DETECTION OF DELIRIUM IN HOSPITALISED CANCER PATIENTS

Abstract

Delirium is an important syndrome associated with poor outcomes for patients, carers and staff. The incidence and prevalence of delirium in people with cancer in the hospital in-patient setting, is not established. The few studies from this setting, report wide-ranging incidence and prevalence rates. Similarly, some data exist relating to reversibility of delirium in the index setting, but not a great deal is known about reversibility. Delirium detection is critical for treatment, but not well established for in-patient oncology settings. The first chapter of this thesis is a scoping review of the literature relating to incidence, prevalence and reversibility of delirium in the index setting. In addition, we sought to determine which delirium screening tools and which reference standards were used as the basis of case ascertainment to underpin epidemiological studies. Critical appraisal of methodological constraints of the studies was considered and the implications for knowledge gaps were identified. The second chapter reports findings from our original study investigating the clinical utility of the Single Question in Delirium (SQiD), a novel tool which was previously developed by the author. The methodological approach compared the SQiD against clinical review by consultant liaison psychiatrists in admitted, oncology patients. In summary this thesis provides a synthesis of knowledge to August 2017 relating to the epidemiology of delirium in admitted cancer patients and tests a short pragmatic delirium screening tool against a diagnostic reference standard. It contributes to the knowledge base relating to delirium in cancer patients admitted in the acute setting and is hypothesis generating for future research.