Pharmacologic Management of End-of-Life Delirium: Translating Evidence into Practice

Author:

Hui David1ORCID,Cheng Shao-Yi2ORCID,Paiva Carlos Eduardo3ORCID

Affiliation:

1. Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA

2. Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei 10617, Taiwan

3. Department of Clinical Oncology, Barretos Cancer Hospital, Barretos 1331, SP, Brazil

Abstract

End-of-life delirium affects a vast majority of patients before death. It is highly distressing and often associated with restlessness or agitation. Unlike delirium in other settings, it is considered irreversible, and non-pharmacologic measures may be less feasible. The objective of this review is to provide an in-depth discussion of the clinical trials on delirium in the palliative care setting, with a particular focus on studies investigating pharmacologic interventions for end-of-life delirium. To date, only six randomized trials have examined pharmacologic options in palliative care populations, and only two have focused on end-of-life delirium. These studies suggest that neuroleptics and benzodiazepines may be beneficial for the control of the terminal restlessness or agitation associated with end-of-life delirium. However, existing studies have significant methodologic limitations. Further studies are needed to confirm these findings and examine novel therapeutic options to manage this distressing syndrome.

Funder

National Cancer Institute

Publisher

MDPI AG

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