Lawlor Peter G, Davis Daniel H J, Ansari Mohammed, Hosie Annmarie, Kanji Salmaan, Momoli Franco, Bush Shirley H, Watanabe Sharon, Currow David C, Gagnon Bruno, Agar Meera, Bruera Eduardo, Meagher David J, de Rooij Sophia E J A, Adamis Dimitrios, Caraceni Augusto, Marchington Katie, Stewart David J
Division of Palliative Care (P.G.L.), Department of Medicine, Epidemiology and Community Medicine, University of Ottawa; Bruyère Research Institute (P.G.L., S.H.B.), Bruyère Continuing Care; The Ottawa Hospital Research Institute (P.G.L., S.K.), Ottawa, Ontario, Canada; Institute of Public Health (D.H.J.D.), University of Cambridge, Cambridge, United Kingdom; Knowledge Synthesis Group (M.An.), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Faculty of Nursing (A.H.), University of Notre Dame, Sydney, New South Wales, Australia; The Ottawa Hospital (S.K.); Clinical Epidemiology Program (F.M.), Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (F.M.), University of Ottawa; Division of Palliative Care (S.H.B.), Department of Medicine, University of Ottawa, Ottawa, Ontario; Department of Symptom Control and Palliative Care (S.W.), Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; Discipline of Palliative and Supportive Services (D.C.C., M.Ag.), Flinders University, Adelaide, South Australia, Australia; Département de médecine familiale et de médecine d'urgence (B.G.), Université Laval; Centre de recherche du CHU de Québec (B.G.), Québec City, Québec, Canada; South West Sydney Clinical School (M.Ag.), University of New South Wales; Department of Palliative Care (M.Ag.), Braeside Hospital, Hammond Care, Sydney, New South Wales, Australia; The University of Texas M. D. Anderson Cancer Center (E.B.), Houston, Texas, USA; Graduate Entry Medical School (D.J.M.), University of Limerick, Limerick, Ireland; Academic Medical Centre (S.E.J.A.d.R.), University of Amsterdam, Amsterdam, The Netherlands; Research and Academic Institute of Athens (D.A.), Athens, Greece; Palliative Care, Pain Therapy and Rehabilitation Unit (A.C.), Fondazione IRCCS, Istituto Nazionale Dei Tumori, Milan, Italy; Department of Palliative Care (K.M.), Bruyère Continuing Care; and Department of Medical Oncology (D.J.S.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
J Pain Symptom Manage. 2014 Aug;48(2):159-175. doi: 10.1016/j.jpainsymman.2013.12.245. Epub 2014 Apr 12.
Delirium often presents difficult management challenges in the context of goals of care in palliative care settings.
The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research.
We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions.
Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of "very" or "extremely" important confirmed their priority.
Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings.
在姑息治疗环境中，谵妄在护理目标方面常常带来棘手的管理挑战。
旨在构建一个分析框架，用于姑息治疗环境中谵妄的进一步研究，对相关研究问题进行优先级排序，讨论相关研究中固有的方法学挑战，并概述谵妄研究项目的后续步骤。
我们在一次国际谵妄研究规划会议上整合了谵妄研究人员和知识使用者的多学科意见、相关文献检索、流行病学专业知识的重点意见以及会议参与者和共同作者的调查，以构建一个概念性研究框架并对研究问题进行优先级排序。
我们提出的框架包含三组主要研究问题：第一组主要是流行病学问题，如谵妄发生率、危险因素评估、筛查和诊断；第二组涵盖实际管理问题；第三组与谵妄结局预测模型的开发有关。根据对每个研究问题或领域的汇总调查回复，“非常”或“极其”重要的综合模态评分确认了它们的优先级。
通过使用一个分析框架来呈现姑息治疗环境中谵妄的完整临床护理路径，我们发现了该人群在谵妄发生率、评估、管理和结局预测方面存在多个知识空白。通过有足够样本量的多中心研究来回答框架中的研究问题所产生的知识综合，将为谵妄检测和管理的决策制定和政策制定提供信息，从而有助于为姑息治疗环境中的患者实现更好的结局。
