Prevalence, detection and treatment of delirium in terminal cancer inpatients: a prospective survey

Abstract

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.