Use of an expert panel to identify domains and indicators of delirium severity

doi:10.1007/s11136-019-02201-0

Observational Study

. 2019 Sep;28(9):2565-2578.

doi: 10.1007/s11136-019-02201-0. Epub 2019 May 17.

Use of an expert panel to identify domains and indicators of delirium severity

Dena Schulman-Green¹, Eva M Schmitt², Tamara G Fong^{2

3

4}, Sarinnapha M Vasunilashorn^{3

4}, Jacqueline Gallagher⁴, Edward R Marcantonio^{3

4}, Charles H Brown 4th⁵, Diane Clark⁶, Joseph H Flaherty⁷, Anne Gleason², Sharon Gordon⁸, Ann M Kolanowski⁹, Karin J Neufeld⁵, Margaret O'Connor¹⁰, Margaret A Pisani¹¹, Thomas N Robinson¹², Joe Verghese¹³, Heidi L Wald¹², Richard N Jones¹⁴, Sharon K Inouye^{2

3

4}; BASIL Study Group

Collaborators, Affiliations

Collaborators

Affiliations

¹ Yale School of Nursing, P.O. Box 27399, West Haven, CT, 06516, USA. dena.schulman-green@yale.edu.
² Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
³ Harvard Medical School, Boston, MA, USA.
⁴ Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁵ School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁶ Dept. of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Envision-Questcare Physician Services, Dallas, TX, USA.
⁸ VA Tennessee Valley Healthcare System, Nashville, TN, USA.
⁹ College of Nursing, Pennsylvania State University, University Park, PA, USA.
¹⁰ Brigham and Women's Hospital, Boston, MA, USA.
¹¹ School of Medicine, Yale University, New Haven, CT, USA.
¹² School of Medicine, University of Colorado, Denver, CO, USA.
¹³ Albert Einstein College of Medicine, Bronx, NY, USA.
¹⁴ Warren Alpert Medical School, Brown University, Providence, RI, USA.

PMID: 31102155
PMCID: PMC6858057
DOI: 10.1007/s11136-019-02201-0

Observational Study

Use of an expert panel to identify domains and indicators of delirium severity

Dena Schulman-Green et al. Qual Life Res. 2019 Sep.

. 2019 Sep;28(9):2565-2578.

doi: 10.1007/s11136-019-02201-0. Epub 2019 May 17.

Authors

Collaborators

Affiliations

¹ Yale School of Nursing, P.O. Box 27399, West Haven, CT, 06516, USA. dena.schulman-green@yale.edu.
² Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
³ Harvard Medical School, Boston, MA, USA.
⁴ Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁵ School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁶ Dept. of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Envision-Questcare Physician Services, Dallas, TX, USA.
⁸ VA Tennessee Valley Healthcare System, Nashville, TN, USA.
⁹ College of Nursing, Pennsylvania State University, University Park, PA, USA.
¹⁰ Brigham and Women's Hospital, Boston, MA, USA.
¹¹ School of Medicine, Yale University, New Haven, CT, USA.
¹² School of Medicine, University of Colorado, Denver, CO, USA.
¹³ Albert Einstein College of Medicine, Bronx, NY, USA.
¹⁴ Warren Alpert Medical School, Brown University, Providence, RI, USA.

PMID: 31102155
PMCID: PMC6858057
DOI: 10.1007/s11136-019-02201-0

Abstract

Purpose: Our purpose was to create a content domain framework for delirium severity to inform item development for a new instrument to measure delirium severity.

Methods: We used an established, multi-stage instrument development process during which expert panelists discussed best approaches to measure delirium severity and identified related content domains. We conducted this work as part of the Better ASsessment of ILlness (BASIL) study, a prospective, observational study aimed at developing and testing measures of delirium severity. Our interdisciplinary expert panel consisted of twelve national delirium experts and four expert members of the core research group. Over a one-month period, experts participated in two rounds of review.

Results: Experts recommended that the construct of delirium severity should reflect both the phenomena and the impact of delirium to create an accurate, patient-centered instrument useful to interdisciplinary clinicians and family caregivers. Final content domains were Cognitive, Level of consciousness, Inattention, Psychiatric-Behavioral, Emotional dysregulation, Psychomotor features, and Functional. Themes debated by experts included reconciling clinical geriatrics and psychiatric content, mapping symptoms to one specific domain, and accurate capture of unclear clinical presentations.

