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J Pain Symptom Manage. 2014 Aug;48(2):159-175. doi: 10.1016/j.jpainsymman.2013.12.245. Epub 2014 Apr 12.

An analytical framework for delirium research in palliative care settings: integrated epidemiologic, clinician-researcher, and knowledge user perspectives.

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Division of Palliative Care (P.G.L.), Department of Medicine, Epidemiology and Community Medicine, University of Ottawa; Bruyère Research Institute (P.G.L., S.H.B.), Bruyère Continuing Care; The Ottawa Hospital Research Institute (P.G.L., S.K.), Ottawa, Ontario, Canada; Institute of Public Health (D.H.J.D.), University of Cambridge, Cambridge, United Kingdom; Knowledge Synthesis Group (M.An.), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Faculty of Nursing (A.H.), University of Notre Dame, Sydney, New South Wales, Australia; The Ottawa Hospital (S.K.); Clinical Epidemiology Program (F.M.), Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (F.M.), University of Ottawa; Division of Palliative Care (S.H.B.), Department of Medicine, University of Ottawa, Ottawa, Ontario; Department of Symptom Control and Palliative Care (S.W.), Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; Discipline of Palliative and Supportive Services (D.C.C., M.Ag.), Flinders University, Adelaide, South Australia, Australia; Département de médecine familiale et de médecine d'urgence (B.G.), Université Laval; Centre de recherche du CHU de Québec (B.G.), Québec City, Québec, Canada; South West Sydney Clinical School (M.Ag.), University of New South Wales; Department of Palliative Care (M.Ag.), Braeside Hospital, Hammond Care, Sydney, New South Wales, Australia; The University of Texas M. D. Anderson Cancer Center (E.B.), Houston, Texas, USA; Graduate Entry Medical School (D.J.M.), University of Limerick, Limerick, Ireland; Academic Medical Centre (S.E.J.A.d.R.), University of Amsterdam, Amsterdam, The Netherlands; Research and Academic Institute of Athens (D.A.), Athens, Greece; Palliative Care, Pain Therapy and Rehabilitation Unit (A.C.), Fondazione IRCCS, Istituto Nazionale Dei Tumori, Milan, Italy; Department of Palliative Care (K.M.), Bruyère Continuing Care; and Department of Medical Oncology (D.J.S.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Contributed equally



Delirium often presents difficult management challenges in the context of goals of care in palliative care settings.


The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research.


We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions.


Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of "very" or "extremely" important confirmed their priority.


Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings.


Delirium; assessment; decision making; hospice; palliative care; predictive model; research framework; risk factors; treatment

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