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Presentation Description
Institution: New South Wales, Australia
Background
Delirium is a serious acute neurocognitive condition and is common in severe illness. The Delirium Standard requires primary interventions (identify/treat root causes and provide person-centred information/support) and avoidance of antipsychotics. Quantitative results of our 2019 national survey of clinicians’ (medical practitioners, nurses, pharmacists) delirium treatment practice, practice change and influences suggested increasing adoption of primary interventions, yet antipsychotic use remained common, especially in palliative care.
Aim
To explore influences on clinicians’ delirium treatment practice and practice change, and explain dissonant quantitative results of the survey.
Methods
A qualitative study using a behaviour change theory, the Theoretical Domains Framework (TDF). We performed directed content analysis of free-text responses about influences on delirium treatment practice and practice change provided by 280 (59%) of the 475 survey participants. Analysis entailed deductive data coding and categorisation against the TDF’s 17 domains, followed by inductive categorisation and development of themes. Data analysis was performed using Excel, NVivo and Word.
Findings
Free-text respondents were registered nurses (77%), medical practitioners (18%) and pharmacists (5%). Most were female (81%), aged 40+ years (81%), experienced (10+ years 77%), hospital-based (67%), and saw a new patient with delirium at least weekly (62%). They were from diverse specialties, with geriatrics/aged care (32%) and palliative care (31%) the most common. Data analysis generated four themes: (1) Increasing awareness of delirium and readiness to change treatment practices; (2) Variance in practice and resources across settings; (3) Connections and tensions: the complex interplay between broader influences and clinical practice; and (4) Shared pervasive distress.
Conclusions
Findings reveal multiple and complex influences on clinicians’ delirium treatment practice and practice change and help to explain quantitative survey results. We plan to integrate all survey data (quantitative and qualitative) and then develop theory-guided multi-pronged strategies to support clinicians in achieving evidence-based delirium treatment practice.
Presenters
Authors
Authors
Associate Professor Annmarie Hosie - University of Notre Dame Australia & St Vincent's Health Network Sydney , Mr Prince Peprah - University of Notre Dame Australia; University of NSW , Professor Brian Draper - University of NSW , Professor Meera Agar - University of Technology Sydney , Associate Professor Gideon Caplan - University of NSW; Prince of Wales Hospital , Dr Bora Kim - University of Sydney , Professor Jane Phillips - Queensland University of Technology , Professor Debra Rowett - University of South Australia , Ms Penelope Tuffin - Curtin University , Dr Seong Cheah - Novotech , Ms Linda Brown - University of Technology Sydney , Professor David Currow - University of Wollongong
