Clinicians' delirium treatment practice, practice change, and influences: A national online survey.

Hosie, A; Agar, M; Caplan, GA; Draper, B; Hedger, S; Rowett, D; Tuffin, P; Cheah, SL; Phillips, JL; Brown, L; Sidhu, M; Currow, DC

Clinicians' delirium treatment practice, practice change, and influences: A national online survey.

Hosie, A

Agar, M

Caplan, GA Draper, B Hedger, S Rowett, D Tuffin, P Cheah, SL Phillips, JL Brown, L Sidhu, M Currow, DC

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Publisher:: SAGE PUBLICATIONS LTD
Publication Type:: Journal Article
Citation:: Palliative medicine, 2021, pp. 2692163211022183
Issue Date:: 2021-06-06

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Field	Value	Language
dc.contributor.author	Hosie, A https://orcid.org/0000-0003-1674-2124
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119
dc.contributor.author	Caplan, GA
dc.contributor.author	Draper, B
dc.contributor.author	Hedger, S
dc.contributor.author	Rowett, D
dc.contributor.author	Tuffin, P
dc.contributor.author	Cheah, SL
dc.contributor.author	Phillips, JL
dc.contributor.author	Brown, L
dc.contributor.author	Sidhu, M
dc.contributor.author	Currow, DC
dc.date.accessioned	2021-09-14T01:15:57Z
dc.date.available	2021-09-14T01:15:57Z
dc.date.issued	2021-06-06
dc.identifier.citation	Palliative medicine, 2021, pp. 2692163211022183
dc.identifier.issn	0269-2163
dc.identifier.issn	1477-030X
dc.identifier.uri	http://hdl.handle.net/10453/150521
dc.description.abstract	<h4>Background</h4>Recent studies cast doubt on the net effect of antipsychotics for delirium.<h4>Aim</h4>To investigate the influence of these studies and other factors on clinicians' delirium treatment practice and practice change in palliative care and other specialties using the Theoretical Domains Framework.<h4>Design</h4>Australia-wide online survey of relevant clinicians.<h4>Setting/participants</h4>Registered nurses (72%), doctors (16%), nurse practitioners (6%) and pharmacists (5%) who cared for patients with delirium in diverse settings, recruited through health professionals' organisations.<h4>Results</h4>Most of the sample (<i>n</i> = 475): worked in geriatrics/aged (31%) or palliative care (30%); in hospitals (64%); and saw a new patient with delirium at least weekly (61%). More (59%) reported delirium practice change since 2016, mostly by increased non-pharmacological interventions (53%). Fifty-five percent reported current antipsychotic use for delirium, primarily for patient distress (79%) and unsafe behaviour (67%). Common Theoretical Domains Framework categories of influences on respondents' delirium practice were: emotion (54%); knowledge (53%) and physical (43%) and social (21%) opportunities. Palliative care respondents more often reported: awareness of any named key study of antipsychotics for delirium (73% vs 39%, <i>p</i> < 0.001); changed delirium treatment (73% vs 53%, <i>p</i> = 0.017); decreased pharmacological interventions (60% vs 15%, <i>p</i> < 0.001); off-label medication use (86% vs 51%, <i>p</i> < 0.001: antipsychotics 79% vs 44%, <i>p</i> < 0.001; benzodiazepines 61% vs 26%, <i>p</i> < 0.001) and emotion as an influence (82% vs 39%, <i>p</i> < 0.001).<h4>Conclusion</h4>Clinicians' use of antipsychotic during delirium remains common and is primarily motivated by distress and safety concerns for the patient and others nearby. Supporting clinicians to achieve evidence-based delirium practice requires further work.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SAGE PUBLICATIONS LTD
dc.relation.ispartof	Palliative medicine
dc.relation.isbasedon	10.1177/02692163211022183
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	Gerontology
dc.title	Clinicians' delirium treatment practice, practice change, and influences: A national online survey.
dc.type	Journal Article
utslib.location.activity	England
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
utslib.copyright.status	closed_access	*
dc.date.updated	2021-09-14T01:15:56Z
pubs.publication-status	Published

Abstract:

Background

Recent studies cast doubt on the net effect of antipsychotics for delirium.

Aim

To investigate the influence of these studies and other factors on clinicians' delirium treatment practice and practice change in palliative care and other specialties using the Theoretical Domains Framework.

Design

Australia-wide online survey of relevant clinicians.

Setting/participants

Registered nurses (72%), doctors (16%), nurse practitioners (6%) and pharmacists (5%) who cared for patients with delirium in diverse settings, recruited through health professionals' organisations.

Results

Most of the sample (n = 475): worked in geriatrics/aged (31%) or palliative care (30%); in hospitals (64%); and saw a new patient with delirium at least weekly (61%). More (59%) reported delirium practice change since 2016, mostly by increased non-pharmacological interventions (53%). Fifty-five percent reported current antipsychotic use for delirium, primarily for patient distress (79%) and unsafe behaviour (67%). Common Theoretical Domains Framework categories of influences on respondents' delirium practice were: emotion (54%); knowledge (53%) and physical (43%) and social (21%) opportunities. Palliative care respondents more often reported: awareness of any named key study of antipsychotics for delirium (73% vs 39%, p < 0.001); changed delirium treatment (73% vs 53%, p = 0.017); decreased pharmacological interventions (60% vs 15%, p < 0.001); off-label medication use (86% vs 51%, p < 0.001: antipsychotics 79% vs 44%, p < 0.001; benzodiazepines 61% vs 26%, p < 0.001) and emotion as an influence (82% vs 39%, p < 0.001).

Conclusion

Clinicians' use of antipsychotic during delirium remains common and is primarily motivated by distress and safety concerns for the patient and others nearby. Supporting clinicians to achieve evidence-based delirium practice requires further work.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/150521