinary input from delirium researchers and other relevant stakeholders at an international meeting, we searched PubMed (1990-2012) and relevant reference lists to identify delirium assessment tools used either exclusively or partly in the context of palliative care.


RESULTS
Of the 26 delirium scales identified, we selected six for in-depth review: three screening tools, two severity measures, and one research tool for neuropsychological assessment of delirium. These tools differed regarding intended use, ease of use, training requirements, psychometric properties, and validation in or suitability for palliative care populations. The Nursing Delirium Screening Scale, Single Question in Delirium, or Confusion Assessment Method, ideally with a brief attention test, can effectively screen for delirium. Favoring inclusivity, use of Diagnostic and Statistical Manual of Mental Disorders-IV criteria gives the best results for delirium diagnosis. The Revised Delirium Rating Scale and the Memorial Delirium Assessment Scale are the best available options for monitoring severity, and the Cognitive Test for Delirium provides detailed neuropsychological assessment for research purposes.


CONCLUSIONS
Given the unique characteristics of patients in palliative care settings, further contextually sensitive studies of delirium assessment are required in this population.
University of Limerick, Limerick, Ireland.
Maeve M
MM
Leonard
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Alberta, Canada; Tertiary Palliative Care Unit, Covenant Health, Grey Nuns Hospital, Edmonton, Alberta, Canada.
Cheryl
C
Nekolaichuk
University of Limerick, Limerick, Ireland; Department of Adult Psychiatry, Limerick Regional Hospital, Limerick, Ireland.
David J
DJ
Meagher
Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Christopher
C
Barnes
Centre de recherche du CHU de Québec and Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada.
Jean-David
JD
Gaudreau
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Alberta, Canada; Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton, Alberta, Canada.
Sharon
S
Watanabe
Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia; South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Meera
M
Agar
Bruyère and Ottawa Hospital Research Institutes, Ottawa, Ontario, Canada; Division of Palliative Care, Departments of Medicine, Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Shirley H
SH
Bush
Bruyère and Ottawa Hospital Research Institutes, Ottawa, Ontario, Canada; Division of Palliative Care, Departments of Medicine, Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: pglawlor@gmail.com.
Peter G
PG
Lawlor
D003693:Delirium / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D009483:Neuropsychological Tests; D010166:Palliative Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales
D006993:Hypnotics and Sedatives
Delirium; assessment; diagnosis; palliative care; rating scales; screening