Reducing the high occurrence of delirium in palliative care units and hospices may be possible.
To determine the feasibility and acceptability of a non-pharmacological delirium prevention intervention in two New Zealand hospices.
A non-pharmacological delirium prevention intervention (sleep, vision, hearing, hydration, orientation, mobility, family partnership) previously piloted in four Australian palliative care units was adapted for a single arm cohort study in two New Zealand hospices (‘PRESERVE Aotearoa’). Existing relationships between one study site and a Māori health and research trust also helped to adapt study materials and processes to ensure the cultural safety of Māori. Following these adaptations and staff training, study recruitment and delirium screening, diagnosis, and the prevention intervention for consented patients began in May 2021. Quantitative and qualitative methods will assess the intervention’s feasibility and acceptability for 40 Māori and non-Māori patients with advanced cancer, their family (whānau) carers, staff, and volunteers.
Of 63 eligible patients to date, 26 (41%) have consented to and received the intervention (median (SD) age 73.5 (13.2) years, median (SD) Australian-modified Karnofsky Performance Score 50 (15), 62% male). Four participants (15%) were Māori (representative of New Zealand); and 11 (42%) completed the seven-day intervention. Nurses screened patients for delirium at least once/day for 152/155 patient days (98%), but physicians did not apply diagnostic measures within 24 hours (as per the protocol) for any of the six patients with a positive screen. Full intervention adherence (>4 completed delirium prevention domains for >5 days) was achieved for nineteen participants (73%), with 16 (62%) receiving family/whānau partnership strategies. The intervention is showing no adverse effects.
Results thus far indicate that studying non-pharmacological delirium prevention interventions in Aotearoa New Zealand hospices is feasible and acceptable. Additional efforts to improve the timeliness of diagnostic assessment by physicians after a positive delirium screen are now in place. The PRESERVE Aotearoa study is demonstrating higher adherence to the intervention (including family/whānau partnership) than was achieved in Australia. Importantly, the hospices sought to achieve cultural safety for Māori and are recruiting Māori participants, demonstrating how collaboration with Indigenous peoples supports their participation in palliative care research.
Funding acknowledgement: The study is funded by a Research Project Grant from Cancer Research Trust NZ.