Peace Home Care Clinic, Otsu, (K.O,) Shiga, Japan; Clinical Research Support Office, (K.O., T.M) Iizuka Hospital, Iizuka-shi, Fukuoka, Japan.
Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, (T.M.) Shizuoka Japan.
J Pain Symptom Manage. 2022 Aug;64(2):110-118. doi: 10.1016/j.jpainsymman.2022.04.176. Epub 2022 Apr 28.
The perspective toward hypoactive delirium in the last days of life could be different among physicians.
To clarify the attitudes, beliefs, and opinions of palliative care physicians and liaison psychiatrists toward hypoactive delirium in the last days of life and to explore the association among these factors.
A nationwide cross-sectional questionnaire survey was conducted among 1667 physicians who were either certified palliative care specialists or liaison psychiatrists. Physicians' agreement with the appropriateness of pharmacological management (e.g., antipsychotics) (one item), their beliefs (11 items), and their opinions (four items) were measured.
787 (47%) physicians responded. 481 (62%) agreed to use of medications for hypoactive delirium in the last days of life, whereas 296 (38.1%) disagreed. More than 95% agreed with "hypoactive delirium at the end of life can be considered as a part of natural dying process." Multivariate analysis identified two belief subscales of "hypoactive delirium at the end of life is a natural dying process" and "antipsychotics are futile and harmful in managing hypoactive delirium" had a significant negative correlation with the use of medications. On the other hand, one belief subscale of "hypoactive delirium can be distressing even if patients' consciousness is impaired" had significant positive correlations with the use of medications.
Pharmacological management of hypoactive delirium in the last days of life differs depending on physicians' beliefs. Future research is needed to clarify the efficacy and safety of pharmacological management of hypoactive delirium.
在生命的最后几天，医生对低活动度谵妄的看法可能有所不同。
阐明姑息治疗医师和联络精神科医师对生命最后几天低活动度谵妄的态度、信念和意见，并探讨这些因素之间的关联。
对 1667 名经认证的姑息治疗专家或联络精神科医师进行了全国性的横断面问卷调查。测量了医生对药物治疗（如抗精神病药）的适宜性（一个项目）、信念（11 个项目）和意见（四个项目）的一致性。
787 名（47%）医生做出了回应。481 名（62%）医生同意在生命的最后几天使用药物治疗低活动度谵妄，而 296 名（38.1%）医生不同意。超过 95%的医生同意“生命末期的低活动度谵妄可以被认为是自然死亡过程的一部分”。多变量分析确定了两个信念子量表，即“生命末期的低活动度谵妄是自然死亡过程”和“抗精神病药在治疗低活动度谵妄时无效且有害”，与药物治疗的使用呈显著负相关。另一方面，信念子量表“即使患者意识受损，低活动度谵妄也可能令人痛苦”与药物治疗的使用呈显著正相关。
生命末期低活动度谵妄的药物治疗取决于医生的信念。需要进一步研究阐明低活动度谵妄药物治疗的疗效和安全性。
