Journal of pain and symptom management
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Delirium is a condition of acute onset and fluctuating course in which a person's level of consciousness and cognition become disturbed. Delirium is a common and distressing phenomenon in end-of-life care, yet it is underrecognized and undertreated. ⋯ We propose three themes that explain the distressing nature of delirium in palliative care: 1) experiences of relational tension; 2) challenges in recognizing the delirious person; and 3) struggles to interpret the meaning of delirious behaviors. By approaching end-of-life delirium from a perspective of relational ethics, attention is focused on the implications for the therapeutic relationship with patients and families when delirium becomes part of the dying trajectory.
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J Pain Symptom Manage · Aug 2014
ReviewTreating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development.
Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. ⋯ Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed.
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J Pain Symptom Manage · Aug 2014
ReviewEthical challenges and solutions regarding delirium studies in palliative care.
Delirium occurs commonly in settings of palliative care (PC), in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges. ⋯ Delirium research in PC patients must meet the common standards for such research in any setting. Certain features unique to PC establish a need for extra diligence in meeting these standards and the employment of assessments, consent procedures, and patient-family interactions that are clearly grounded on the tenets of PC.
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J Pain Symptom Manage · Aug 2014
ReviewDelirium diagnostic and classification challenges in palliative care: subsyndromal delirium, comorbid delirium-dementia, and psychomotor subtypes.
Delirium often presents difficult diagnostic and classification challenges in palliative care settings. ⋯ Challenges in the diagnosis and classification of delirium in people with advanced disease are compounded by the generalized disturbance of central nervous system function that occurs in the seriously ill, often with comorbid illness, including dementia. Further research is needed to delineate the pathophysiological and clinical associations of these presentations and thus inform therapeutic strategies. The expanding aged population and growing focus on dementia care in palliative care highlight the need to conduct this research.
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J Pain Symptom Manage · Aug 2014
ReviewClinical practice guidelines for delirium management: potential application in palliative care.
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. ⋯ Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.