Research On Preventive Program For Delirium Of Patients With Advanced Cancer

ObjectiveTo investigate the occurrence and influencing factors of delirium in patients with advance cancer receiving hospice care services,and to construct preventive program for delirium of patients with advanced cancer,and to explore the application effect of this program inpatients with advanced cancer receiving hospice care services.MethodsThe research consisted of two parts: descriptive study and intervention study.231 patients with advance cancer in hospice units in zhengzhou were investigated.By patients' clinical data questionnaire,the eastern cooperative oncology group,and palliative prognosis index to know the demographic information,cancer type,the type of drug use,symptoms,physical state and expected survival time.By the confusion assessment method to evaluation and diagnosis of delirium.The data collected was analyzed by SPSS 21.0 and the statistic methods included chi-test,t-test,Mann-whitney U rank test and multiple Logistic regression analysis.?=0.05.The intervention stage consists with construction of intervention program and implementation.The first draft of preventive program for delirium of patients with advanced cancer was formulated by consulting a number of literature and combing with the actual clinical situation,and integrating the opinions of hospice care experts and psychiatrists.Finally,revise and improve the intervention plan by the expert advice and preliminary experiments.This study was a type of experimental study.The intervention group was established and trained before the intervention.The patients were divided into intervention group(N=76)and control group(N=76).The control group' patients received usual care,the intervention group received both usual care and delirium early nursing intervention.All patients of the intervention time was at the beginning of admission to the hospice unit,the end of the intervention if they died,transferred or discharge.And the statistic methods included chi-square test,Mann-whitney U rank test.Results1.This study included 231 patients with 139 cases of delirium,and the incidence of delirium was 60.2%.Multiple Logistic regression analysis showed that use of opioids,infection,sleep disturbance,and palliative prognostic index were the risk factors.Early screening and control of potentially reversible factors that cause delirium are key interventions that focus on ensuring the comfort,safety,and dignity of patients at the end of life.2.A total of 152 patients with end-stage cancer were enrolled.Data on 141 patients with advance cancer were collected after the intervention.Three patients in the control group were lost and eight patients in the intervention group were lost to follow-up,with a loss rate of 7.24%.The rate of adherence to the delirium early screening evaluation and orientation and cognitive training in the intervention group were 88.24% and 76.47%,respectively.After the intervention,compared with the control group,duration of delirium and delirium severity in the intervention group were all lower than those in the control group,with statistically significant differences(P<0.05).After the intervention,the morbidity and mortality of delirium between the two groups were not statistically significant(P>0.05).ConclusionThe incidence of delirium in patients with advance cancer receiving hospice care receives is still high.The use of opioids,infection,sleep disturbance,and palliative prognostic index are risk factors of advanced cancer with receiving hospice care receives.In this study,the construction of preventive program for delirium could shorten duration of delirium,and reduce delirium severity for patients with advance cancer.