Authors
- Thomas Fischer1,
- Meera Agar2,
- Annmarie Hosie2,
- Tim Luckett2,
- Jane Phillips2
- Evangelische Hochschule Dresden1,
- University of Technology Sydney (UTS)2
2018
Excerpt
Biography:
Professor Phillips is the Director of IMPACCT- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, and Professor of Nursing (Palliative Care) within the Faculty of Health, University of Technology Sydney. Prof Phillips has a strong interprofessional track record and extensive cancer and palliative care clinical experience, in both urban and rural Australian care settings. She has led a number of major health service reform initiatives at both the local and national level. She has developed and evaluated nurse coordinated models of palliative care and has extensive experience in cancer and chronic disease nursing, and research.
Significance
Delirium is an acute neurocognitive disorder that often occurs in palliative care patients and that is characterised by disturbances in attention, awareness and cognition. It may compromise the ability to self-report pain, arising from attentional and cognitive changes that impair memory, perception and orientation, either in the form of hyper or hypoactive delirium. The ability to report pain may fluctuate during episodes of delirium. In the literature, no consistent body of knowledge has emerged so far on pain assessment in persons with delirium.
Aims
To examine and map the range of underlying concepts of pain, instruments and strategies, that have been reported for the assessment of pain in adult patients with delirium in palliative care.
Methods
A scoping review was conducted, following the Joanna Briggs Institute’s methodology.
Findings
No evidence for the use of self-report measures of pain or behavioural pain tools in patients with delirium in palliative care was identified. Overlap between symptoms of delirium and behavioural pain signs has been marginally explored. Hierarchical concepts for pain assessments based on a combination of self-report, collateral history, physical examination and analgesic trials in patients with delirium lack testing beyond face validity. Pain assessment practices have not been adapted to account for the fluctuating nature of delirium and to hypoactive delirium. On a conceptual level pain assessment in this population has been mostly relied on measuring pain intensity while affective, cognitive and social aspects of pain in delirious patients have been neglected.
Discussion
Pain assessment in patients with delirium has not been well studied and evidence for any kind of instrument or strategy is insufficient to inform clinical practice.
Conclusion
Further research is needed to understand and put measures in place to ensure that palliative care patients with delirium have their pain assessed and addressed.
Professor Phillips is the Director of IMPACCT- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, and Professor of Nursing (Palliative Care) within the Faculty of Health, University of Technology Sydney. Prof Phillips has a strong interprofessional track record and extensive cancer and palliative care clinical experience, in both urban and rural Australian care settings. She has led a number of major health service reform initiatives at both the local and national level. She has developed and evaluated nurse coordinated models of palliative care and has extensive experience in cancer and chronic disease nursing, and research.
Significance
Delirium is an acute neurocognitive disorder that often occurs in palliative care patients and that is characterised by disturbances in attention, awareness and cognition. It may compromise the ability to self-report pain, arising from attentional and cognitive changes that impair memory, perception and orientation, either in the form of hyper or hypoactive delirium. The ability to report pain may fluctuate during episodes of delirium. In the literature, no consistent body of knowledge has emerged so far on pain assessment in persons with delirium.
Aims
To examine and map the range of underlying concepts of pain, instruments and strategies, that have been reported for the assessment of pain in adult patients with delirium in palliative care.
Methods
A scoping review was conducted, following the Joanna Briggs Institute’s methodology.
Findings
No evidence for the use of self-report measures of pain or behavioural pain tools in patients with delirium in palliative care was identified. Overlap between symptoms of delirium and behavioural pain signs has been marginally explored. Hierarchical concepts for pain assessments based on a combination of self-report, collateral history, physical examination and analgesic trials in patients with delirium lack testing beyond face validity. Pain assessment practices have not been adapted to account for the fluctuating nature of delirium and to hypoactive delirium. On a conceptual level pain assessment in this population has been mostly relied on measuring pain intensity while affective, cognitive and social aspects of pain in delirious patients have been neglected.
Discussion
Pain assessment in patients with delirium has not been well studied and evidence for any kind of instrument or strategy is insufficient to inform clinical practice.
Conclusion
Further research is needed to understand and put measures in place to ensure that palliative care patients with delirium have their pain assessed and addressed.