TY - JOUR
T1 - Clinical practice guidelines for delirium management
T2 - Potential application in palliative care
AU - Bush, Shirley H.
AU - Bruera, Eduardo
AU - Lawlor, Peter G.
AU - Kanji, Salmaan
AU - Davis, Daniel H.J.
AU - Agar, Meera
AU - Wright, David Kenneth
AU - Hartwick, Michael
AU - Currow, David C.
AU - Gagnon, Bruno
AU - Simon, Jessica
AU - Pereira, José L.
N1 - Funding Information:
The authors acknowledge input from the participants (listed in the Foreword to this Section) at the SUNDIPS Meeting, Ottawa, June 2012. This meeting received administrative support from Bruyère Research Institute and funding support through a joint research grant to Dr. Lawlor from the Gillin Family and Bruyère Foundation.
Funding Information:
There was no funding source or sponsorship for this article. Drs. Bush, Lawlor and Pereira receive research awards from the Department of Medicine, University of Ottawa. Dr. Bruera is supported in part by National Institutes of Health grant numbers RO1 NR010162-01A1 , RO1 CA122292-01 , and RO1 CA124481-01 , and in part by the M. D. Anderson Cancer Center support grant # CA 016672 . Dr. Davis is funded by the Wellcome Trust as a Research Training Fellow. Dr. Gagnon is the recipient of the “Chercheur-Boursier” award, from the Fonds de la recherche du Québec, Sante (FRQS). The authors have no conflicts of interest to disclose.
PY - 2014/8
Y1 - 2014/8
N2 - Context Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. Objectives This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. Methods We searched PubMed (1990-2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. Results There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from "expert opinion" for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. Conclusion Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.
AB - Context Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. Objectives This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. Methods We searched PubMed (1990-2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. Results There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from "expert opinion" for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. Conclusion Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.
KW - Delirium
KW - palliative care
KW - practice guidelines
UR - http://www.scopus.com/inward/record.url?scp=84905905788&partnerID=8YFLogxK
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U2 - 10.1016/j.jpainsymman.2013.09.023
DO - 10.1016/j.jpainsymman.2013.09.023
M3 - Article
C2 - 24766743
AN - SCOPUS:84905905788
SN - 0885-3924
VL - 48
SP - 249
EP - 258
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 2
ER -