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Delirium is
one of the most frequent complications in terminal cancer and
has a devastating impact on the quality of life of patients and
their families. Even so, this symptom has been inadequately investigated
in many of its aspects including pathophysiology, clinical course,
management, and psychosocial impact.
While there
are significant challenges facing investigators studying delirium,
it is possible to design meaningful studies by considering the
impact of different diagnostic criteria, adapting study protocols
to the seriously ill patient population (including how to obtain
informed consent), choosing validated tools to assess and monitor
delirium severity, recognizing the variable clinical characteristics
and etiology, and exploring different approaches to managing delirium.
Research is
particularly important in the area of psychosocial implications
of delirium. Prospective studies are needed to assess family perception
of symptoms in delirious patients, especially their interpretation
of physical or emotional suffering and the effect of this on bereavement
outcomes. This should allow for more effective counseling, and
the impact of this on family satisfaction and family staff conflicts
could also be studied.
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