e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

The degree of coincidence between medical staffs and bereaved families regarding the presence or absence of terminal delirium, and its related factors (#390)

Megumi Uchida 1 2 , Tasuo Akechi 1 2 , Tatsuya Morita 3 , Kento Masukawa 4 , Yoshiyuki Kizawa 5 , Satoru Tsuneto 6 , Yasuo Shima 7 , Masaki Mori 3 , Mitsunori Miyashita 4
  1. Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Aichi, Japan
  2. Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
  3. Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
  4. Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
  5. Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
  6. Department of Human Health Sciences,, Kyoto University Graduate School of Medicine, Kyoto, Japan
  7. Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaragi, Japan

Aims:

The aims of this study are to investigate the degree of coincidence between  medical staffs and bereaved families regarding the presence or absence of terminal delirium in cancer patients admitted to palliative care units and to examine the related factors when both matched.

 

Methods:

We continuously sampled end-of-life cancer patients admitted to the palliative care units. The medical staffs were asked at the time of patients’ death if they explained about terminal delirium and if their patient had terminal delirium. At a later date, the bereaved family answered the questionnaire by mail which asked their background, mental and physical condition and distress by end-of-life delirium.

 

Results,

Responses were received from both medical staffs and bereaved families in 676 (78%). Medical staffsevaluated 316 patients and bereaved families 362 as having terminal delirium. The degree of coincidence between medical staff and bereaved family regarding the presence or absence of end-of-life delirium was κ = -0.066. In multivariate analysis (logistic regression analysis), the family was ready for the patient's death (β = 1.12, odds ratio = 3.06, 95% CI = 1.39-6.72), patients had psychomotor agitation due to end-of-life delirium. (β= -0.64, odds ratio = 0.53, 95% CI = 0.29-0.97), and the medical staff explained delirium was a disturbance of consciousness (β = 2.62, odds ratio = 13.8, 95 % CI = 6.06-31.2) was significantly associated with the degree of coincidence between bereaved family and medical staff regarding the presence or absence of terminal delirium.

 

Conclusions. 

The bereaved family and medical staff did not agree on the presence or absence of end-of-life delirium. It is suggested family may be able to get more recognition of delirium and reduce their distress by it if medical staffs encourage families to prepare for patient’s death and explain delirium is a disturbance of consciousness to family.