Does the way palliative care clinicians talk about delirium influence clinical care in the last days of life? A secondary analysis of qualitative interview data

Background: Delirium in the last days of life is common. Inconsistent terminology in clinical practice is common and recognised internationally. Whether this adversely affects management is a concern, but unknown. Aim: We explored how hospice staff talk about delirium, agitation or withdrawal in the last days of life and whether the language used influences practice. Design: Secondary analysis of qualitative data. Setting/participants: 25 clinicians from two hospices, including doctors, nurses, healthcare assistants and allied health professionals. Results: Two themes were generated; (i) Understanding and communicating delirium and agitation and (ii) the influence of terminology on patient care. The term ‘delirium’ was not commonly used in practice, instead, patients’ behaviour was described, especially by non-medical staff. Use of ‘delirium’ seemed to be associated with more transparent decision-making regarding assessment and management, even in the last days of life when this was tailored for prognosis. When terms such as ‘terminal’, ‘agitation’ and ‘confusion’ were used, the use of sedatives for agitation received more emphasis. The importance of non-pharmacological approaches was recognised but close to death these were limited by the perceived need for sedation. Hypoactive delirium was poorly identified, rarely named, with little discourse relating to its management in the dying phase. Conclusion: We found novel evidence that terminology used appeared to affect delirium management. Establishing a shared consistent and clear terminology could enhance patient and family care and staff confidence. Further research is needed to develop evidence-based guidelines for identifying and managing delirium in the last days of life.