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.