Conclusions: We believe this work represents the first application of instrument development science to delirium. The identified content domains are inclusive of various, wide-ranging domains of delirium severity and are reflective of a consistent framework that relates delirium severity to potential clinical outcomes. Our content domain framework provides a foundation for development of delirium severity instruments that can help improve care and quality of life for patients with delirium.

Keywords: Delirium; Expert panel; Instrument development; Severity.

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Conflict of interest statement

Conflict of Interest

CHB discloses consultation and a data share with Medtronic. DC discloses receiving honoraria from the Commission on Accreditation in Physical Therapy Education. DSG declares that she has no conflict of interest. EMS declares that she has no conflict of interest. TGF declares that she has no conflict of interest. SMV declares that she has no conflict of interest. ERM declares that he has no conflict of interest. JHF declares that he has no conflict of interest. AG declares that she has no conflict of interest. SG declares that she has no conflict of interest. AMK declares that she has no conflict of interest. KJN declares that she has no conflict of interest. MO declares that she has no conflict of interest. MAP declares that she has no conflict of interest. TNR declares that he has no conflict of interest. JV declares that he has no conflict of interest. HLW declares that she has no conflict of interest. RNJ declares that he has no conflict of interest. SKI declares that she has no conflict of interest.

Figures

**Figure 1.**
Delirium Severity Content Domains

See this image and copyright information in PMC

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References

1. Flaherty JH, Morley JE (2013). Delirium in the Nursing Home; Journal of the American Medical Directors Association. 14, 632–634. - PubMed
1. Inouye SK, Westendorp RG, Saczynski JS (2014). Delirium in elderly people. Lancet. 383, 911–22. - PMC - PubMed
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[1] Flaherty JH, Morley JE (2013). Delirium in the Nursing Home; Journal of the American Medical Directors Association. 14, 632–634. - PubMed

[2] Flaherty JH, Morley JE (2013). Delirium in the Nursing Home; Journal of the American Medical Directors Association. 14, 632–634. - PubMed

[3] Inouye SK, Westendorp RG, Saczynski JS (2014). Delirium in elderly people. Lancet. 383, 911–22. - PMC - PubMed

[4] Inouye SK, Westendorp RG, Saczynski JS (2014). Delirium in elderly people. Lancet. 383, 911–22. - PMC - PubMed

[5] Rudolph JL, Jones RN, Inouye SK, Shi P, Marcantonio ER (2009). Delirium and functional decline after cardiac surgery. Journal of the American Geriatrics Society. 57, S111. - PMC - PubMed

[6] Rudolph JL, Jones RN, Inouye SK, Shi P, Marcantonio ER (2009). Delirium and functional decline after cardiac surgery. Journal of the American Geriatrics Society. 57, S111. - PMC - PubMed

[7] Dharmarajan K, Swami S, Gou RY, Jones RN, Inouye SK (2017). Pathway from delirium to death: Potential in-hospital mediators of excess mortality. Journal of the American Geriatrics Society. 65, 1026–1033. - PMC - PubMed

[8] Dharmarajan K, Swami S, Gou RY, Jones RN, Inouye SK (2017). Pathway from delirium to death: Potential in-hospital mediators of excess mortality. Journal of the American Geriatrics Society. 65, 1026–1033. - PMC - PubMed

[9] Oh ES, Fong TG, Hshieh TT, Inouye SK (2017). Delirium in older persons: Advances in diagnosis and treatment. Journal of the American Medical Association. 318, 1161–1174. - PMC - PubMed

[10] Oh ES, Fong TG, Hshieh TT, Inouye SK (2017). Delirium in older persons: Advances in diagnosis and treatment. Journal of the American Medical Association. 318, 1161–1174. - PMC - PubMed

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Use of an expert panel to identify domains and indicators of delirium severity

Collaborators

Affiliations

Use of an expert panel to identify domains and indicators of delirium severity

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

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