Treating an established episode of delirium in palliative care: Expert opinion and review of the current evidence base with recommendations for future development

Bush, SH; Kanji, S; Pereira, JL; Davis, DHJ; Currow, DC; Meagher, DJ; Rabheru, K; Wright, DK; Bruera, E; Agar, M; Hartwick, M; Gagnon, PR; Gagnon, B; Breitbart, W; Regnier, L; Lawlor, PG

Treating an established episode of delirium in palliative care: Expert opinion and review of the current evidence base with recommendations for future development

Bush, SH Kanji, S Pereira, JL Davis, DHJ Currow, DC

Meagher, DJ Rabheru, K Wright, DK Bruera, E Agar, M

Hartwick, M Gagnon, PR Gagnon, B Breitbart, W Regnier, L Lawlor, PG

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Publication Type:: Journal Article
Citation:: Journal of Pain and Symptom Management, 2014, 48 (2), pp. 231 - 248
Issue Date:: 2014-01-01

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Field	Value	Language
dc.contributor.author	Bush, SH	en_US
dc.contributor.author	Kanji, S	en_US
dc.contributor.author	Pereira, JL	en_US
dc.contributor.author	Davis, DHJ	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.contributor.author	Meagher, DJ	en_US
dc.contributor.author	Rabheru, K	en_US
dc.contributor.author	Wright, DK	en_US
dc.contributor.author	Bruera, E	en_US
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119	en_US
dc.contributor.author	Hartwick, M	en_US
dc.contributor.author	Gagnon, PR	en_US
dc.contributor.author	Gagnon, B	en_US
dc.contributor.author	Breitbart, W	en_US
dc.contributor.author	Regnier, L	en_US
dc.contributor.author	Lawlor, PG	en_US
dc.date.available	2013-07-31	en_US
dc.date.issued	2014-01-01	en_US
dc.identifier.citation	Journal of Pain and Symptom Management, 2014, 48 (2), pp. 231 - 248	en_US
dc.identifier.issn	0885-3924	en_US
dc.identifier.uri	http://hdl.handle.net/10453/115550
dc.description.abstract	Context Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. Objectives To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed. © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.	en_US
dc.relation.ispartof	Journal of Pain and Symptom Management	en_US
dc.relation.isbasedon	10.1016/j.jpainsymman.2013.07.018	en_US
dc.subject.classification	Anesthesiology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Delirium	en_US
dc.subject.mesh	Haloperidol	en_US
dc.subject.mesh	Antipsychotic Agents	en_US
dc.subject.mesh	Palliative Care	en_US
dc.subject.mesh	Randomized Controlled Trials as Topic	en_US
dc.title	Treating an established episode of delirium in palliative care: Expert opinion and review of the current evidence base with recommendations for future development	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	48	en_US
utslib.for	1110 Nursing	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	48	en_US

Abstract:

Context Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. Objectives To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed. © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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http://hdl.handle.net/10453/115550