Although delirium is a common complication in terminally ill cancer patients and can cause considerable distress for family members, little is known about effective care strategies for terminal delirium. The primary aims of this study were 1) to clarify the distress levels of bereaved families and their perceived necessity of care; and 2) to explore the association between these levels and family-reported professional care practice, family-reported patient behavior, and their interpretation of the causes of delirium. A multicenter questionnaire survey was conducted on 560 bereaved family members of cancer patients who developed delirium during their final two weeks in eight certified palliative care units across Japan. We obtained 402 effective responses (response rate, 72%) and, as 160 families denied delirium episodes, 242 responses were analyzed. The bereaved family members reported that they were very distressed (32%) and distressed (22%) about the experience of terminal delirium. On the other hand, 5.8% reported that considerable or much improvement was necessary, and 31% reported some improvement was necessary in the professional care they had received. More than half of the respondents had ambivalent wishes, guilt and self-blame, and worries about staying with the patient. One-fourth to one-third reported that they felt a burden concerning proxy judgments, burden to others, acceptance, and helplessness. High-level emotional distress and family-perceived necessity of improvement were associated with a younger family age; male gender; their experience of agitation and incoherent speech; their interpretation of the causes of delirium as pain/physical discomfort, medication effects, or mental weakness/death anxiety; and their perception that medical staff were not present with the family, not respecting the patient's subjective world, not explaining the expected course with daily changes, and not relieving family care burden. In terminal delirium, a considerable number of families experienced high levels of emotional distress and felt some need for improvement of the specialized palliative care service. Control of agitation symptoms with careful consideration of ambivalent family wishes, providing information about the pathology of delirium, being present with the family, respecting the patient's subjective world, explaining the expected course with daily changes, and relieving family care burden can be useful care strategies.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2007.01.012DOI Listing

Publication Analysis

Top Keywords

terminal delirium
16
family members
12
delirium
9
family
9
care
9
cancer patients
8
care strategies
8
professional care
8
interpretation delirium
8
bereaved family
8

Similar Publications

Background: Research on achieving a good death for terminally delirious patients is scarce, with limited knowledge about the level of good death and influencing factors. This study investigates the level of good death among delirium patients, factors influencing it, and the correlation between distress, end-of-life care needs, and achieving a good death by surveying bereaved family members of deceased patients in Chinese hospitals.

Methods: This cross-sectional study from January 2022 to January 2024 was conducted among bereaved family members of patients using an online questionnaire.

View Article and Find Full Text PDF

Background: Delirium is a condition characterized by an acute and transient disturbance in attention, cognition, and consciousness. It is increasingly prevalent at the end of life in patients with cancer. While non-pharmacological nursing interventions are essential for delirium prevention, their effectiveness in terminally ill patients with cancer remains unclear.

View Article and Find Full Text PDF

Background: Palliative Sedation (PS) at the end of life is practiced and perceived differently by health professionals depending on the geographical location in which they provide their health care. Taking into account this heterogeneity, it is necessary to expand knowledge and provide data on this clinical practice in different contexts and countries. On the other hand, the identification of factors associated with PS could help healthcare professionals, at an early stage, to identify patients more likely to require sedation.

View Article and Find Full Text PDF
Article Synopsis
  • Inpatient hospices (IHs) showed potential to reduce distress and financial burden for terminal lung cancer patients, but findings on cost savings and medication use were inconsistent.
  • A study analyzed data from 31,139 Korean patients who died between 2017 and 2020, focusing on hospitalization costs and medication use depending on the timing of their first hospitalization before death.
  • Results indicated that IHs had lower costs during the final 30 days of life but no difference in total costs for the year before death, and they prescribed significantly more opioid analgesics and other symptom-oriented medications compared to non-IHs.
View Article and Find Full Text PDF
Article Synopsis
  • The study investigates the frequency and complications of falls in palliative care units (PCUs) for advanced cancer patients and how these relate to independence and quality of dying.
  • Among 1,633 patients observed, 150 (9.2%) experienced falls in the last month of life, primarily due to needing to use the toilet, with serious injuries being very rare.
  • The findings suggest that while falls can be common, they are not necessarily harmful and may reflect a patient's independence, indicating that healthcare providers should balance fall prevention with supporting patient autonomy.
View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!