Ryan K, Leonard M, Guerin S, Donnelly S, Conroy M, Meagher D
Department of Palliative Medicine, Mater Misericordiae University Hospital, Connolly Hospital Blanchardstown and St Francis Hospice, Raheny, Dublin.
Palliat Med. 2009 Jan;23(1):40-5. doi: 10.1177/0269216308099210. Epub 2008 Nov 14.
The Confusion Assessment Method (CAM) is widely used in the palliative care setting despite the fact that its performance in this population has not been validated. The aim of the study was to determine the sensitivity and specificity of the CAM when used by Non-Consultant Hospital Doctors (NCHDs) working in a specialist palliative care unit. A pilot phase was performed in which NCHDs received a 1-hour training session based on the original CAM training manual. 32 patients underwent 33 assessments in the pilot phase but the sensitivity of the CAM was only 0.5 (0.22-0.78) and specificity was 1.0 (0.81-1.0). An 'enhanced' training programme was devised that took place over two 1-hour sessions and involved case-based learning focused on the areas where the NCHDs were experiencing difficulty. 52 patients underwent 54 assessments in the main phase of the study and the performance of the CAM improved significantly. Sensitivity was 0.88 (0.62-0.98) and specificity was 1.0 (0.88-1.0). The results suggest that the CAM is a valid screening tool for delirium in the palliative care setting but its performance is dependent on the skill of the operator. NCHDs require a certain standard of training before becoming proficient in its use.
混乱评估方法（CAM）在姑息治疗环境中被广泛使用，尽管其在该人群中的表现尚未得到验证。本研究的目的是确定在专科姑息治疗病房工作的非顾问医院医生（NCHDs）使用CAM时的敏感性和特异性。进行了一个试点阶段，在此阶段NCHDs根据原始的CAM培训手册接受了1小时的培训课程。在试点阶段，32名患者接受了33次评估，但CAM的敏感性仅为0.5（0.22 - 0.78），特异性为1.0（0.81 - 1.0）。设计了一个“强化”培训计划，该计划分两个1小时的课程进行，包括基于案例的学习，重点关注NCHDs遇到困难的领域。在研究的主要阶段，52名患者接受了54次评估，CAM的表现有了显著改善。敏感性为0.88（0.62 - 0.98），特异性为1.0（0.88 - 1.0）。结果表明，CAM是姑息治疗环境中谵妄的有效筛查工具，但其表现取决于操作者的技能。NCHDs在熟练使用它之前需要一定标准的培训。
