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The experience of delirium in palliative care settings for patients, family, clinicians and volunteers: A qualitative systematic review and thematic synthesis.

Authors
  • Featherstone, Imogen1
  • Hosie, Annmarie2, 3
  • Siddiqi, Najma1, 4
  • Grassau, Pamela5, 6, 7
  • Bush, Shirley H6, 7, 8, 9
  • Taylor, Johanna1
  • Sheldon, Trevor10
  • Johnson, Miriam J11
  • 1 Department of Health Sciences, University of York, York, UK.
  • 2 School of Nursing, The University of Notre Dame Australia, Sydney, NSW, Australia. , (Australia)
  • 3 The Cunningham Centre for Palliative Care, St Vincent's Health Network, Sydney, NSW, Australia. , (Australia)
  • 4 Hull York Medical School, University of York, York, UK.
  • 5 School of Social Work, Carleton University, Ottawa, ON, Canada. , (Canada)
  • 6 Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada. , (Canada)
  • 7 Bruyere Research Institute, Ottawa, ON, Canada. , (Canada)
  • 8 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. , (Canada)
  • 9 Department of Palliative Care, Bruyere Continuing Care, Ottawa, ON, Canada. , (Canada)
  • 10 Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
  • 11 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
Type
Published Article
Journal
Palliative medicine
Publication Date
Jun 01, 2021
Volume
35
Issue
6
Pages
988–1004
Identifiers
DOI: 10.1177/02692163211006313
PMID: 33784915
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Delirium is common in palliative care settings and is distressing for patients, their families and clinicians. To develop effective interventions, we need first to understand current delirium care in this setting. To understand patient, family, clinicians' and volunteers' experience of delirium and its care in palliative care contexts. Qualitative systematic review and thematic synthesis (PROSPERO 2018 CRD42018102417). The following databases were searched: CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Embase, MEDLINE and PsycINFO (2000-2020) for qualitative studies exploring experiences of delirium or its care in specialist palliative care services. Study selection and quality appraisal were independently conducted by two reviewers. A total of 21 papers describing 16 studies were included. In quality appraisal, trustworthiness (rigour of methods used) was assessed as high (n = 5), medium (n = 8) or low (n = 3). Three major themes were identified: interpretations of delirium and their influence on care; clinicians' responses to the suffering of patients with delirium and the roles of the family in delirium care. Nursing staff and other clinicians had limited understanding of delirium as a medical condition with potentially modifiable causes. Practice focused on alleviating patient suffering through person-centred approaches, which could be challenging with delirious patients, and medication use. Treatment decisions were also influenced by the distress of family and clinicians and resource limitations. Family played vital roles in delirium care. Increased understanding of non-pharmacological approaches to delirium prevention and management, as well as support for clinicians and families, are important to enable patients' multi-dimensional needs to be met.

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