Vol. 48 No. 2 August 2014
Journal of Pain and Symptom Management
157
Special Section: Studies to Understand Delirium In Palliative Settings (SUNDIPS)
Foreword The SUNDIPS Meeting and Papers Peter G. Lawlor, MB, FRCPI, MMedSc Division of Palliative Care, Department of Medicine, Epidemiology and Community Medicine, University of Ottawa; The Ottawa Hospital Research Institute; and Bruye re Research Institute, Bruye re Continuing Care, Ottawa, Ontario, Canada
Although delirium is a highly prevalent neurocognitive disorder in palliative care and therein precedes death for most patients, it is remarkably under-researched in this population. We convened a two day international delirium research planning meeting in Ottawa in June 2012. This conference was designed to promote collaboration, obtain multidisciplinary input, and advance the development of a research framework under the title, ‘‘Studies to Understand Delirium in Palliative Settings’’ (SUNDIPS). We obtained multidisciplinary researcher, knowledge-user input from 33 participants, representing psychiatry, gerontology, intensive care, research methods and epidemiology, neurology, neuropsychology, oncology, palliative medicine, nursing administration and research, ethics, pharmacology, and a national palliative care association. The data synthesis from this meeting and the associated literature searches were supplemented by subsequent focused input from some additional co-authors with recognized epidemiological or other expertise, who were unable to attend the meeting. In this Special Section, we present a series of eight articles that have emerged from our SUNDIPS meeting.1e8 These articles are largely anchored to an analytic framework depicting the clinical care pathway for an episode
of delirium in palliative care.1 They specifically address epidemiological, assessment, ethical, experiential, diagnostic, and treatment issues in relation to delirium in palliative care.
Address correspondence to: Peter G. Lawlor, MB, FRCPI, MMedSc, Department of Palliative Care, Bruy ere Continuing Care, 43 Bruyere Street, Ottawa, Ontario, Canada K1N 5C8. E-mail: [email protected]
Accepted for publication: May 28, 2014.
Ó 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Disclosures and Acknowledgments The Studies to Understand Delirium in Palliative Settings (SUNDIPS) meeting received administrative support from Bruyere Research Institute and funding support through a joint research grant to the author from the Gillin Family and Bruyere Foundation. The author gratefully acknowledges the input of all SUNDIPS meeting participants, namely Dimitrios Adamis, Meera Agar, Christopher Barnes, Sharon Baxter, Susan Brajtman, Eduardo Bruera, Shirley H. Bush, David C. Currow, Daniel H.J. Davis, Sophia E.J.A. de Rooij, Bruno Gagnon, Pierre Gagnon, Jean-David Gaudreau, Debbie Gravelle, Michael Hartwick, James C. Jackson, Salmaan Kanji, Nathalie Lacaze-Masmonteil, Maeve M. Leonard, Katie Marchington, Franco Momoli, Cheryl Nekolaichuk, Jose L. Pereira, Kiran Rabheru, Laura Regnier, Jessica Simon, David Stewart, Lisa Sweet, Sharon Watanabe, and David Kenneth Wright. Also, the author is deeply appreciative of the input of those who were mostly unable to attend the SUNDIPS meeting but subsequently contributed as manuscript
0885-3924/$ - see front matter http://dx.doi.org/10.1016/j.jpainsymman.2014.05.019
158
co-authors, namely Mohammed Ansari, William Breitbart, Augusto Caraceni, Brid Davis, Annmarie Hosie, Mary Ellen Macdonald, Neil MacDonald, David J. Meagher, Mas M. Mohamad, and Juliette A. Spiller. The author dedicates the SUNDIPS series of articles to the memory of his esteemed colleague, Dr. Pierre Allard, who was too unwell to directly participate in the meeting, and subsequently died in 2013. However, his input before the SUNDIPS meeting was immense and his memory continues to inspire us in our delirium research efforts.
References 1. Lawlor PG, Davis DHJ, Ansari M, et al. An analytical framework for delirium research in palliative care settings: integrated epidemiologic, clinicianresearcher, and knowledge user perspectives. J Pain Symptom Manage 2014;48:159e175. 2. Leonard MM, Nekolaichuk C, Meagher DJ, et al. Practical assessment of delirium in palliative care. J Pain Symptom Manage 2014;48:176e190.
Lawlor
Vol. 48 No. 2 August 2014
3. Wright DK, Brajtman S, Macdonald ME. A relational ethical approach to end-of-life delirium. J Pain Symptom Manage 2014;48:191e198. 4. Leonard MM, Agar M, Spiller JA, et al. Delirium diagnostic and classification challenges in palliative care: subsyndromal delirium, comorbid deliriumdementia and psychomotor subtypes. J Pain Symptom Manage 2014;48:199e214. 5. Bush SH, Leonard MM, Agar M, et al. End-oflife delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase. J Pain Symptom Manage 2014;48:215e230. 6. Bush SH, Kanji S, Pereira JL, et al. Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development. J Pain Symptom Manage 2014; 48:231e248. 7. Bush SH, Bruera E, Lawlor PG, et al. Clinical practice guidelines for delirium management: potential application in palliative care. J Pain Symptom Manage 2014;48:249e258. 8. Sweet L, Adamis D, Meagher DJ, et al. Ethical challenges and solutions regarding delirium studies in palliative care. J Pain Symptom Manage 2014;48: 259e271.
