Incorporation of Delirium Prevention in Palliative Medicine
The article by Bausewein et al. successfully unites the multiprofessional aspects of palliative care for adult cancer patients (1). The article discusses not only cancer pain and its drug treatment, but also important concomitant phenomena in palliative care, such as the emergence of depression, as well as communication skills in terminally ill patients.
We are particularly grateful that the subject of delirium at the end of life has been addressed in this context. Delirium in particular is often responsible in clinical routine for the transferal of dying patients to a psychiatric unit. However, the article points out that delirium is a classic concomitant phenomenon in the dying process of cancer patients. The literature also provides indications that the transferal of delirious patients with advanced, life-shortening physical disease to psychiatric units is inappropriate (2). Change of environment as a risk factor, as well as ethical and legal considerations, speak against this approach.
Our working group considers it important to point out that delirium prevention is particularly crucial in the palliative care of cancer patients. The deployment of specially trained nursing staff in the form of specialist delirium liaison nurses can be a beneficial step here (3). Increasing importance should be attached to focusing on delirium prevention in the palliative care of cancer patients in clinical routine. The article in question does much to encourage this move.
Prof. Dr. med. Torsten Kratz
Prof. Dr. med. Albert Diefenbacher, MBA
Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH,
Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Berlin
Conflict of interest statement
Prof. Kratz has received lecture fees from Janssen-Cilag, Pfizer, and Lilly.
Prof. Diefenbacher has received lecture fees from Janssen-Cilag.
|1.||Bausewein C, Simon ST, Pralong A, Radbruch L, Nauck F, Voltz R: Clinical practice guideline: Palliative care of adult patients with cancer. Dtsch Arztebl Int 2015; 112: 863–70 VOLLTEXT|
|2.||Macleod S, Schulz C: Psychiatrie in der Palliativmedizin. Bern: Huber 2013; 167–78 MEDLINE PubMed Central|
|3.||Kratz T, Heinrich M, Schlauß E, Diefenbacher A: Preventing postoperative delirium: a prospective intervention with psychogeriatric liaison on surgical wards in a general hospital. Dtsch Arztebl Int 2015; 112: 289–96 VOLLTEXT|