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, 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.