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Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development

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Show simple item record Bush, Shirley H. Kanji, Salmaan Pereira, José L. Davis, Daniel H.J. Currow, David C. Meagher, David Rabheru, Kiran Wright, David K. Bruera, Eduardo Hartwick, Michael Gagnon, Pierre R. Gagnon, Bruno Breitbart, William Regnier, Laura Lawlor, Peter G. 2018-11-15T16:39:13Z 2018-11-15T16:39:13Z 2014
dc.description peer-reviewed en_US
dc.description.abstract Objectives—To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods—We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results—The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion—Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed. en_US
dc.language.iso eng en_US
dc.publisher Elsevier en_US
dc.relation.ispartofseries Journal of Pain and Symtom Management;42 (2), pp. 231-248
dc.rights This is the author’s version of a work that was accepted for publication in Journal of Pain and Symtom Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Pain and Symtom Management, 2014, 42 (2), pp. 231-248, en_US
dc.subject delirium en_US
dc.subject palliative care en_US
dc.subject evidence-based medicine en_US
dc.subject therapeutics en_US
dc.subject decision making en_US
dc.subject hospices en_US
dc.title Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1016/j.jpainsymman.2013.07.018
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US

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