111 6 DELIRIUM | PART THREE Background Delirium is the most common neuropsychiatric complication in patients with advanced cancer especially during hospitalization, with incidence rates ranging from 16% to 85%, depending on the stage of disease [1-7]. In a previous study from our group we found a higher number of patients with skin cancer and brain cancer in the group of patients with delirium compared to the patients without delirium [8]. Other studies showed conflicting results [9, 10]. Therefore, there is no compelling evidence that delirium is more prevalent in certain cancer types. Because attention and awareness deficits impede the ability to communicate and participate in treatment decisions and symptom assessment, delirium has a negative influence on quality of life in a crucial phase at the end of life [1]. The presentation of delirium is quite variable among patients, and even within a given patient because of its waxing and waning course [11]. This hampers recognition and adequate treatment of delirium [1]. Therefore it is recommended to screen for delirium in patients with (advanced) cancer admitted to the hospital [1, 11]. The diagnosis delirium should be made according to the DSM-criteria for delirium. Currently, version 5 is the most recent, but most screening and diagnostic instruments are based on the DSM-IV [12]. Efforts are being made to validate these instruments with the DSM 5 criteria [13, 14]. Available screening instruments which have been designed to be used by health care professionals for evaluating patients for possible delirium symptoms include: CAM [15], NEECHAM Confusion Scale [16], DOSS/DOS [17, 18]. Nu-DESC [5], ICDSC [19], and PAED scale [20]. Some of these instruments have been designed to be used in a specific treatment setting like the ICU, whereas others focus on specific age groups, like children and adolescents. There is no specific screening instrument for delirium in patients with advanced cancer. A comparison between various features of the available screening and diagnostic instruments for delirium in adults was made by Grover and Kate in 2012 [12]. Delirium screening should be preferably performed by nurses because they have frequent contact with the patient throughout the day, and could therefore easily observe changes in the patient’s attention and awareness over time, which is one of the main criteria for delirium according to the DSM 5 criteria [21]. The Delirium Observation Scale (DOS) appears to be the most suitable nurse-rated screening instrument for patients in general medical and surgical wards with a strong foundation in the DSM-IV criteria and good psychometric properties [3, 22]. It can be assessed by nurses without specific training, and is experienced as user-friendly. A previous, small study by Detroyer et al [23] suggests good sensitivity and specificity of the DOS in a palliative care population. The aim of our study is to evaluate the diagnostic accuracy of the DOS as screening instrument for hospitalized patients diagnosed with advanced cancer.
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