title: Development of a practice guideline for optimal symptom relief for patients with pneumonia and dementia in nursing homes using a Delphi study.
abstract: OBJECTIVE
  This study aimed to develop a practice guideline for a structured and consensus-based approach to relieve symptoms of pneumonia in patients with dementia in nursing homes.
  
  
  METHODS
  A five-round Delphi study involving a panel consisting of 24 experts was conducted. An initial version of the practice guideline was developed with leading representatives of Dutch University Medical Centers with a department for elderly care medicine, based on existing guidelines for palliative care. The experts evaluated the initial version, after which we identified topics that reflected the main divergences. The experts rated their agreement with statements that addressed the main divergences on a 5-point Likert scale. Consensus was determined according to pre-defined criteria. The practice guideline was then revised according to the final decisions made by the project group and the representatives.
  
  
  RESULTS
  The response rate for the expert panel was 67%. Main divergences included the applicability of guidelines for palliative care to patients with dementia and pneumonia in long-term care and the appropriateness of specific pharmacological treatment of dyspnea and coughing. Moderate consensus was reached for 80% of the statements. Major revisions included adding pharmacological treatment for coughing and recommending opioid rotation in the case of opioid-induced delirium. Two areas of divergent opinion remained: the usefulness of oxygen administration and treatment of rattling breath. The project group made the final decision in these areas.
  
  
  CONCLUSIONS
  We developed a mostly consensus-based practice guideline for patients with dementia and pneumonia and mapped controversial issues for future investigation.
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Tessa
authors.initials: T
authors.lastname: van der Maaden
authors.forename: Jenny T
authors.initials: JT
authors.lastname: van der Steen
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: Wilco P
authors.initials: WP
authors.lastname: Achterberg
authors.forename: Froukje
authors.initials: F
authors.lastname: Boersma
authors.forename: Jos M G A
authors.initials: JM
authors.lastname: Schols
authors.forename: Jos F J M
authors.initials: JF
authors.lastname: van Berkel
authors.forename: David R
authors.initials: DR
authors.lastname: Mehr
authors.forename: Marcel
authors.initials: M
authors.lastname: Arcand
authors.forename: Andy I M
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
authors.forename: Cees M P M
authors.initials: CM
authors.lastname: Hertogh
mesh_terms: D000368:Aged; D015897:Comorbidity; D032921:Consensus; D003371:Cough / Q000628:therapy; D003697:Delphi Technique; D003704:Dementia; D004417:Dyspnea / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010166:Palliative Care / Q000379:methods; D011014:Pneumonia / Q000628:therapy*; D017410:Practice Guidelines as Topic
keywords: Delphi study; dementia; nursing homes; pneumonia; practice guideline; quality improvement