The clinical presentation of cognitive disorders and delirium is associated with a high level of distress in patients, family members, and health care personnel.[1,2] Delirium is associated with a high burden of symptom distress, particularly in relation to delusions, perceptual disturbances, and psychomotor agitation. Incontinence, falls, failure to maintain adequate hydration, a prolonged hospital stay, and death are more likely to occur in the patient with delirium.[3-9] Dysfunctional cognition in the delirious patient hinders communication between patient and family and between patient and health care personnel. As a result, reliable symptom assessment, counseling, and active patient participation in the therapeutic decision-making process are all compromised.[10] Psychomotor agitation and emotional lability in the delirious patient may be misinterpreted as a presentation of increased pain expression.[11] Consequently, conflict can arise among the patient, family, and staff concerning the level of analgesia needed. A potentially destructive triangle can develop when the patient’s family misinterprets agitation as increased pain and advocates for inappropriate escalation of opioid dosing.[12] A psychosocial intervention for family caregivers of patients with advanced cancer may be beneficial in providing knowledge of delirium and detection rates and in increasing family caregiver self-confidence in decision making.[13]

References

1. Breitbart W, Gibson C, Tremblay A: The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics 43 (3): 183-94, 2002 May-Jun.  [PUBMED Abstract]
   
   
2. Morita T, Hirai K, Sakaguchi Y, et al.: Family-perceived distress from delirium-related symptoms of terminally ill cancer patients. Psychosomatics 45 (2): 107-13, 2004 Mar-Apr.  [PUBMED Abstract]
   
   
3. Lawlor PG, Gagnon B, Mancini IL, et al.: Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 160 (6): 786-94, 2000.  [PUBMED Abstract]
   
   
4. Bruera E, Miller L, McCallion J, et al.: Cognitive failure in patients with terminal cancer: a prospective study. J Pain Symptom Manage 7 (4): 192-5, 1992.  [PUBMED Abstract]
   
   
5. Hogan DB: Revisiting the O complex: urinary incontinence, delirium and polypharmacy in elderly patients. CMAJ 157 (8): 1071-7, 1997.  [PUBMED Abstract]
   
   
6. O'Keeffe ST, Lavan JN: Clinical significance of delirium subtypes in older people. Age Ageing 28 (2): 115-9, 1999.  [PUBMED Abstract]
   
   
7. Lawlor PG: Delirium and dehydration: some fluid for thought? Support Care Cancer 10 (6): 445-54, 2002.  [PUBMED Abstract]
   
   
8. O'Keeffe S, Lavan J: The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc 45 (2): 174-8, 1997.  [PUBMED Abstract]
   
   
9. Caraceni A, Nanni O, Maltoni M, et al.: Impact of delirium on the short term prognosis of advanced cancer patients. Italian Multicenter Study Group on Palliative Care. Cancer 89 (5): 1145-9, 2000.  [PUBMED Abstract]
   
   
10. Lawlor PG, Fainsinger RL, Bruera ED: Delirium at the end of life: critical issues in clinical practice and research. JAMA 284 (19): 2427-9, 2000.  [PUBMED Abstract]
    
    
11. Gagnon B, Lawlor PG, Mancini IL, et al.: The impact of delirium on the circadian distribution of breakthrough analgesia in advanced cancer patients. J Pain Symptom Manage 22 (4): 826-33, 2001.  [PUBMED Abstract]
    
    
12. Fainsinger RL, Tapper M, Bruera E: A perspective on the management of delirium in terminally ill patients on a palliative care unit. J Palliat Care 9 (3): 4-8, 1993 Autumn.  [PUBMED Abstract]
    
    
13. Gagnon P, Charbonneau C, Allard P, et al.: Delirium in advanced cancer: a psychoeducational intervention for family caregivers. J Palliat Care 18 (4): 253-61, 2002 Winter.  [PUBMED Abstract]