Development of Standardized Case Vignettes to Assess Palliative Care Professionals' Recognition of Delirium, Dementia, and Depression (S737)

Abstract

•Describe a systematic process used in developing standardized case vignettes of patients with delirium, dementia, and depression in the context of palliative care.•Examine palliative care professionals' recognition of delirium, dementia, and depression in patients with advanced life-limiting illnesses. Timely and accurate diagnosis of delirium in palliative care is challenging. Palliative care professionals often fail to recognize delirium because of its variable presentation and overlap with other conditions such as dementia and depression. To develop and test standardized case vignettes to assess palliative care professionals’ recognition of delirium, dementia, and depression. Case vignettes of patients experiencing hyperactive, hypoactive, and mixed delirium; dementia; hyperactive delirium superimposed on dementia (DSD); hypoactive DSD; and depression were drafted and presented to 10 delirium experts who assessed content and construct validity. Revised vignettes were then reviewed by a subset of four experts. Final vignettes were incorporated into a web-based survey and administered to an interdisciplinary panel of palliative care professionals, including physicians (n=8), nurses (n=7), and social workers (n=5). More than 70% of experts agreed that each vignette had an appropriate level of simplicity. At least 80% agreed that each was very plausible. There was more variation regarding clarity. Correct diagnostic agreement (CDA) among the experts was at least 90% for all but one vignette. In the second review, simplicity and plausibility were rated high, with 100% CDA for all but one vignette. All palliative care professionals correctly identified depression. CDA was 95% for dementia and hyperactive delirium and 90% for hypoactive delirium. CDA was lower for both hyperactive and hypoactive DSD (75%) and mixed delirium (70%). Overall, palliative care professionals accurately identified depression, dementia, and hyperactive and hypoactive delirium. They were less accurate in identifying mixed delirium and DSD.