Delirium, a common neuropsychiatric condition ranges in prevalence among patients with cancer from 10% to 30% in hospitalized patients, to up to 85% in terminally ill cancer patients. However, it often goes undiagnosed. A research team at Cleveland Clinic found that the integration of mental health professionals into the cancer care team aided in the better recognition and management of delirium in cancer patients. The results were presented at the 2018 American Society of Clinical Oncology (ASCO) Quality Care Symposium.
As a first step, psychiatrists, psychologists, and clinical social workers provided training to a range of oncology caregivers including physicians, nurses, and advanced practice providers, on the identification of both hyper-and hypoactive delirium using the Brief Confusion Assessment Method (bCAM). Oncology caregivers were then taught to perform an assessment and comparison of the patient’s current mental status with that of their baseline status prior to hospitalization. If delirium was identified a delirium order set was used to treat and manage patient symptoms. As part of the integration, psychiatrists, psychologists, and clinical social workers accompanied caregivers on multidisciplinary rounds to facilitate discussions about delirium and its management.
After a year of multidisciplinary care team integration, there was an increase from 3.4% to 15.8% in the number of cancer patients identified with delirium. The number of delirium order sets also increased from 11.1% to 58.3%. Notably, the average nursing unit length of stay for delirium-positive patients decreased by more than 2 days. Altogether supporting the idea that education combined with team integration improved delirium identification and management in oncology inpatients.
Hooley J, Ralston L, Marcus JD, Best C, Karius D, Koniarczyk H.Integrating mental health professionals into the care team to better recognize and manage delirium in hospitalized oncology patients. Oral presentation at: 2018 ASCO Quality care Symposium; September 28-29, 2018; Phoenix, AZ. Abstract 83.