Development and validation of the Terminal Delirium-Related Distress Scale to assess irreversible terminal delirium

Development and validation of the Terminal Delirium-Related Distress Scale - Shortform

BACKGROUND

We previously developed a 24-item Terminal Delirium-Related Distress Scale (TDDS) to evaluate patient and family distress due to terminal delirium. However, a scale with fewer evaluation items was needed to reduce the burden on terminally ill patients and their families. Thus, the TDDS Shortform (TDDS-SF) was developed, and the validity and reliability of the scale were evaluated.

OBJECTIVES

The aim of this study is to evaluate the validity and reliability of TDDS-SF.

METHODS

Items with insufficient loading (<0.6) based on factor analysis were removed from the TDDS. Palliative care experts reviewed each item and checked the structure of the scale. Based on their feedback, we developed the TDDS-SF, a 15-item questionnaire consisting of 4 subscales, including "Care for the family," "Ability to communicate," "Psychiatric symptoms," and "Adequate information and discussion about treatment for delirium." A cross-sectional, self-completed questionnaire survey of bereaved families of cancer patients who were admitted to a hospice/palliative care unit was conducted in August 2018. The survey included the TDDS-SF, Good Death Inventory (GDI), Care Evaluation Scale (CES), and distress score in the Delirium Experience Questionnaire. The validity, including construct validity, convergent validity, discriminant validity, and internal consistency, and reliability, including the Cronbach's alpha coefficient for internal consistency, of the TDDS-SF were evaluated.

RESULTS

The study included 366 bereaved family members. Factor analysis revealed good construct validity. Convergent validity was demonstrated based on good correlations with the CES (r = - 0.54, P < 0.001) and the GDI (r = - 0.54, P < 0.001). Discriminant validity was demonstrated by a low correlation (r = 0.23, P < 0.001) with the distress scores of bereaved families. The internal consistency was also good (Cronbach's alpha = 0.70-0.94).

SIGNIFICANCE OF RESULTS

The TDDS-SF is a valid and feasible tool for assessing irreversible terminal delirium-related distress. A study targeting patients and their families with end-of-life delirium is planned for the near future.

Assessing the relationship between the distress levels in patients with irreversible terminal delirium and the good quality of death from the perspective of bereaved family

BACKGROUND

Research on achieving a good death for terminally delirious patients is scarce, with limited knowledge about the level of good death and influencing factors. This study investigates the level of good death among delirium patients, factors influencing it, and the correlation between distress, end-of-life care needs, and achieving a good death by surveying bereaved family members of deceased patients in Chinese hospitals.

METHODS

This cross-sectional study from January 2022 to January 2024 was conducted among bereaved family members of patients using an online questionnaire. The questionnaires consisted of (1) participants' demographic and disease-related questionnaires; (2) the Good Death Inventory (GDI) China version; (3) Terminal Delirium-Related Distress Scale (TTDS) China version; (4) the Care Evaluation Scale - short form (CES) China version. All data were analyzed using descriptive statistics, and the associated factors influencing good death were analyzed by multiple linear regression analyses.

RESULT

A total of 263 subjects were enrolled. More males (63.5%) participated than females (36.5%), the mean age was 75.35 ± 13.90 years. Good quality of death was significantly and negatively related to the distress in patients with irreversible terminal delirium (r = -0.458, P<0.01).The multiple linear regression model indicates that TDDS score, CES score, types of diseases, smoking history, nutritional deficiency are important factor affecting the good quality of death.

CONCLUSIONS

The good quality of death from the perspective of bereaved family, a negative correlation was found between the distress in patients with irreversible terminal delirium and good death. Medical staff should be more aware of good quality of death in patients, future research should expand sample sizes to include more demographic data, and explore the concept of a good death across different cultural contexts.