An analytical framework for delirium research in palliative care settings: Integrated epidemiologic, clinician-researcher, and knowledge user perspectives

Lawlor, PG; Davis, DHJ; Ansari, M; Hosie, A; Kanji, S; Momoli, F; Bush, SH; Watanabe, S; Currow, DC; Gagnon, B; Agar, M; Bruera, E; Meagher, DJ; De Rooij, SEJA; Adamis, D; Caraceni, A; Marchington, K; Stewart, DJ

An analytical framework for delirium research in palliative care settings: Integrated epidemiologic, clinician-researcher, and knowledge user perspectives

Lawlor, PG Davis, DHJ Ansari, M Hosie, A

Kanji, S Momoli, F Bush, SH Watanabe, S Currow, DC

Gagnon, B Agar, M

Bruera, E Meagher, DJ De Rooij, SEJA Adamis, D Caraceni, A Marchington, K Stewart, DJ

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Publication Type:: Journal Article
Citation:: Journal of Pain and Symptom Management, 2014, 48 (2), pp. 159 - 175
Issue Date:: 2014-01-01

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Field	Value	Language
dc.contributor.author	Lawlor, PG	en_US
dc.contributor.author	Davis, DHJ	en_US
dc.contributor.author	Ansari, M	en_US
dc.contributor.author	Hosie, A https://orcid.org/0000-0003-1674-2124	en_US
dc.contributor.author	Kanji, S	en_US
dc.contributor.author	Momoli, F	en_US
dc.contributor.author	Bush, SH	en_US
dc.contributor.author	Watanabe, S	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.contributor.author	Gagnon, B	en_US
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119	en_US
dc.contributor.author	Bruera, E	en_US
dc.contributor.author	Meagher, DJ	en_US
dc.contributor.author	De Rooij, SEJA	en_US
dc.contributor.author	Adamis, D	en_US
dc.contributor.author	Caraceni, A	en_US
dc.contributor.author	Marchington, K	en_US
dc.contributor.author	Stewart, DJ	en_US
dc.date.available	2013-12-09	en_US
dc.date.issued	2014-01-01	en_US
dc.identifier.citation	Journal of Pain and Symptom Management, 2014, 48 (2), pp. 159 - 175	en_US
dc.identifier.issn	0885-3924	en_US
dc.identifier.uri	http://hdl.handle.net/10453/115548
dc.description.abstract	Context Delirium often presents difficult management challenges in the context of goals of care in palliative care settings. Objectives The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research. Methods We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions. Results Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of "very" or "extremely" important confirmed their priority. Conclusion Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings. © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.	en_US
dc.relation.ispartof	Journal of Pain and Symptom Management	en_US
dc.relation.isbasedon	10.1016/j.jpainsymman.2013.12.245	en_US
dc.subject.classification	Anesthesiology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Delirium	en_US
dc.subject.mesh	Palliative Care	en_US
dc.subject.mesh	Biomedical Research	en_US
dc.subject.mesh	Research Design	en_US
dc.subject.mesh	Critical Pathways	en_US
dc.subject.mesh	Multicenter Studies as Topic	en_US
dc.title	An analytical framework for delirium research in palliative care settings: Integrated epidemiologic, clinician-researcher, and knowledge user perspectives	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	48	en_US
utslib.for	1110 Nursing	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	48	en_US

Abstract:

Context Delirium often presents difficult management challenges in the context of goals of care in palliative care settings. Objectives The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research. Methods We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions. Results Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of "very" or "extremely" important confirmed their priority. Conclusion Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings. © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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http://hdl.handle.net/10453/115548