Palliative and Supportive Care

Original Articles

The recognition and documentation of delirium in hospital palliative care inpatients

Julia Barnesa1 c1, Suzanne Kitea2 and Manoj Kumara3

a1 Specialist Registrar in Palliative Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, England

a2 Consultant in Palliative Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, England

a3 Consultant in Psycho-oncology and Community Psychiatry, Mehac Foundation, Institute of Palliative Medicine, Calicut, Kerala, India

Abstract

Objective: Delirium is a clinical syndrome that is known to be under recognized by palliative care teams. A wide variation in reported prevalence may reflect differences in definitions and assessment methods, patient characteristics, and study design. The aim of this study was to test an intervention to improve recognition of delirium in the inpatient palliative care setting.

Method: We conducted a retrospective palliative care notes review of documented prevalence of delirium among 61 patients referred to the Specialist Palliative Care Advisory Team (SPCT). Subsequently, training in the use of the Confusion Assessment Method (CAM) was provided to the SPCT and a prospective survey of the prevalence of delirium measured by the CAM was undertaken with the next 59 patients referred.

Results: In the retrospective chart review, the term “delirium” was not used, and synonyms were identified and used to establish a delirium prevalence of 11.5%. In the intervention utilizing the CAM in a prospective sample of 59 referred patients, a prevalence rate of 8.5–15.2% for delirium was found. Use of the CAM was received favorably by the SPCT.

Significance of Results: The institution of the use of the CAM as a screening and assessment tool in the inpatient palliative care setting did not significantly increase the recognition of delirium. Reasons for the low prevalence of delirium are discussed.

(Received August 03 2009)

(Accepted October 17 2009)

Correspondence:

c1 Address correspondence and reprint requests to: J. Barnes, Palliative Care Team, Robert Ogden Centre, St. James' University Hospital, Leeds, England. E-mail: jebarnes@doctors.org.uk