A Scoping Review to Map Empirical Evidence Regarding Key Domains and Questions in the Clinical Pathway of Delirium in Palliative Care

Lawlor, PG; Rutkowski, NA; MacDonald, AR; Ansari, MT; Sikora, L; Momoli, F; Kanji, S; Wright, DK; Rosenberg, E; Hosie, A; Pereira, JL; Meagher, D; Rice, J; Scott, J; Bush, SH

A Scoping Review to Map Empirical Evidence Regarding Key Domains and Questions in the Clinical Pathway of Delirium in Palliative Care

Lawlor, PG Rutkowski, NA MacDonald, AR Ansari, MT Sikora, L Momoli, F Kanji, S Wright, DK Rosenberg, E Hosie, A

Pereira, JL Meagher, D Rice, J Scott, J Bush, SH

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Publication Type:: Journal Article
Citation:: Journal of Pain and Symptom Management, 2019, 57 (3), pp. 661 - 681.e12
Issue Date:: 2019-03-01

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Field	Value	Language
dc.contributor.author	Lawlor, PG	en_US
dc.contributor.author	Rutkowski, NA	en_US
dc.contributor.author	MacDonald, AR	en_US
dc.contributor.author	Ansari, MT	en_US
dc.contributor.author	Sikora, L	en_US
dc.contributor.author	Momoli, F	en_US
dc.contributor.author	Kanji, S	en_US
dc.contributor.author	Wright, DK	en_US
dc.contributor.author	Rosenberg, E	en_US
dc.contributor.author	Hosie, A https://orcid.org/0000-0003-1674-2124	en_US
dc.contributor.author	Pereira, JL	en_US
dc.contributor.author	Meagher, D	en_US
dc.contributor.author	Rice, J	en_US
dc.contributor.author	Scott, J	en_US
dc.contributor.author	Bush, SH	en_US
dc.date.available	2020-05-25T19:09:46Z
dc.date.issued	2019-03-01	en_US
dc.identifier.citation	Journal of Pain and Symptom Management, 2019, 57 (3), pp. 661 - 681.e12	en_US
dc.identifier.issn	0885-3924	en_US
dc.identifier.uri	http://hdl.handle.net/10453/134054
dc.description.abstract	© 2018 The Authors Context: Based on the clinical care pathway of delirium in palliative care (PC), a published analytic framework (AF) formulated research questions in key domains and recommended a scoping review to identify evidence gaps. Objectives: To produce a literature map for key domains of the published AF: screening, prognosis and diagnosis, management, and the health-related outcomes. Methods: A standard scoping review framework was used by an interdisciplinary study team of nurse- and physician-delirium researchers, an information specialist, and review methodologists to conduct the review. Knowledge user engagement provided context in refining 19 AF questions. A peer-reviewed search strategy identified citations in Medline, PsycINFO, Embase, and CINAHL databases between 1980 and 2018. Two reviewers independently screened records for inclusion using explicit study eligibility criteria for the population, design, delirium diagnosis, and investigational intent. Results: Of 104 studies reporting empirical data and meeting eligibility criteria, most were conducted in patients with cancer (73.1%) and in inpatient PC units (52%). The most frequent study design was a one or more group, nonrandomized trial or cohort (67.3%). Evidence gaps were identified: delirium risk prediction; comparative effectiveness and harms of prevention, variability in delirium management across PC settings, advanced directive and substitute decision-maker input, and transition of care location; and estimating delirium reversibility. Future rigorous primary studies are required to address these gaps and preliminary concerns regarding the quality of extant literature. Conclusion: Substantial evidence gaps exist, providing opportunities for future research regarding the assessment, prognosis, and management of delirium in PC settings.	en_US
dc.relation.ispartof	Journal of Pain and Symptom Management	en_US
dc.relation.isbasedon	10.1016/j.jpainsymman.2018.12.002	en_US
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	Anesthesiology	en_US
dc.subject.mesh	Critical Pathways	en_US
dc.subject.mesh	Delirium	en_US
dc.subject.mesh	Delivery of Health Care	en_US
dc.subject.mesh	Hospice and Palliative Care Nursing	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Palliative Care	en_US
dc.title	A Scoping Review to Map Empirical Evidence Regarding Key Domains and Questions in the Clinical Pathway of Delirium in Palliative Care	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	57	en_US
utslib.for	1117 Public Health and Health Services	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	open_access	*
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	57	en_US

Abstract:

© 2018 The Authors Context: Based on the clinical care pathway of delirium in palliative care (PC), a published analytic framework (AF) formulated research questions in key domains and recommended a scoping review to identify evidence gaps. Objectives: To produce a literature map for key domains of the published AF: screening, prognosis and diagnosis, management, and the health-related outcomes. Methods: A standard scoping review framework was used by an interdisciplinary study team of nurse- and physician-delirium researchers, an information specialist, and review methodologists to conduct the review. Knowledge user engagement provided context in refining 19 AF questions. A peer-reviewed search strategy identified citations in Medline, PsycINFO, Embase, and CINAHL databases between 1980 and 2018. Two reviewers independently screened records for inclusion using explicit study eligibility criteria for the population, design, delirium diagnosis, and investigational intent. Results: Of 104 studies reporting empirical data and meeting eligibility criteria, most were conducted in patients with cancer (73.1%) and in inpatient PC units (52%). The most frequent study design was a one or more group, nonrandomized trial or cohort (67.3%). Evidence gaps were identified: delirium risk prediction; comparative effectiveness and harms of prevention, variability in delirium management across PC settings, advanced directive and substitute decision-maker input, and transition of care location; and estimating delirium reversibility. Future rigorous primary studies are required to address these gaps and preliminary concerns regarding the quality of extant literature. Conclusion: Substantial evidence gaps exist, providing opportunities for future research regarding the assessment, prognosis, and management of delirium in PC settings.

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http://hdl.handle.net/10453/134054