Open AccessThe experience of delirium in palliative care settings for patients, family, clinicians and volunteers: A qualitative systematic review and thematic synthesis
Author(s) -
Imogen Featherstone,
Annmarie Hosie,
Najma Siddiqi,
Pamela Grassau,
Shirley H. Bush,
Johanna Taylor,
Trevor Sheldon,
Miriam Johnson
Publication year - 2021
Publication title -
palliative medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.989
H-Index - 106
eISSN - 1477-030X
pISSN - 0269-2163
DOI - 10.1177/02692163211006313
Subject(s) - delirium , cinahl , medicine , palliative care , psycinfo , medline , critical appraisal , systematic review , thematic analysis , psychological intervention , qualitative research , distress , nursing , cochrane library , family medicine , psychiatry , intensive care medicine , alternative medicine , clinical psychology , social science , pathology , sociology , political science , law
Background: Delirium is common in palliative care settings and is distressing for patients, their families and clinicians. To develop effective interventions, we need first to understand current delirium care in this setting.Aim: To understand patient, family, clinicians’ and volunteers’ experience of delirium and its care in palliative care contexts.Design: Qualitative systematic review and thematic synthesis (PROSPERO 2018 CRD42018102417).Data sources: The following databases were searched: CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Embase, MEDLINE and PsycINFO (2000–2020) for qualitative studies exploring experiences of delirium or its care in specialist palliative care services. Study selection and quality appraisal were independently conducted by two reviewers.Results: A total of 21 papers describing 16 studies were included. In quality appraisal, trustworthiness (rigour of methods used) was assessed as high ( n = 5), medium ( n = 8) or low ( n = 3). Three major themes were identified: interpretations of delirium and their influence on care; clinicians’ responses to the suffering of patients with delirium and the roles of the family in delirium care. Nursing staff and other clinicians had limited understanding of delirium as a medical condition with potentially modifiable causes. Practice focused on alleviating patient suffering through person-centred approaches, which could be challenging with delirious patients, and medication use. Treatment decisions were also influenced by the distress of family and clinicians and resource limitations. Family played vital roles in delirium care.Conclusions: Increased understanding of non-pharmacological approaches to delirium prevention and management, as well as support for clinicians and families, are important to enable patients’ multi-dimensional needs to be met.