Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan.
Palliat Support Care. 2021 Jun;19(3):287-293. doi: 10.1017/S1478951520001340.
There is no tool to appropriately assess terminal delirium, including the natural terminal course. The objective of this study was to develop an evaluation scale to assess distress from irreversible terminal delirium and to examine the validity of the scale.
Based on previous qualitative analysis and systematic literature searches, we carried out a survey regarding the views of bereaved families and developed a questionnaire. We extracted items that bereaved families regarded as important and constructed an evaluation scale of terminal delirium. Then, we applied the questionnaire in a cross-sectional questionnaire survey of bereaved relatives of cancer patients who were admitted to a hospice or a palliative care unit.
We developed the Terminal Delirium-Related Distress Scale (TDDS), a 24 item questionnaire consisting of five subscales (support for families and respect for a patient, ability to communicate, hallucinations and delusions, adequate information about the treatment of delirium, and agitation and restlessness). Two hundred and eighty-one bereaved relatives participated in the validation phase. The construct validity was shown to be good by repeated factor analysis. Convergent validity, confirmed by the correlation between the TDDS and the Care Evaluation Scale (r = 0.651, P < 0.001), was also good. The TDDS had good internal consistency (Cronbach's alpha coefficient for all 24 items = 0.84).
This study showed that the TDDS is a valid and feasible measure of irreversible terminal delirium.
目前尚无工具可适当评估终末期谵妄，包括其自然病程。本研究旨在开发一种评估工具来评估不可逆转的终末期谵妄所致痛苦，并检验该评估工具的有效性。
基于先前的定性分析和系统文献检索，我们对丧亲家庭的意见进行了调查，并编制了一份问卷。我们提取了丧亲家庭认为重要的项目，并构建了终末期谵妄评估量表。然后，我们在一个姑息治疗或临终关怀病房的癌症患者丧亲亲属的横断面问卷调查中应用了该问卷。
我们开发了终末期谵妄相关痛苦量表（TDDS），这是一个包含 24 个项目的五分量表问卷，包括：家庭支持和对患者的尊重、沟通能力、幻觉和妄想、有关谵妄治疗的充分信息、以及激越和不安。281 名丧亲亲属参与了验证阶段。通过重复因子分析显示其结构效度良好。通过与关怀评估量表（TDDS 与关怀评估量表之间的相关性 r = 0.651，P < 0.001）的相关性验证了其收敛效度也较好。TDDS 的内部一致性良好（所有 24 个项目的 Cronbach's alpha 系数 = 0.84）。
本研究表明 TDDS 是评估不可逆转的终末期谵妄的有效且可行的工具。
