Accuracy of Delirium Screening Tools in Older People with Cancer-A Systematic Review

One of the main complications of cancer is delirium, especially in advanced stages. Our aim is to determine which delirium screening instrument is the most accurate in older people with cancer. A systematic review was performed on 13 different assessment tools, reporting an incidence of delirium ranging from 14.3% to 68.3%. The Delirium Observation Screening Scale (DOSS) showed the best metric properties, followed by the Nursing Delirium Screening Scale (NuDESC), Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS). Screening tools for delirium are heterogeneous, and there is a need to analyze metric properties exclusively in the older population as knowing the tools with the greatest diagnostic accuracy will enable physicians and nurses to make the correct choice for early detection of delirium. In this way, the most appropriate measures could be implemented to avoid harmful consequences.Background: The increase in life expectancy worldwide has led to a larger population of older people, which in turn entails a rising prevalence of cancer. One of the main complications of cancer is delirium, especially in advanced stages. Objective: To determine which delirium screening instrument is the most accurate in older people with cancer. Methods: A systematic review was designed. A literature search was performed in MEDLINE, EBSCO and SCOPUS; additional records were identified by handsearching. Selection criteria were studies involving people with cancer and a mean sample age of 60 years or older, assessing delirium, and reporting the metric properties of the assessment instrument. Studies with post-surgical patients and substance abuse delirium were excluded. Results: From 2001 to 2021, 14 eligible studies evaluated 13 different assessment tools, reporting an incidence of delirium ranging from 14.3% to 68.3%. The Delirium Observation Screening Scale (DOSS) showed the best metric properties, followed by the Nursing Delirium Screening Scale (NuDESC), Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS). Only two studies were considered to be at low risk of bias using the QUADAS-2 Tool. No study exclusively examined this population group. Conclusions: Screening tools for delirium are heterogeneous for older people with cancer, and there is a need to analyze metric properties exclusively in the older population. Registered on PROSPERO ID: CRD42022303530.

Automated summary

One of the main complications of cancer, especially in advanced stages, is delirium. This study aimed to determine the most accurate delirium screening instrument for older people with cancer. A systematic review of 13 different assessment tools found that the Delirium Observation Screening Scale (DOSS) had the best metric properties, followed by the Nursing Delirium Screening Scale (NuDESC), Confusion Assessment Method (CAM), and Memorial Delirium Assessment Scale (MDAS). It is important to analyze the metric properties specifically in the older population to facilitate early detection of delirium and implementation of appropriate measures.