Symptom expression in advanced cancer patients admitted to hospice or home care with and without delirium

Mercadante, Sebastiano; Masedu, Francesco; Maltoni, Marco; Giovanni, Daniela De; Montanari, Luigi; Pittureri, Cristina; Bertè, Raffaella; Russo, Domenico; Ursini, Laura; Marinangeli, Franco; Aielli, Federica

doi:10.1007/s11739-018-1969-9

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…Moreover, patients with normal cognitive function at admission, but whose condition deteriorated after admission, were unlikely to respond to treatments and had a short survival [ 4 ]. In studies performed in patients admitted to palliative care settings [ 6 , 8 , 26 ], a large number of patients reported delirium. Despite a palliative care intervention, a large number of patients exhibited alterations in cognitive status after 1 week.…”

Section: Measurement Of Painmentioning

confidence: 99%

Factors Influencing Pain Expression in Patients with Cancer: An Expert Opinion

Mercadante

Coluzzi

2021

Pain Ther

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Pain is a multidimensional experience that requires an appropriate assessment, and simple numbering may not be enough for the different components that are involved in the clinical expression. In consideration of the subjectivity of the symptom, each assessment should start from the way in which the patients perceive the pain and from how they deal with it. Some factors related to individual patient characteristics may make pain management difficult because of interference with the clinical pain expression. These factors may amplify the reporting of pain. Cognitive disorders and psychological distress seem to strongly influence pain expression and may render the analgesic treatment more difficult. Aberrant behaviors, such as alcoholism, smoking, and opioid misuse, may play a role, although geographic differences were found in terms of prevalence of the phenomenon, especially in some countries. Finally, the assessment of patients' expectation and the meaning of the personal feeling of changes in pain intensity provide new concepts in pain assessment, which may allow better personalization of the analgesic therapy. A modern pain assessment should include a multitude of factors influencing the phenotype of pain.

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Section: Measurement Of Painmentioning

confidence: 99%

Factors Influencing Pain Expression in Patients with Cancer: An Expert Opinion

Mercadante

Coluzzi

2021

Pain Ther

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“…Twenty eight studies reported in 30 articles were included (Figure 1). Three studies were each reported in two articles [32][33][34][35][36][37][38] , two studies were reported in one article. 39…”

Section: Study Selectionmentioning

confidence: 99%

Risk factors for delirium in adult patients receiving specialist palliative care: A systematic review and meta-analysis

et al. 2021

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Background: Delirium is common and distressing for patients receiving palliative care. Interventions targetting modifiable risk factors in other settings have been shown to prevent delirium. Research on delirium risk factors in palliative care can inform context-specific risk-reduction interventions. Aim: To investigate risk factors for the development of delirium in adult patients receiving specialist palliative care. Design: Systematic review and meta-analysis (PROSPERO CRD42019157168). Data sources: CINAHL, Cochrane Database of Systematic Reviews, Embase, MEDLINE and PsycINFO (1980-2021) were searched for studies reporting the association of risk factors with delirium incidence/prevalence for patients receiving specialist palliative care. Study risk of bias and certainty of evidence for each risk factor were assessed. Results: Of 28 included studies, 16 conducted only univariate analysis, 12 conducted multivariate analysis. The evidence for delirium risk factors was limited with low to very low certainty. Potentially modifiable risk factors: Opioids and lower performance status were positively associated with delirium, with some evidence also for dehydration, hypoxaemia, sleep disturbance, liver dysfunction and infection. Mixed, or very limited, evidence was found for some factors targetted in multicomponent prevention interventions: sensory impairments, mobility, catheter use, polypharmacy (single study), pain, constipation, nutrition (mixed evidence). Non-modifiable risk factors: Older age, male sex, primary brain cancer or brain metastases and lung cancer were positively associated with delirium. Conclusions: Findings may usefully inform interventions to reduce delirium risk but more high quality prospective cohort studies are required to enable greater certainty about associations of different risk factors with delirium during specialist palliative care.

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“…Estas podem ser reportadas pelo doente, cuidador ou familiar e, nesse caso, um profissional treinado para reconhecer o diagnóstico de delirium deve avaliar clinicamente o doente de forma a confirmar o diagnóstico. [40][41][42] Orientações formais para o rastreio e abordagem do delirium têm sido extensivamente desenvolvidas em unidades de cuidados intensivos, podendo servir de modelo para outros contextos clínicos. 43,44 Contudo, o reconhecimento do delirium permanece insuficiente na maioria dos contextos clínicos, incluindo naqueles em que CP ou de fim de vida serão, provavelmente, instituídos, como a comunidade.…”

Section: Diagnósticounclassified

Abordagem do Delirium na Comunidade

Rebelo

Oliveira

Rocha

2021

Gaz Med

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INTRODUÇÃO: O delirium é uma das complicações neuropsiquiátricas mais frequentes em Cuidados Paliativos. Constitui uma disfunção neurológica grave, não existindo diretrizes bem estabelecidas para a sua gestão na comunidade. O objetivo deste trabalho consiste na revisão da evidência existente sobre a abordagem do delirium na comunidade, em particular em Portugal.MÉTODOS: Revisão da literatura utilizando os termos MeSH delirium, palliative care, domiciliary care, general practitioners, general physicians, primary care, Portugal e end of life.RESULTADOS E CONCLUSÃO: O delirium é, habitualmente, multifatorial, tendo um impacto importante nos serviços de saúde, profissionais, cuidadores e, sobretudo, nos doentes. A evidência científica para o seu tratamento é escassa e aplica-se, sobretudo, aos cuidados hospitalares. A estruturação de cuidados de qualidade no âmbito da prevenção, identificação atempada e gestão precoce do delirium, no contexto dos Cuidados Paliativos na comunidade, deve incluir o doente, a sua família e o ambiente onde se insere.

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Symptom expression in advanced cancer patients admitted to hospice or home care with and without delirium

Cited by 8 publications

References 22 publications

Factors Influencing Pain Expression in Patients with Cancer: An Expert Opinion

Factors Influencing Pain Expression in Patients with Cancer: An Expert Opinion

Risk factors for delirium in adult patients receiving specialist palliative care: A systematic review and meta-analysis

Abordagem do Delirium na Comunidade

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