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Use of an expert panel to identify domains and indicators of delirium severity

  • Dena Schulman-GreenEmail author
  • Eva M. Schmitt
  • Tamara G. Fong
  • Sarinnapha M. Vasunilashorn
  • Jacqueline Gallagher
  • Edward R. Marcantonio
  • Charles H. BrownIV
  • Diane Clark
  • Joseph H. Flaherty
  • Anne Gleason
  • Sharon Gordon
  • Ann M. Kolanowski
  • Karin J. Neufeld
  • Margaret O’Connor
  • Margaret A. Pisani
  • Thomas N. Robinson
  • Joe Verghese
  • Heidi L. Wald
  • Richard N. Jones
  • Sharon K. Inouye
  • BASIL Study Group
Article

Abstract

Purpose

Our purpose was to create a content domain framework for delirium severity to inform item development for a new instrument to measure delirium severity.

Methods

We used an established, multi-stage instrument development process during which expert panelists discussed best approaches to measure delirium severity and identified related content domains. We conducted this work as part of the Better ASsessment of ILlness (BASIL) study, a prospective, observational study aimed at developing and testing measures of delirium severity. Our interdisciplinary expert panel consisted of twelve national delirium experts and four expert members of the core research group. Over a one-month period, experts participated in two rounds of review.

Results

Experts recommended that the construct of delirium severity should reflect both the phenomena and the impact of delirium to create an accurate, patient-centered instrument useful to interdisciplinary clinicians and family caregivers. Final content domains were Cognitive, Level of consciousness, Inattention, Psychiatric-Behavioral, Emotional dysregulation, Psychomotor features, and Functional. Themes debated by experts included reconciling clinical geriatrics and psychiatric content, mapping symptoms to one specific domain, and accurate capture of unclear clinical presentations.

Conclusions

We believe this work represents the first application of instrument development science to delirium. The identified content domains are inclusive of various, wide-ranging domains of delirium severity and are reflective of a consistent framework that relates delirium severity to potential clinical outcomes. Our content domain framework provides a foundation for development of delirium severity instruments that can help improve care and quality of life for patients with delirium.

Keywords

Expert panel Delirium Instrument development Severity 

Abbreviations

BIDMC

Beth Israel Deaconess Medical Center

BWH

Brigham and Women’s Hospital

HMS

Harvard Medical School

HSL

Hebrew SeniorLife

PI

Principal Investigator

Notes

Acknowledgements

The authors would like to acknowledge the entire BASIL study team: Principal Investigators (Multi-PIs): Sharon K. Inouye, MD, MPH (Overall PI, HSL, BIDMC, HMS); Richard N. Jones, ScD (Brown University); Co-Investigators: Sevdenur Cizginer, MD, (Brown University); Tamara G. Fong, MD, PhD (HSL, BIDMC, HMS); Tammy Hshieh, MD, MPH (BWH); Edward R. Marcantonio, MD, SM (BIDMC, HMS); Annie Racine, PhD (HSL, HMS); Eva M. Schmitt, PhD (HSL); Dena Schulman-Green, PhD (Yale University); Patricia A. Tabloski, PhD, GNP-BC, FGSA, FAAN (Boston College); Thomas Travison, PhD (HSL, HMS); Field Team: Tatiana Abrantes, BS (HSL); Brett Armstrong, MPH (BIDMC); Sylvia Bertrand, BS (HSL); Angelee Butters, MA (BIDMC); Madeline D’Aquila, BS (HSL); Jacqueline Gallagher, MS (BIDMC); Jennifer Kettell, BS (HSL); Jacqueline Nee, BA (HSL); Katelyn Parisi, BA, (HSL); Margaret Vella, BS (HSL); Guoquan Xu, MD, PhD (HSL); Lauren Weiner, MA (BIDMC). Data Management and Statistical Analysis Team: Yun Gou, MA (HSL); Douglas Tommet, MPH (Brown University). Expert Review Panel: Charles H. Brown, MD, MHS (Johns Hopkins); Diane Clark, PT, DScPT, MBA (University of Alabama); Joseph H. Flaherty, MD (Envision-Questcare Physician Services); Anne Gleason, OTR/L (HSL); Sharon M. Gordon, PsyD (Vanderbilt-VA Tennessee Valley Healthcare System); Ann M. Kolanowski, PhD, RN (Penn State); Karin J. Neufeld, MD, MPH (Johns Hopkins University); Margaret G. O’Connor, PhD (Brigham and Women’s Hospital); Margaret A. Pisani, MD, MPH (Yale University); Thomas N. Robinson, MD (University of Colorado); Joe Verghese, MB, BS, MS (Albert Einstein); Heidi L. Wald, MD, MSPH (University of Colorado).

Funding

This study was funded by grants from the National Institutes of Health [R01AG044518 (SKI/RNJ), R24AG054259 (SKI), K07AG041835 (SKI), P01AG031720 (SKI), R01AG030618 (ERM), K24AG035075 (ERM), K01AG057836 (SMV)], and the Alzheimer’s Association (AARF-18-560786 (SMV)].

Compliance with ethical standards

Conflict of interest

CHB discloses consultation and a data share with Medtronic. DC discloses receiving honoraria from the Commission on Accreditation in Physical Therapy Education. All other authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants for whom informed consent was required per IRB review.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Dena Schulman-Green
    • 1
    Email author
  • Eva M. Schmitt
    • 2
  • Tamara G. Fong
    • 2
    • 3
    • 4
  • Sarinnapha M. Vasunilashorn
    • 3
    • 4
  • Jacqueline Gallagher
    • 4
  • Edward R. Marcantonio
    • 3
    • 4
  • Charles H. BrownIV
    • 5
  • Diane Clark
    • 6
  • Joseph H. Flaherty
    • 7
  • Anne Gleason
    • 2
  • Sharon Gordon
    • 8
  • Ann M. Kolanowski
    • 9
  • Karin J. Neufeld
    • 5
  • Margaret O’Connor
    • 10
  • Margaret A. Pisani
    • 11
  • Thomas N. Robinson
    • 12
  • Joe Verghese
    • 13
  • Heidi L. Wald
    • 12
  • Richard N. Jones
    • 14
  • Sharon K. Inouye
    • 2
    • 3
    • 4
  • BASIL Study Group
  1. 1.Yale School of NursingWest HavenUSA
  2. 2.Institute for Aging ResearchHebrew SeniorLifeBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.Beth Israel Deaconess Medical CenterBostonUSA
  5. 5.School of MedicineJohns Hopkins UniversityBaltimoreUSA
  6. 6.Dept. of Physical TherapyUniversity of Alabama at BirminghamBirminghamUSA
  7. 7.Envision-Questcare Physician ServicesDallasUSA
  8. 8.VA Tennessee Valley Healthcare SystemNashvilleUSA
  9. 9.College of NursingPennsylvania State UniversityUniversity ParkUSA
  10. 10.Brigham and Women’s HospitalBostonUSA
  11. 11.School of MedicineYale UniversityNew HavenUSA
  12. 12.School of MedicineUniversity of ColoradoDenverUSA
  13. 13.Albert Einstein College of MedicineBronxUSA
  14. 14.Warren Alpert Medical SchoolBrown UniversityProvidenceUSA

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