Journal of Pain and Symptom Management
157
Special Section: Studies to Understand Delirium In Palliative Settings (SUNDIPS)
Foreword The SUNDIPS Meeting and Papers Peter G. Lawlor, MB, FRCPI, MMedSc Division of Palliative Care, Department of Medicine, Epidemiology and Community Medicine, University of Ottawa; The Ottawa Hospital Research Institute; and Bruye re Research Institute, Bruye re Continuing Care, Ottawa, Ontario, Canada
Although delirium is a highly prevalent neurocognitive disorder in palliative care and therein precedes death for most patients, it is remarkably under-researched in this population. We convened a two day international delirium research planning meeting in Ottawa in June 2012. This conference was designed to promote collaboration, obtain multidisciplinary input, and advance the development of a research framework under the title, ‘‘Studies to Understand Delirium in Palliative Settings’’ (SUNDIPS). We obtained multidisciplinary researcher, knowledge-user input from 33 participants, representing psychiatry, gerontology, intensive care, research methods and epidemiology, neurology, neuropsychology, oncology, palliative medicine, nursing administration and research, ethics, pharmacology, and a national palliative care association. The data synthesis from this meeting and the associated literature searches were supplemented by subsequent focused input from some additional co-authors with recognized epidemiological or other expertise, who were unable to attend the meeting. In this Special Section, we present a series of eight articles that have emerged from our SUNDIPS meeting.1e8 These articles are largely anchored to an analytic framework depicting the clinical care pathway for an episode
of delirium in palliative care.1 They specifically address epidemiological, assessment, ethical, experiential, diagnostic, and treatment issues in relation to delirium in palliative care.
Address correspondence to: Peter G. Lawlor, MB, FRCPI, MMedSc, Department of Palliative Care, Bruy ere Continuing Care, 43 Bruyere Street, Ottawa, Ontario, Canada K1N 5C8. E-mail: [email protected]
Accepted for publication: May 28, 2014.
Ó 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Disclosures and Acknowledgments The Studies to Understand Delirium in Palliative Settings (SUNDIPS) meeting received administrative support from Bruyere Research Institute and funding support through a joint research grant to the author from the Gillin Family and Bruyere Foundation. The author gratefully acknowledges the input of all SUNDIPS meeting participants, namely Dimitrios Adamis, Meera Agar, Christopher Barnes, Sharon Baxter, Susan Brajtman, Eduardo Bruera, Shirley H. Bush, David C. Currow, Daniel H.J. Davis, Sophia E.J.A. de Rooij, Bruno Gagnon, Pierre Gagnon, Jean-David Gaudreau, Debbie Gravelle, Michael Hartwick, James C. Jackson, Salmaan Kanji, Nathalie Lacaze-Masmonteil, Maeve M. Leonard, Katie Marchington, Franco Momoli, Cheryl Nekolaichuk, Jose L. Pereira, Kiran Rabheru, Laura Regnier, Jessica Simon, David Stewart, Lisa Sweet, Sharon Watanabe, and David Kenneth Wright. Also, the author is deeply appreciative of the input of those who were mostly unable to attend the SUNDIPS meeting but subsequently contributed as manuscript
0885-3924/$ - see front matter http://dx.doi.org/10.1016/j.jpainsymman.2014.05.019
158
co-authors, namely Mohammed Ansari, William Breitbart, Augusto Caraceni, Brid Davis, Annmarie Hosie, Mary Ellen Macdonald, Neil MacDonald, David J. Meagher, Mas M. Mohamad, and Juliette A. Spiller. The author dedicates the SUNDIPS series of articles to the memory of his esteemed colleague, Dr. Pierre Allard, who was too unwell to directly participate in the meeting, and subsequently died in 2013. However, his input before the SUNDIPS meeting was immense and his memory continues to inspire us in our delirium research efforts.
References 1. Lawlor PG, Davis DHJ, Ansari M, et al. An analytical framework for delirium research in palliative care settings: integrated epidemiologic, clinicianresearcher, and knowledge user perspectives. J Pain Symptom Manage 2014;48:159e175. 2. Leonard MM, Nekolaichuk C, Meagher DJ, et al. Practical assessment of delirium in palliative care. J Pain Symptom Manage 2014;48:176e190.
Lawlor
Vol. 48 No. 2 August 2014
3. Wright DK, Brajtman S, Macdonald ME. A relational ethical approach to end-of-life delirium. J Pain Symptom Manage 2014;48:191e198. 4. Leonard MM, Agar M, Spiller JA, et al. Delirium diagnostic and classification challenges in palliative care: subsyndromal delirium, comorbid deliriumdementia and psychomotor subtypes. J Pain Symptom Manage 2014;48:199e214. 5. Bush SH, Leonard MM, Agar M, et al. End-oflife delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase. J Pain Symptom Manage 2014;48:215e230. 6. Bush SH, Kanji S, Pereira JL, et al. Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development. J Pain Symptom Manage 2014; 48:231e248. 7. Bush SH, Bruera E, Lawlor PG, et al. Clinical practice guidelines for delirium management: potential application in palliative care. J Pain Symptom Manage 2014;48:249e258. 8. Sweet L, Adamis D, Meagher DJ, et al. Ethical challenges and solutions regarding delirium studies in palliative care. J Pain Symptom Manage 2014;48: 259e271.
