Patients with advanced cancer often experience severe and distressing symptoms that need to be addressed by palliative care. Delirium occurs frequently in patients admitted to hospitals, and it is particularly distressing to patients and their caregivers. It includes features such as restlessness, impaired cognition, and confusion. Many patients with delirium have a more severe subtype, termed agitated delirium. Because of these patients' confusion and impaired cognition, they are unable to communicate with their families and healthcare team, and they may have difficulties making decisions about their care. Unfortunately, no studies have yet shown which of the available treatments have the m...

Read More

Patients with advanced cancer often experience severe and distressing symptoms that need to be addressed by palliative care. Delirium occurs frequently in patients admitted to hospitals, and it is particularly distressing to patients and their caregivers. It includes features such as restlessness, impaired cognition, and confusion. Many patients with delirium have a more severe subtype, termed agitated delirium. Because of these patients' confusion and impaired cognition, they are unable to communicate with their families and healthcare team, and they may have difficulties making decisions about their care. Unfortunately, no studies have yet shown which of the available treatments have the most benefit for patients with agitated delirium.

The overall goal of this study is to investigate four treatment options for agitated delirium: three drugs (haloperidol, chlorpromazine, and valproate) and a standardized suite of non-drug treatments (such as aids to help patients remain oriented, assistance with sleep, and other supportive measures). Hospitalized patients with any type of advanced cancer diagnosed with agitated delirium will be included in the study, and each will be assigned to one of the four treatments. The primary goal is to determine if any of the three drugs can reduce the number of episodes of restlessness in patients with agitated delirium, but we will also investigate additional measurements of delirium, perceptions of patients' caregivers and nurses, and other symptoms the patients experience. We will also assess the impact of the non-drug treatments on patients' delirium.

We expect that this study will provide important evidence for the use of specific treatments in cancer patients with agitated delirium. Since agitated delirium affects a high proportion of patients with all types of advanced cancer, understanding which treatments work will have a very widespread impact on cancer patients and their families.

Read Less