An Analytical Framework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives

Peter G. Lawlor*, Daniel H. J. Davis, Mohammed Ansari, Annmarie Hosie, Salmaan Kanji, Franco Momoli, Shirley H. Bush, Sharon Watanabe, David C. Currow, Bruno Gagnon, Meera Agar, Eduardo Bruera, David J. Meagher, Sophia E. J. A. de Rooij, Dimitrios Adamis, Augusto Caraceni, Katie Marchington, David J. Stewart

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

39 Citations (Scopus)

Abstract

Context. Delirium often presents difficult management challenges in the context of goals of care in palliative care settings. Objectives. The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research.

Methods. We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions.

Results. Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of "very'' or "extremely'' important confirmed their priority.

Conclusion. Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)159-175
Number of pages17
JournalJournal of Pain and Symptom Management
Volume48
Issue number2
DOIs
Publication statusPublished - Aug-2014
Externally publishedYes

Keywords

  • Delirium
  • palliative care
  • risk factors
  • decision making
  • hospice
  • research framework
  • assessment
  • treatment
  • predictive model
  • CONFUSION ASSESSMENT METHOD
  • HEALTH-CARE
  • ADVANCED CANCER
  • HOSPITALIZED-PATIENTS
  • MULTICOMPONENT INTERVENTION
  • COGNITIVE IMPAIRMENT
  • SYSTEMATIC REVIEWS
  • FAMILY CAREGIVERS
  • RISK-FACTORS
  • TASK-FORCE

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