Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2018

Are existing delirium assessment tools appropriate for terminal delirium assessment among cancer patients? (#270)

Megumi Uchida 1 2 , Tatsuya Morita 3 , Tatsuo Akechi 1 2 , Asao Ogawa 4 , Kazuhiro Yoshiuchi 5 , Satoru Iwase 6
  1. Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Aichi, Japan
  2. Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
  3. Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, , Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
  4. Department of Psycho-Oncology Service, National Cancer Center Hospital East, kashiwa, Chiba, Japan
  5. Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyou-ku, Japan
  6. Research Hospital, The Institute of Medical Science, The University of Tokyo,, Minato-ku, Japan

Aims: The balance between agitation and communication is necessary to assess terminal delirium. The aim of this study is to evaluate if improvement of Communication Capacity Scale (CSS) item 4 (voluntary communication) and Agitation Distress Scale (ADS) item 2 (motor anxiety) is associated with improvement of existing delirium assessment tools among cancer patients of terminal delirium with strong motor anxiety and good communication ability.

Methods: All of the patients treated terminal delirium at fifteen palliative care wards or by nine consultation-liaison teams were registered via the Web. We used Richmond Agitation-Sedation Scale: RASS, Delirium Rating Scale Revised-98:DRSR-98, Nursing Delirium Screening Scale (Nu-DESC) item 2-4, CCS item4 and ADS item2 to assess delirium at T0(at registration) and T1(72 hours later).

Results: Eight hundred eighteen subjects were registered and 251 of them had motor anxiety (ADS>=2) and could communicate voluntary (CCS=0,1,2) at T0. Forty-two of them recovered (R: ADS=0, CCS=0), seventy-six partially improved (PI:ADS=1, CCS=0,1,2), fifty-two was acceptable in palliative treatment (AP:ADS<=1, CCS=3), seventy-five didn’t change (NC:ADS>=2, CCS=0,1,2) and six worsened (W:ADS=>2,CCS=3) at T1. In these groups, we investigated how the average scores of existing delirium assessment tool changed. The average total score of DRSR-98, 6 agitation items of DRSR-98, 7 cognitive items of DRSR-98, 3 items of NuDESC and RASS at To were 19.9, 9.0, 10.9, 4.3, 0.53. Average total score in R, PI, AP, NC, W group at T1 of DRSR-98, 6 agitation items of DRSR-98, 7 cognitive items of DRSR-98, 3 items of NuDESC and RASS were 5.3, 12.5, 27.1, 20.2, 17.3 and 1.7, 5.0, 6.4, 8.8, 10.3 and 3.6, 7.5, 20.9, 11.2, 17 and 0.17, 1.9, 0.21, 3.6, 4.3 and -0.26, -0.21, -3.9, 0.43, 0.83.

Conclusions: Improvement of CCS item4 and ADS item 2 was not associated with improvement of existing delirium assessment tools except for 6 agitation items of DRSR-98. It is necessary to find a balanced scale to assess terminal delirium.