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Validation of the confusion assessment method in the palliative care setting

Department of Palliative Medicine, Mater Misericordiae University Hospital, Connolly Hospital Blanchardstown and St Francis Hospice, Raheny, Dublin kryan{at}sfh.ie

M Leonard

Department of Adult Psychiatry, Health Service Executive Midwest Hospital, Limerick

S Guerin

Department of Psychology, University College Dublin, Dublin

S Donnelly

Department of Palliative Medicine, Health Service Executive Midwest Hospital, Limerick and Milford Care Centre, Limerick

M Conroy

Department of Palliative Medicine, Health Service Executive Midwest Hospital, Limerick and Milford Care Centre, Limerick

D Meagher

Department of Adult Psychiatry, Health Service Executive Midwest Hospital, Limerick

The Confusion Assessment Method (CAM) is widely used in the palliative care setting despite the fact that its performance in this population has not been validated. The aim of the study was to determine the sensitivity and specificity of the CAM when used by Non-Consultant Hospital Doctors (NCHDs) working in a specialist palliative care unit. A pilot phase was performed in which NCHDs received a 1-hour training session based on the original CAM training manual. 32 patients underwent 33 assessments in the pilot phase but the sensitivity of the CAM was only 0.5 (0.22–0.78) and specificity was 1.0 (0.81–1.0). An 'enhanced' training programme was devised that took place over two 1-hour sessions and involved case-based learning focused on the areas where the NCHDs were experiencing difficulty. 52 patients underwent 54 assessments in the main phase of the study and the performance of the CAM improved significantly. Sensitivity was 0.88 (0.62–0.98) and specificity was 1.0 (0.88–1.0). The results suggest that the CAM is a valid screening tool for delirium in the palliative care setting but its performance is dependent on the skill of the operator. NCHDs require a certain standard of training before becoming proficient in its use.

Key Words: Confusion Assessment Method • delirium • diagnostic tests and procedures • palliative care • sensitivity and specificity

This version was published on January 1, 2009

Palliative Medicine, Vol. 23, No. 1, 40-45 (2009)
DOI: 10.1177/0269216308099210


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