Wit, C. de (Casper) (2021) The assessment and management of delirium at the end of life: a survey of Dutch healthcare professionals. thesis, Medicine.
Full text available on request.Abstract
Introduction: Delirium is a common neuro psychiatric condition at the end of life. Prevention and management of end-of-life delirium consists of screening, diagnosis, non-pharmacological interventions, and support for family members. Emerging evidence suggests that antipsychotics should be avoided when managing mildly and moderately severe delirium. Aim: The aims of this study were to survey the current assessment and management of delirium at the end of life and assess variations in clinical practice between hospital and non-hospital settings. Methods: A 33 question anonymous survey was distributed to healthcare professionals involved in end-of-life care in Dutch care settings via email. The survey asked about their assessment and management of delirium in patients at the end-of-life. Results: We received 119 responses. Forty-three percent of respondents were geriatricians and internist geriatricians. Many respondents only screen for delirium upon indication (35%) and use a formal screening tool (84%). More respondents in hospital settings screen for delirium on a daily basis (43%) than in non-hospital settings (5%). Non-pharmacological interventions are implemented by 90% of responders for the prevention of delirium in patients at the end-of-life at risk of developing a delirium. Hypoactive delirium is managed with only non-pharmacological interventions by 42% of respondents. Hyperactive delirium is managed with the addition of haloperidol by 97% of respondents. Eighty-three percent of respondents in hospital settings manage delirium using a non-pharmacological approach compared to 64% in non-hospital settings. The emotional burden and wishes of family members, along with personal experience are the most important factors that influenced management choice. Fifty-six percent of respondents indicated that family members are given structured information on delirium in their practice setting. Conclusions: This survey shows that nearly all healthcare professionals implement non-pharmacological interventions managing delirium, but many still routinely use antipsychotics as a first line treatment for hyperactive delirium. The optimal application of the current delirium guidelines and emerging evidence into clinical practice for patients at the end-of-life should be investigated in future studies.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Reyners, prof. dr. A.K.L. and Graeff, dr. P. de |
| Faculty: | Medical Sciences |
| Date Deposited: | 07 Jan 2022 08:48 |
| Last Modified: | 07 Jan 2022 08:48 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2982 |
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