Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

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. Me...

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Bibliographic Details
Published in:Journal of pain and symptom management 2014-08, Vol.48 (2), p.231-248
Main Authors: Bush, Shirley H., MBBS, MRCGP, FAChPM, Kanji, Salmaan, BSc Pharm, PharmD, Pereira, José L., MBChB, CCFP, MSc, Davis, Daniel H.J., MBChB, MRCP, Currow, David C., BMed, MPH, FRACP, Meagher, David J., MD, PhD, MRCPsych, Rabheru, Kiran, MD, CCFP, FRCP, DABPN, Wright, David Kenneth, RN, PhD, CHPCN(C), Bruera, Eduardo, MD, Agar, Meera, MBBS, FRACP, Hartwick, Michael, MD, FRCPC, Gagnon, Pierre R., MD, FRCPC, Gagnon, Bruno, MD, MSc, Breitbart, William, MD, FAPM, FAPA, Regnier, Laura, BSc, MSc, MD, CCFP, Lawlor, Peter G., MB, FRCPI, MMedSc
Format: Article
Language:English
Subjects:
Adult and adolescent clinical studies
Anesthesia & Perioperative Care
Antipsychotic Agents - adverse effects
Antipsychotic Agents - therapeutic use
Biological and medical sciences
decision making
Delirium
Delirium - therapy
evidence-based medicine
Haloperidol - adverse effects
Haloperidol - therapeutic use
hospices
Humans
Medical sciences
Organic mental disorders. Neuropsychology
Pain Medicine
palliative care
Palliative Care - methods
Pharmacology. Drug treatments
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Randomized Controlled Trials as Topic
therapeutics
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Summary: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.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2013.07.018