Use of an expert panel to identify domains and indicators of delirium severity
Our purpose was to create a content domain framework for delirium severity to inform item development for a new instrument to measure delirium severity.
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.
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.
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.
KeywordsExpert panel Delirium Instrument development Severity
Beth Israel Deaconess Medical Center
Brigham and Women’s Hospital
Harvard Medical School
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).
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.
This article does not contain any studies with human participants for whom informed consent was required per IRB review.
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