Clinical practice guidelines for delirium management: potential application in palliative care.
BACKGROUND
Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear.


OBJECTIVE
This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development.


METHODS
We searched PubMed (1990-2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting.


RESULTS
There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from "expert opinion" for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care.


CONCLUSIONS
Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.
Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada. Electronic address: sbush@bruyere.org.
Shirley H
SH
Bush
The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Eduardo
E
Bruera
Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Peter G
PG
Lawlor
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada.
Salmaan
S
Kanji
Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.
Daniel H J
DH
Davis
Discipline, Palliative & Supportive Services, Flinders University, Adelaide, South Australia, Australia; South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia.
Meera
M
Agar
McGill University, Montreal, Québec, Canada.
David Kenneth
DK
Wright
Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada.
Michael
M
Hartwick
Discipline, Palliative & Supportive Services, Flinders University, Adelaide, South Australia, Australia.
David C
DC
Currow
Département de médecine familiale et de médecine d'urgence, Université Laval, Québec City, Québec, Canada; Centre de recherche du CHU de Québec, Québec City, Québec, Canada.
Bruno
B
Gagnon
Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
Jessica
J
Simon
Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada.
José L
JL
Pereira
D003693:Delirium / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D017410:Practice Guidelines as Topic
Delirium; palliative care; practice guidelines