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Delirium, agitation, and symptom distress within the final seven days of life among cancer patients receiving hospice care

Published online by Cambridge University Press:  20 February 2014

Maxine de la Cruz ,
Antonio Noguera ,
Maria Teresa San Miguel-Arregui ,
Janet Williams ,
Gary Chisholm  and
Eduardo Bruera
Maxine de la Cruz*
Affiliation:
The University of Texas MD Anderson Cancer Center, Department of Palliative and Rehabilitation Medicine. Houston, Texas
Antonio Noguera
Affiliation:
Laguna Hospital Centro de Cuidados, Palliative Care, Madrid, Spain
Maria Teresa San Miguel-Arregui
Affiliation:
The University of Texas MD Anderson Cancer Center, Department of Palliative and Rehabilitation Medicine. Houston, Texas
Janet Williams
Affiliation:
The University of Texas MD Anderson Cancer Center, Department of Palliative and Rehabilitation Medicine. Houston, Texas
Gary Chisholm
Affiliation:
The University of Texas MD Anderson Cancer Center, Department of Palliative and Rehabilitation Medicine. Houston, Texas
Eduardo Bruera
Affiliation:
The University of Texas MD Anderson Cancer Center, Department of Palliative and Rehabilitation Medicine. Houston, Texas The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, Texas
*
Address correspondence and reprint requests to: Maxine de la Cruz, The University of Texas MD Anderson Cancer Center, Department of Palliative Care and Rehabilitation Medicine, 1515 Holcombe Boulevard, Unit 1414, Houston, Texas 77030. E-Mail: mdelacruz@mdanderson.org.
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Abstract

Objective:

Knowledge of symptom prevalence and adequate assessment of such symptoms at the end of life is important in clinical practice. We determined the frequency and severity of symptom distress and delirium using the Edmonton Assessment Scale (ESAS) and the Memorial Delirium Assessment Scale (MDAS) and evaluated the clinical utility of the Nursing Delirium Screening Scale (Nu-DESC) as scored by a caregiver as a screening tool for delirium.

Method:

We conducted a secondary analysis of the data from a previous randomized controlled trial on parenteral hydration at the end of life of patients admitted to home hospice. Only patients that had assessments within the last week of life were included. We collected the ESAS, MDAS, Nu-DESC, and Richmond Agitation Sedation Scale (RASS) results. The sensitivity and specificity of the Nu-DESC were then calculated.

Results:

Some 78 of 261 patients were included in our study, 62 (80%) of which had moderate-to-severe symptoms corresponding to an ESAS score >4. These symptoms include: 73 (94%) anorexia, 63 (81%) fatigue, 56 (73%) drowsiness, 58 (75%) decreased well-being, and 39 (51%) pain. Delirium was diagnosed in 34 (44%) of patients using the MDAS. The Nu-DESC was found to have a sensitivity of 35%, a specificity of 80%, a positive predictive value (PPV) of 58%, and an negative predictive value (NPV) of 61% when used by caregivers.

Significance of Results:

Hospice patients at the end of life have a high rate of symptom distress and delirium. The Nu-DESC is not a reliable tool for screening delirium when scoring is conducted by a caregiver. Our study illustrates the need for routine use of assessment tools to improve care.

Keywords

DeliriumAdvanced cancerSymptom distress
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 211 - 216
Copyright
Copyright © Cambridge University Press 2014 

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