IMPACCT Centre (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, Sydney, 2007, Australia.
South West Sydney Clinical School, University of New South Wales, Sydney, Australia.
Curr Treat Options Oncol. 2022 Jul;23(7):951-960. doi: 10.1007/s11864-022-00987-9. Epub 2022 May 11.
Delirium is a common medical complication in people living with cancer, particularly with more advanced disease. Delirium is associated with significant symptom burden which causes distress and impacts quality of life. As recommended by international guidelines, a high degree of suspicion is needed to ensure delirium is detected early. Attention to collateral history can provide clues to changes in cognition and attention. Non-pharmacological approaches that can be considered essential elements of care are effective in reducing the risk of delirium. Delirium screening using a validated measure is recommended as even expert clinicians can underdiagnose or miss delirium. The diagnostic assessment requires consideration of the cancer diagnosis and comorbidities, in the context of potential reversibility, goals of care, and patient preferences. The gold standard approach based on expert consensus is to institute management for delirium precipitants supported by non-pharmacological essential care, with the support of an interdisciplinary team. Medication management should be used sparingly and for a limited period of time wherever possible for severe perceptual disturbance or agitation which has not improved with non-pharmacological approaches. Clinicians should be familiar with the registered indication for medications and seek informed consent for off-label use. All interventions put in place to manage delirium need to consider net clinical benefit, including harms such as sedation and loss of capacity for meaningful interaction. Clear communication and explanation are needed regularly, with the person with delirium as far as possible and with surrogate decision makers. Delirium can herald a poor prognosis and this needs to be considered and be discussed as appropriate in shared decision-making. Recall after delirium has resolved is common, and opportunity to talk about this experience and the related distress should be offered during the period after recovery.
谵妄是癌症患者常见的医学并发症，尤其是在疾病更晚期的患者中。谵妄与严重的症状负担相关，会引起痛苦并影响生活质量。国际指南建议，需要高度怀疑以确保及早发现谵妄。关注旁证病史可以提供认知和注意力变化的线索。可以考虑将非药物方法作为护理的基本要素，这些方法可以有效降低谵妄的风险。建议使用经过验证的措施进行谵妄筛查，因为即使是专家临床医生也可能会漏诊或误诊谵妄。诊断评估需要考虑癌症诊断和合并症，同时考虑潜在的可逆转性、护理目标和患者偏好。基于专家共识的金标准方法是针对谵妄诱因进行管理，辅以非药物基本护理，并得到跨学科团队的支持。应尽可能避免且仅在有限的时间内使用药物管理，对于严重的知觉障碍或非药物方法无法改善的激越症状。临床医生应熟悉药物的注册适应证，并在使用非适应证药物时寻求知情同意。为管理谵妄而采取的所有干预措施都需要考虑净临床获益，包括镇静和丧失有意义互动能力等危害。应定期与谵妄患者（在可能的情况下）及其替代决策者进行清晰的沟通和解释。谵妄可能预示着预后不良，需要在共同决策中考虑并酌情讨论。谵妄后常常会出现回忆，在康复后期间应提供机会谈论这段经历和相关痛苦。
