Skip to main content
    • Aa
    • Aa

The recognition and documentation of delirium in hospital palliative care inpatients

  • Julia Barnes (a1), Suzanne Kite (a2) and Manoj Kumar (a3)

Delirium is a clinical syndrome that is known to be under recognized by palliative care teams. A wide variation in reported prevalence may reflect differences in definitions and assessment methods, patient characteristics, and study design. The aim of this study was to test an intervention to improve recognition of delirium in the inpatient palliative care setting.


We conducted a retrospective palliative care notes review of documented prevalence of delirium among 61 patients referred to the Specialist Palliative Care Advisory Team (SPCT). Subsequently, training in the use of the Confusion Assessment Method (CAM) was provided to the SPCT and a prospective survey of the prevalence of delirium measured by the CAM was undertaken with the next 59 patients referred.


In the retrospective chart review, the term “delirium” was not used, and synonyms were identified and used to establish a delirium prevalence of 11.5%. In the intervention utilizing the CAM in a prospective sample of 59 referred patients, a prevalence rate of 8.5–15.2% for delirium was found. Use of the CAM was received favorably by the SPCT.

Significance of Results:

The institution of the use of the CAM as a screening and assessment tool in the inpatient palliative care setting did not significantly increase the recognition of delirium. Reasons for the low prevalence of delirium are discussed.

Corresponding author
Address correspondence and reprint requests to: J. Barnes, Palliative Care Team, Robert Ogden Centre, St. James' University Hospital, Leeds, England. E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

W. Breitbart , C. Gibson & A. Tremblay (2002). The delirium experience: Delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers and their nurses. Psychosomatics, 43, 183194.

A. Burns , A. Gallagley & J. Byrne (2004). Delirium. Journal of Neurology, Neurosurgery and Psychiatry, 75, 362367.

C.-K. Fang , H.-W. Chen , S.-I. Liu , (2008). Prevalence, detection and treatment of delirium in terminal cancer inpatients: A prospective survey. Japanese Journal of Clinical Oncology, 38, 5663.

M. Hjermstad , J. Loge & S. Kaasa (2004). Methods for assessment of cognitive failure and delirium in palliative care patients: Implications for practice and research. Palliative Medicine, 18, 494506.

S. Inouye , C. van Dyck , C. Alessi , (1990). Clarifying confusion: The Confusion Assessment Method. Annals of Internal Medicine, 113, 941948.

P. Lawlor , B. Gagnon , I. Mancini , (2000). Occurrence, causes and outcome of delirium in patients with advanced cancer. Archives of Internal Medicine, 160, 786794.

T. Morita , K. Hirai , Y. Sakaguchi , (2004). Family-perceived distress from delirium-related symptoms of terminally ill cancer patients. Psychosomatics, 45, 107113.

K. Ryan , M. Leonard , S. Guerin , (2009). Validation of the confusion assessment method in the palliative care setting. Palliative Medicine, 23, 4045.

J. Spiller & J. Keen (2006). Hypoactive delirium: Assessing the extent of the problem for inpatient specialist palliative care. Palliative Medicine, 20, 1723.

N. Tabet , S. Hudson , V. Sweeney , (2005). An educational intervention can prevent delirium on acute medical wards. Age and Ageing, 34, 152156.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 2
Total number of PDF views: 30 *
Loading metrics...

Abstract views

Total abstract views: 153 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 28th May 2017. This data will be updated every 24 hours.