Validity of the Delirium Observation Screening Scale in Identifying Delirium in Home Hospice Patients.

BACKGROUND

Delirium is common in home hospice patients and conveys significant morbidity to both patients and caregivers. The Delirium Observation Screening Scale (DOS) was developed to improve delirium recognition but has yet to be validated in the home hospice setting.

OBJECTIVE

This pilot study aimed to explore the accuracy of the DOS for identifying delirium in home hospice patients.

DESIGN

Prospective delirium evaluation using a convenience sample.

SETTING/PARTICIPANTS: Community hospice patients were approached for study inclusion.

MEASUREMENTS

Participants were assessed using the Delirium Rating Scale-Revised-98 (DRS-R-98), with results being categorized as "delirium" or "no delirium." The Delirium Observation Screening Scale scores, completed by hospice nurses during weekly patient assessment visits, were compared to the DRS-R-98 results.

RESULTS

Within this population, 30/78 (38%) assessments were categorized as delirious. In the majority of assessments, 69/75 (92%), the DRS-R-98 and DOS provided congruent results. There were 5 false positives and 1 false negative, demonstrating the DOS to be a clinically useful tool with a sensitivity of 0.97 and specificity of 0.89.

CONCLUSION

The DOS appears to be an accurate way to screen for delirium in home hospice patients. Validation of the DOS may help to improve delirium recognition and treatment and has the potential to increase quality of life in this vulnerable population. This input will also be taken into consideration in the development of a systematic screening procedure for delirium diagnosis at our local hospice, which we hope will be generalizable to other hospice agencies.