Screening and Detection of Delirium in the Acute Palliative Care Setting Using the “Months of the Year Backwards” Test: A Cross-Sectional Study

BACKGROUND: Delirium is a common disorder in patients with serious illness with prevalence ranging between 9% and 57% at the time of initial palliative care (PC) consultation. If detected early, morbidity and mortality from delirium can be reduced significantly. This study aims to evaluate the performance of the Months of the Year Backwards test as a promising screening tool for delirium in the acute PC setting. OBJECTIVE: Analyze the efficacy of the MOTYB test for delirium screening in the inpatient palliative care setting. METHODS: This multisite cross-sectional study included patients who received PC consultation at our institutions over 6 months. Recruiting PC professionals determined delirium status, including definite and possible diagnosis, using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria. We assessed the ease of administration and predictive performance of the Months of the Year Backwards test by comparing logistic regression models on sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiving operating characteristic curve. RESULTS: In total, 147 patients (59.2% women, 58.5% African American, mean age 65.9 years) were included. Thirty-four patients (23%) were designated with having delirium by DSM-5-TR criteria. Not reaching January or reaching January in over 90 s provided the highest sensitivity (93.8%) and negative predictive value (95.7%). CONCLUSIONS: Different models of the Months of the Year Backwards test demonstrated high prediction of delirium on initial PC consultation with consistently high sensitivity, negative predictive value, and area under the receiving operating characteristic curve of the receiving operating characteristic. These findings support its utility as an effective screening tool for delirium in this context. The Months of the Year Backwards test can be seamlessly integrated into the initial biopsychosocial and spiritual assessment in PC, significantly enhancing providers' ability to address the complex challenge of delirium in serious illness.