Optimal goal of management of delirium in end-of-life cancer care.

Abstract

Delirium is a highly prevalent neuropsychiatric problem in patients with advanced cancer. Delirium that develops in the last days and hours of life is not only very common, but also distressing both for patients and their families; 1 Morita T Akechi T Ikenaga M et al. Terminal delirium: recommendations from bereaved families' experiences. J Pain Symptom Manage. 2007; 34: 579-589 Summary Full Text Full Text PDF PubMed Scopus (79) Google Scholar , 2 Breitbart W Gibson C Tremblay A The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics. 2002; 43: 183-194 Crossref PubMed Scopus (382) Google Scholar therefore, appropriate management of terminal delirium is essential. Among the various symptoms of delirium, persistent agitation or restlessness, are considered to cause the most distress to patients. Although sufficient relief from distressing symptoms is indispensable for good palliative care, patients who are terminally ill might have needs beyond just symptom management—eg, to achieve a so-called good death, clear decision-making in relation to care, adequate preparation for death, a sense of completion, a feeling of having made a contribution to others' wellbeing, and affirmation of themselves as a whole person are as important to the patient as appropriate symptom management. 3 Steinhauser KE Clipp EC McNeilly M Christakis NA McIntyre LM Tulsky JA In search of a good death: observations of patients, families, and providers. Ann Intern Med. 2000; 132: 825-832 Crossref PubMed Scopus (768) Google Scholar Therefore, in addition to the alleviation of distressing symptoms, the maintenance of mental capacity, including the ability to communicate with others—especially significant others—is therefore essential. Previous studies 4 Uchida M Morita T Ito Y Koga K Akechi T Goals of care and treatment in terminal delirium: a qualitative study of the views and experiences of healthcare professionals caring for patients with cancer. Palliat Support Care. 2019; 17: 403-408 Crossref PubMed Scopus (4) Google Scholar have shown that achieving a balance between symptom alleviation and maintenance of communication capacity is important in the goals of care and treatment in terminal delirium. Thus, medical staff should consider and balance the various aspects affecting the values and quality of life of patients with terminal illnesses when individualised optimal care is needed. Neuroleptic strategies for terminal agitation in patients with cancer and delirium at an acute palliative care unit: a single-centre, double-blind, parallel-group, randomised trialOur data provide preliminary evidence that the three strategies of neuroleptics might reduce agitation in patients with terminal agitation. These findings are in the context of the single-centre design, small sample size, and lack of a placebo-only group. Full-Text PDF