Japanese Journal of Clinical Oncology Advance Access originally published online on January 31, 2008
Japanese Journal of Clinical Oncology 2008 38(1):56-63; doi:10.1093/jjco/hym155
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© The Authors (2008). Published by Oxford University Press. All rights reserved
Prevalence, Detection and Treatment of Delirium in Terminal Cancer Inpatients: A Prospective Survey
1 Department of Psychiatry and Center of Suicide Prevention, Mackay Memorial Hospital, Taipei, Taiwan
2 Department of Nursing, Mackay Medicine, Nursing, and Management College, Taipei, Taiwan
3 Hospice and Palliative Care Center, Mackay Memorial Hospital, Taipei, Taiwan
4 Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan
5 Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
6 Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan
7 Center for General Education, National Yang-Ming University, Taipei, Taiwan
For reprints and all correspondence: Yuen-Liang Lai, Hospice and Palliative Care Center, Mackay Memorial Hospital, 45 Minsheng Road, Damshui 251, Taipei County, Taiwan. E-mail: enochlai49{at}yahoo.com
Received April 2, 2007; accepted October 12, 2007
Background: Delirium is a common syndrome in terminal cancer patients. However, its detection and treatment by palliative care teams are not well documented. This survey aimed to determine the prevalence, detection and treatment of delirium in terminal cancer inpatients.
Methods: The survey was conducted in Mackay Hospice and Palliative Care Center, Taiwan, from August 2006 to January 2007. All terminal cancer inpatients were invited to participate. The Delirium Rating Scale-Chinese Version was used by a research assistant as the screening instrument. Patients detected by screening were reviewed by psychiatrists to verify the diagnosis and determine the sub-type of delirium. The palliative care team members were asked to evaluate all the participants weekly. The medications used for delirium were obtained by a medical chart review.
Result: Two hundred and twenty eight participants (49.9%) among 457 inpatients were screened. The prevalence of delirium was 46.9% (n = 107). Of these, the most common subtype was hypoactive (68.2%, 95% confidence interval (CI): 59.4–77.0%). The mortality rate of inpatients with delirium (77.6%, 95% CI: 69.7–85.5%) was higher (P < 0.0001) than those without delirium (50.9%, 95% CI: 44.4–57.4%). The overall detection rate by any member of the palliative team was 44.9% (n = 48) (95% CI: 35.5–54.3%). The detection rate of the hypoactive subtype was only 20.5% (95% CI: 11.2–29.8%), which was significantly lower than that of the hyperactive/mixed subtypes (P < 0.0001). Therapy for delirium was prescribed in 42.1% (n = 45) (95% CI: 32.7–51.5%) with haloperidol being the most common medication.
Conclusion: The prevalence of delirium was high, but the rates of detection and treatment were low. Interventions are recommended to improve the diagnosis and treatment of delirium in palliative care units.
Key Words: delirium • terminal cancer inpatient • prevalence • detection • treatment