Inclusion, characteristics and outcomes of people requiring palliative care in studies of non-pharmacological interventions for delirium: A systematic review

Hosie, A; Siddiqi, N; Featherstone, I; Johnson, M; Lawlor, PG; Bush, SH; Amgarth-Duff, I; Edwards, L; Cheah, SL; Phillips, J; Agar, M

Inclusion, characteristics and outcomes of people requiring palliative care in studies of non-pharmacological interventions for delirium: A systematic review

Hosie, A

Siddiqi, N Featherstone, I Johnson, M Lawlor, PG Bush, SH Amgarth-Duff, I Edwards, L Cheah, SL

Phillips, J

Agar, M

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Publication Type:: Journal Article
Citation:: Palliative Medicine, 2019, 33 (8), pp. 878 - 899
Issue Date:: 2019-09-01

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Field	Value	Language
dc.contributor.author	Hosie, A https://orcid.org/0000-0003-1674-2124	en_US
dc.contributor.author	Siddiqi, N	en_US
dc.contributor.author	Featherstone, I	en_US
dc.contributor.author	Johnson, M	en_US
dc.contributor.author	Lawlor, PG	en_US
dc.contributor.author	Bush, SH	en_US
dc.contributor.author	Amgarth-Duff, I	en_US
dc.contributor.author	Edwards, L	en_US
dc.contributor.author	Cheah, SL https://orcid.org/0000-0003-4734-5770	en_US
dc.contributor.author	Phillips, J https://orcid.org/0000-0002-3691-8230	en_US
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119	en_US
dc.date.issued	2019-09-01	en_US
dc.identifier.citation	Palliative Medicine, 2019, 33 (8), pp. 878 - 899	en_US
dc.identifier.issn	0269-2163	en_US
dc.identifier.uri	http://hdl.handle.net/10453/135472
dc.description.abstract	© The Author(s) 2019. Background: Delirium is common, distressing, serious and under-researched in specialist palliative care settings. Objectives: To examine whether people requiring palliative care were included in non-pharmacological delirium intervention studies in inpatient settings, how they were characterised and what their outcomes were. Design: Systematic review (PROSPERO 2017 CRD42017062178). Data sources: Systematic search in March 2017 for non-pharmacological delirium intervention studies in adult inpatients. Database search terms were ‘delirium’, ‘hospitalisation’, ‘inpatient’, ‘palliative care’, ‘hospice’, ‘critical care’ and ‘geriatrics’. Scottish Intercollegiate Guidelines Network methodological checklists guided risk of bias assessment. Results: The 29 included studies were conducted between 1994 and 2015 in diverse settings in 15 countries (9136 participants, mean age = 76.5 years (SD = 8.1), 56% women). Most studies tested multicomponent interventions (n = 26) to prevent delirium (n = 19). Three-quarters of the 29 included studies (n = 22) excluded various groups of people requiring palliative care; however, inclusion criteria, participant diagnoses, illness severity and mortality indicated their presence in almost all studies (n = 26). Of these, 21 studies did not characterise participants requiring palliative care or report their specific outcomes (72%), four reported outcomes for older people with frailty, dementia, cancer and comorbidities, and one was explicitly focused on people receiving palliative care. Study heterogeneity and limitations precluded definitive determination of intervention effectiveness and only allowed interpretations of feasibility for people requiring palliative care. Acceptability outcomes (intervention adverse events and patients’ subjective experience) were rarely reported overall. Conclusion: Non-pharmacological delirium interventions have frequently excluded and under-characterised people requiring palliative care and infrequently reported their outcomes.	en_US
dc.relation.ispartof	Palliative Medicine	en_US
dc.relation.isbasedon	10.1177/0269216319853487	en_US
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject.classification	Gerontology	en_US
dc.title	Inclusion, characteristics and outcomes of people requiring palliative care in studies of non-pharmacological interventions for delirium: A systematic review	en_US
dc.type	Journal Article
utslib.citation.volume	8	en_US
utslib.citation.volume	33	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1199 Other 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
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Students
utslib.copyright.status	closed_access	*
pubs.issue	8	en_US
pubs.publication-status	Published	en_US
pubs.volume	33	en_US

Abstract:

© The Author(s) 2019. Background: Delirium is common, distressing, serious and under-researched in specialist palliative care settings. Objectives: To examine whether people requiring palliative care were included in non-pharmacological delirium intervention studies in inpatient settings, how they were characterised and what their outcomes were. Design: Systematic review (PROSPERO 2017 CRD42017062178). Data sources: Systematic search in March 2017 for non-pharmacological delirium intervention studies in adult inpatients. Database search terms were ‘delirium’, ‘hospitalisation’, ‘inpatient’, ‘palliative care’, ‘hospice’, ‘critical care’ and ‘geriatrics’. Scottish Intercollegiate Guidelines Network methodological checklists guided risk of bias assessment. Results: The 29 included studies were conducted between 1994 and 2015 in diverse settings in 15 countries (9136 participants, mean age = 76.5 years (SD = 8.1), 56% women). Most studies tested multicomponent interventions (n = 26) to prevent delirium (n = 19). Three-quarters of the 29 included studies (n = 22) excluded various groups of people requiring palliative care; however, inclusion criteria, participant diagnoses, illness severity and mortality indicated their presence in almost all studies (n = 26). Of these, 21 studies did not characterise participants requiring palliative care or report their specific outcomes (72%), four reported outcomes for older people with frailty, dementia, cancer and comorbidities, and one was explicitly focused on people receiving palliative care. Study heterogeneity and limitations precluded definitive determination of intervention effectiveness and only allowed interpretations of feasibility for people requiring palliative care. Acceptability outcomes (intervention adverse events and patients’ subjective experience) were rarely reported overall. Conclusion: Non-pharmacological delirium interventions have frequently excluded and under-characterised people requiring palliative care and infrequently reported their outcomes.

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http://hdl.handle.net/10453/135472