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

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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.

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Abbreviations

BIDMC:

Beth Israel Deaconess Medical Center

BWH:

Brigham and Women’s Hospital

HMS:

Harvard Medical School

HSL:

Hebrew SeniorLife

PI:

Principal Investigator

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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)].

Author information

Author notes

  1. Richard N. Jones and Sharon K. Inouye are co-senior authors.

Authors and Affiliations

  1. Yale School of Nursing, P.O. Box 27399, West Haven, CT, 06516, USA

    Dena Schulman-Green

  2. Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA

    Eva M. Schmitt, Tamara G. Fong, Anne Gleason & Sharon K. Inouye

  3. Harvard Medical School, Boston, MA, USA

    Tamara G. Fong, Sarinnapha M. Vasunilashorn, Edward R. Marcantonio & Sharon K. Inouye

  4. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Tamara G. Fong, Sarinnapha M. Vasunilashorn, Jacqueline Gallagher, Edward R. Marcantonio & Sharon K. Inouye

  5. School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Charles H. Brown IV & Karin J. Neufeld

  6. Dept. of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA

    Diane Clark

  7. Envision-Questcare Physician Services, Dallas, TX, USA

    Joseph H. Flaherty

  8. VA Tennessee Valley Healthcare System, Nashville, TN, USA

    Sharon Gordon

  9. College of Nursing, Pennsylvania State University, University Park, PA, USA

    Ann M. Kolanowski

  10. Brigham and Women’s Hospital, Boston, MA, USA

    Margaret O’Connor

  11. School of Medicine, Yale University, New Haven, CT, USA

    Margaret A. Pisani

  12. School of Medicine, University of Colorado, Denver, CO, USA

    Thomas N. Robinson & Heidi L. Wald

  13. Albert Einstein College of Medicine, Bronx, NY, USA

    Joe Verghese

  14. Warren Alpert Medical School, Brown University, Providence, RI, USA

    Richard N. Jones

Authors
  1. Dena Schulman-Green
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  2. Eva M. Schmitt
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  11. Sharon Gordon
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  15. Margaret A. Pisani
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  19. Richard N. Jones
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  20. Sharon K. Inouye
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Consortia

BASIL Study Group

  • Sharon K. Inouye
  • , Richard N. Jones
  • , Sevdenur Cizginer
  • , Tamara G. Fong
  • , Tammy Hshieh
  • , Edward R. Marcantonio
  • , Annie Racine
  • , Eva M. Schmitt
  • , Dena Schulman-Green
  • , Patricia A. Tabloski
  • , Thomas Travison
  • , Tatiana Abrantes
  • , Brett Armstrong
  • , Sylvia Bertrand
  • , Angelee Butters
  • , Madeline D’Aquila
  • , Jacqueline Gallagher
  • , Jennifer Kettell
  • , Jacqueline Nee
  • , Katelyn Parisi
  • , Margaret Vella
  • , Guoquan Xu
  • , Lauren Weiner
  • , Yun Gou
  • , Douglas Tommet
  • , Charles H. Brown
  • , Diane Clark
  • , Joseph H. Flaherty
  • , Anne Gleason
  • , Sharon M. Gordon
  • , Ann M. Kolanowski
  • , Karin J. Neufeld
  • , Margaret G. O’Connor
  • , Margaret A. Pisani
  • , Thomas N. Robinson
  • , Joe Verghese
  •  & Heidi L. Wald

Corresponding author

Correspondence to Dena Schulman-Green.

Ethics declarations

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.

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

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Schulman-Green, D., Schmitt, E.M., Fong, T.G. et al. Use of an expert panel to identify domains and indicators of delirium severity. Qual Life Res 28, 2565–2578 (2019). https://doi.org/10.1007/s11136-019-02201-0

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