An integrative literature review exploring the clinical management of delirium in patients with advanced cancer

Abstract

Aims and objectives: To present the findings of an integrative literature review of the evidence for the clinical management of delirium in patients with advanced cancer.

Background: Patients with advanced cancer frequently experience delirium which can be distressing for both patients and their families. Current guidelines recommend that underlying causes of the delirium be addressed and a course of antipsychotics considered. However, the research into the effectiveness of treatments for delirium in people with advanced cancer is limited.

Design: Integrative literature review.

Data sources: Systematic searches of the MEDLINE, CINAHL, ProQuest Nursing and Allied Health and PsychInfo databases were conducted in April 2016 to include papers published in 2000 and later. The returns were screened using inclusion and exclusion criteria, and the seven studies found to be suitable were subject to review.

Review methods: Findings of the seven papers were extracted, appraised critically and reviewed using a narrative approach.

Results: A number of interventions, including the use of atypical antipsychotics, opioid rotation, methylphenidate hydrochloride and coeliac plexus block, were reported; however, there was limited evidence of their effectiveness. One study reported the use of exercise therapy as a nonpharmacological intervention.

Conclusion: A variety of interventions to treat delirium in patients with advanced cancer have been tested through nonblinded, nonrandomised trials which have not produced a clear evidence base for practice.

Relevance to clinical practice: The clinical management of delirium in patients with advanced cancer is poorly understood and remains a clinical issue which requires further research (particularity randomized control trials) in order to determine more effective treatments and management strategies.

Keywords: advanced cancer; delirium; end of life; literature review; management; neoplasm; nursing; palliative care.