DAMPen-Delirium II: Improving Delirium Care in Palliative Care Units

• Research type

  Research Study

• Full title

  DAMPen-D II: Improving the Detection, Assessment, Management, and Prevention of Delirium in Palliative Care Units: a Cluster Randomised-Controlled Trial, Economic Analysis and Process Evaluation.

• IRAS ID

  351878

• Contact name

  Mark Pearson

• Contact email

  mark.pearson@hyms.ac.uk

• Sponsor organisation

  University of Hull

• Clinicaltrials.gov Identifier

  176444, EDGE ID

• Duration of Study in the UK

  3 years, 11 months, 30 days

• Research summary

  What is the issue?
  It is common for people to suffer from acute confusion (delirium) towards the end of their life. One-third of people have delirium when they are admitted to a palliative care unit or hospice and a further one-third develop delirium during their stay. People with delirium may see or hear things that aren’t there, say or do things that are out of character, and can’t ‘think straight’. This is distressing for the person, their family, and staff. Delirium also causes unnecessary ‘downward spirals’ in a person’s day-to-day abilities. This results in them having increased care needs in the community and unplanned and expensive hospital admissions. There is clear national guidance on the actions needed to prevent, detect, assess, and manage delirium. However, it is difficult for hospices to put this guidance into practice because delirium care is complex and involves lots of different people, including family, friends and health professionals.

  What have we already done?
  We have designed a way to help hospices to overcome these difficulties and follow delirium guidelines better. We have tested this on a small scale and shown that we can collect information we need from patients’ notes and hospice staff in a reliable and timely way.

  What do we want to achieve?
  We are now ready to run a major, national trial to test whether this improves delirium care and reduces delirium in hospices. We want to improve the quality of life of the 28,000 people in the UK each year who have delirium whilst in a hospice. We also want to improve the wellbeing of the 112,000 carers (family and friends) who witness the damaging effects of delirium on their loved ones.

  How will we do this?
  1.Compare what happens when 10 hospices test our new approach, alongside 10 hospices who continue their normal ways of working
  2.Assess the cost-effectiveness of our approach
  3.Look at how our approach works in different hospices and what makes it work well
  4.Explore how to adapt our approach for use in different settings, such as care homes and people’s own homes

  How have people with experience helped?
  Our original project was supported and guided by a group of four people with personal experience of caring for a loved one with delirium. People with personal experience, in partnership with hospice staff, also helped to co-design our new approach. In developing this next stage, we reached out to involve new people with different perspectives and backgrounds. They agreed that reducing delirium would make a big difference to distress and could reduce ‘downward spirals’ in people’s day-to-day abilities. They commented on overall design and study materials, e.g. highlighting the importance of including hospices in ethnically-diverse areas and producing study materials in languages other than English. We have found someone with a valuable mixture of personal and professional experience of delirium in a hospice setting who will join the research team as a public co-applicant. She will chair the public advisory group, help to analyse interview data, and help to run our planned workshops.

  How will we share our findings?
  We will prepare Plain English summaries, Evidence Briefings, and policy papers, as well as presenting evidence to policy makers (including All-Party Parliamentary Groups) and working with the NIHR Palliative Care Policy Research Unit. We will also publish papers in peer-reviewed journals and present our findings at conferences.
  

• REC name

  Yorkshire & The Humber - Bradford Leeds Research Ethics Committee

• REC reference

  25/YH/0071

• Date of REC Opinion

  16 Apr 2025

• REC opinion

  Favourable Opinion