Publication related to RSI or an RSI staff member
The incidence and prevalence of delirium across palliative care settings: A systematic review.
BACKGROUND: Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed. AIM: Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings. DESIGN: This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment. DATA SOURCES: Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included. RESULTS: Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer (n = 34) and mixed diagnoses (n = 8) were represented. Delirium point prevalence estimates were 4%-12% in the community, 9%-57% across hospital palliative care consultative services, and 6%-74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings (n = 8) was 42%-88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29-0.40, n = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used. CONCLUSION: Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.
Authors
- Watt, Christine L, Watt CL, 1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.; 2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.
- Momoli, Franco, Momoli F, 3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.; 4 Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.; 5 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Ansari, Mohammed T, Ansari MT, 5 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Sikora, Lindsey, Sikora L, 6 Health Sciences Library, University of Ottawa, Ottawa, ON, Canada.
- Bush, Shirley H, Bush SH, 1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.; 2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.; 3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.; 7 Bruyère Research Institute, Ottawa, ON, Canada.
- Hosie, Annmarie, Hosie A, 8 IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia.
- Kabir, Monisha, Kabir M, 7 Bruyère Research Institute, Ottawa, ON, Canada.
- Rosenberg, Erin, Rosenberg E, 9 Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.; 10 Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada.
- Kanji, Salmaan, Kanji S, 3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.; 11 Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada.; 12 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Lawlor, Peter G, Lawlor PG, 1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.; 2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.; 3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.; 7 Bruyère Research Institute, Ottawa, ON, Canada.
BACKGROUND: Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed. AIM: Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings. DESIGN: This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment. DATA SOURCES: Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included. RESULTS: Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer (n = 34) and mixed diagnoses (n = 8) were represented. Delirium point prevalence estimates were 4%-12% in the community, 9%-57% across hospital palliative care consultative services, and 6%-74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings (n = 8) was 42%-88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29-0.40, n = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used. CONCLUSION: Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.
