Delirium: assessment and treatment of patients with cancer PART 2

Abstract

Delirium at the end of life may present significant ethical dilemmas in clinical practice: whether to simply treat it in order to maximise symptom relief, with the resulting side effect being palliative sedation, or to attempt to reverse delirium and risk prolonging suffering. Determining whether the delirium can be reversed involves comprehensive assessment using established tools, which may or may not provide the answer to the question posed. This article examines the evidence surrounding several assessment tools that have been suggested as effective in identifying delirium, and the consequences of various approaches to the management of delirium in a patient with a cancer diagnosis. It also considers the impact delirium may have on the health professional and those close to the patient.

Improving the Management of Terminal Delirium at the End of Life

“…This may be in part due to difficulties in the detection of terminal delirium, which relies on health-care providers' expertise. [ 19 20 21 ] The ambiguous nature of terminal delirium and lack of universal delirium screening tools in palliative care can create a sense of uncertainty among health-care providers when identifying terminal delirium. [ 5 ] Synonymous terms such as terminal agitation and widely held misconceptions about terminal delirium also contribute to confusion around its identification and management (for example, the falsely held belief that an agitated terminal delirium is an inevitable part of the dying process or misconstruing symptoms of terminal delirium as an expression of pain by dying patients).…”

Delirium onset within a palliative care programme: nursing care for the patient and family

“…2 First of all it is crucial to establish the goals of care, preferably with the patient himself, if not with the family members 14,21 The first aim in the management of delirium is the identification and treatment of potential causes, 12,18 bearing in mind that it might have multiple etiologies. 22,23 Possible causative factors may be hypoxia, infection, malnutrition, unmanaged pain, dehydration and poor renal and liver function. 12 Patient drug therapy should be carefully reviewed since many medications such as sedatives and hypnotics, opioids, anticonvulsants, antiparkinsonians, steroids, antibiotics, selective serotonin reuptake inhibitors (SSRIs) and drugs with anticholinergic effects, may be involved in the onset of acute confusional state.…”