A Multicomponent Nonpharmacological Intervention to Prevent Delirium for Hospitalized People with Advanced Cancer: A Phase II Cluster Randomized Waitlist Controlled Trial (The PRESERVE Pilot Study).

Annmarie Hosie, Jane Phillips, Lawrence Lam, Slavica Kochovska, Beverly Noble, Meg Brassil, Susan Kurrle, Anne Cumming, Gideon A Caplan, Richard Chye, Eugene Wesley Ely, Peter G Lawlor, Shirley H Bush, Jan Maree Davis, Melanie Lovell, Cynthia Parr, Sally Williams, Katherine Hauser, Susan McArdle, Karen Jacquier, Carl Phillipson, Lynne Kuwahata, Jackie Kerfoot, Linda Brown, Belinda Fazekas, Seong Leang Cheah, Layla Edwards, Anna Green, Jane Hunt, Robyn Attwood, Teresa Assen, Maja Garcia, Julie Wilcock, Meera Agar

Journal: Journal of palliative medicine 2021;23(10):1314-1322

PMID: 32343634

Full Text on Atypon View on PubMed

Abstract

Delirium is a common debilitating complication of advanced cancer. To determine if a multicomponent nonpharmacological delirium prevention intervention was feasible for adult patients with advanced cancer, before a phase III (efficacy) trial. Phase II (feasibility) cluster randomized controlled trial. All sites implemented delirium screening and diagnostic assessment. Strategies within sleep, vision and hearing, hydration, orientation, mobility, and family domains were delivered to enrolled patients at intervention site admission days 1-7. Control sites then implemented the intervention ("waitlist sites"). Four Australian palliative care units. The primary outcome was adherence, with an endpoint of at least 60% patients achieving full adherence. Secondary outcomes were interdisciplinary care delivery, delirium measures, and adverse events, analyzed descriptively and inferentially. Sixty-five enrolled patients (25 control, 20 intervention, and 20 waitlist) had 98% delirium screens and 75% diagnostic assessments completed. Nurses (67%), physicians (16%), allied health (8.4%), family (7%), patients (1%), and volunteers (0.5%) delivered the intervention. There was full adherence for 5% patients at intervention sites, partial for 25%. Both full and partial adherence were higher at waitlist sites: 25% and 45%, respectively. One-third of control site patients (32%) became delirious within seven days of admission compared to one-fifth (20%) at both intervention and waitlist sites ( = 0.5). Mean (standard deviation) Delirium Rating Scale-Revised-1998 scores were 16.8 + 12.0 control sites versus 18.4 + 8.2 ( = 0.6) intervention and 18.7 + 7.8 ( = 0.5) waitlist sites. The intervention caused no adverse events. The intervention requires modification for optimal adherence in a phase III trial.

Address: School of Nursing Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.; St. Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia.; IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.; IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.; Northern Clinical School, Hornsby Ku-ring-gai Health Service, University of Sydney, Hornsby, New South Wales, Australia.; Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia.; Prince of Wales Hospital, Geriatric Medicine, Randwick, New South Wales, Australia.; UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia.; St. Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia.; UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia.; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University, Nashville, Tennessee, USA.; Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA.; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.; Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; Department of Palliative Care, Bruyère Research Institute, Ottawa, Ontario, Canada.; Department of Palliative Care, Calvary Health Care Kogarah, Kogarah, New South Wales, Australia.; IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.; HammondCare, Greenwich Hospital, Greenwich, New South Wales, Australia.; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.; HammondCare, Greenwich Hospital, Greenwich, New South Wales, Australia.; The Queen Elizabeth Hospital, Woodville, South Australia, Australia.; Camden Hospital, Camden, New South Wales, Australia.; Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia.; IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.; Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia.

DOI: 10.1089/jpm.2019.0632

Link outs

Free resources

Medical:

https://medlineplus.gov/delirium.html

Subscription / membership required

Full Text Sources:

https://www.liebertpub.com/doi/10.1089/jpm.2019.06...

MeSH Terms: Adult, Australia, Delirium, Hospitalization, Humans, Neoplasms, Pilot Projects