Improving delirium assessment, management and prevention in hospices
Research type
Research Study
Full title
The DAMPen-D study: Improving the Detection, Assessment, Management, and Prevention of Delirium in Hospices - Co-design and feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care
IRAS ID
299277
Contact name
Mark Pearson
Contact email
Sponsor organisation
University of Hull
Duration of Study in the UK
1 years, 2 months, 15 days
Research summary
"Research Summary"
It is common for people to suffer from acute confusion (delirium) towards the end of their life. People with delirium may see or hear things that aren’t there and say or do things that are out of character. This is distressing for them, their family, carers and friends. It’s important to improve how we assess, prevent, and manage delirium in hospices.Guidelines for improving delirium care have been issued by, amongst others, the National Institute for Health & Care Excellence. These guidelines clearly state the role of doctors, nurses, and other staff in assessing (using validated questions), preventing (by enabling daily activities of living and symptom management), and managing delirium (by minimising distress). However, in our national UK survey, 38% of palliative care physicians never used delirium guidelines and only 10% of hospices used a delirium screening tool.
This study addresses the guideline implementation challenge of how to bring together practical support (e.g. screening tools and clinical pathways) and communication between family, friends, volunteers, and health professionals to support hospice teams to deliver guideline-adherent delirium care in everyday practice. At three Yorkshire hospices, we will:
1. Run workshops with members of the public and hospice volunteers, staff, and management to adapt an existing implementation plan for hospices;
2. Test the potential for a future national study to see if better implemented guideline-adherent care benefits patients (reduction in delirium) by studying the feasibility of using clinical record entries to diagnose delirium, study participation, and the extent to which the implementation plan was used; and
3. Assess the acceptability and flexibility of the implementation plan in hospice volunteers, staff, and management using surveys and interviews about their experiences of implementing delirium guidelines.IN THIS APPLICATION WE PRESENT ALL WORK PACKAGES FOR CONTEXT, BUT ONLY WORK PACKAGE 2 REQUIRES COMMITTEE APPROVAL.
"Lay summary of results"
It is common for people to suffer from acute confusion (delirium) towards the end of their life. One-third of people have delirium when they are admitted to a palliative care unit or hospice and a further one-third develop delirium during their stay. People with delirium may see or hear things that aren't there, say or do things that are out of character, and can't 'think straight'. This is distressing for the person, their family, and staff. Delirium also causes unnecessary 'downward spirals' in a person's day-to-day abilities. This results in them having increased care needs in the community and unplanned and expensive hospital admissions. There is clear national guidance on the actions needed to prevent, detect, assess, and manage delirium. However, it is difficult for hospices to put this guidance into practice because delirium care is complex and involves lots of different people, including family, friends and health professionals.In this study, we developed and initially tested an implementation strategy for hospices in Hull, York and Bradford. The study had three parts:
1. Co-design - Workshops with hospice staff, volunteers, service users and carers and lay people to adapt a strategy used in acute hospitals ('Creating Learning Environments for Collaborative Care') for use in hospices to deliver delirium care - this strategy is intended to enable doctors, nurses and other staff to deliver care that incorporates the assessment, prevention, and management of delirium.
2. Feasibility - Data collection about care delivery, staff and carer participation, and clinical outcomes (in particular, number of days in which patients had delirium).
3. Process evaluation - We surveyed and interviewed staff, volunteers and managers about their experiences of using the implementation strategy.In summary, we designed a way to help hospices to overcome these difficulties (an implementation strategy) so that they can follow delirium guidelines better. We have tested this on a small scale and shown that we can collect information we need from patients' notes and hospice staff in a reliable and timely way. This means that we are now ready to run a major, national trial to test whether this improves delirium care and reduces delirium in hospices.
REC name
Wales REC 7
REC reference
21/WA/0180
Date of REC Opinion
28 May 2021
REC opinion
Favourable Opinion