Priority 17 from the Palliative and end of life care PSP

UNCERTAINTY:  What are the best ways to diagnose and treat delirium, agitation, distress, and restlessness in people at the end of life?  Which sedative drugs (such as midazolam, haloperidol and levomepromazine) are most beneficial and best in terms of side-effects?  Do these drugs have an effect on other symptoms?   (JLA PSP Priority 17)
Overall ranking 17
JLA question ID 0026/17
Evidence

Candy B, Jackson KC, Jones L, Tookman A, King M. Drug therapy for symptoms associated with anxiety in adult palliative care patients. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD004596. DOI: 10.1002/14651858.CD004596.pub2.  

Beller EM, van Driel ML, McGregor L, Truong S, Mitchell G. Palliative pharmacological sedation for terminally ill adults. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD010206. DOI: 10.1002/14651858.CD010206.pub2.  

Candy B, Jackson KC, Jones L, Leurent B, Tookman A, King M. Drug therapy for delirium in terminally ill adult patients. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD004770. DOI: 10.1002/14651858.CD004770.pub2.

Wee B, Hillier R. Interventions for noisy breathing in patients near to death. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD005177. DOI: 10.1002/14651858.CD005177.pub2.  

Akechi T, Okuyama T, Onishi J, Morita T, Furukawa TA. Psychotherapy for depression among incurable cancer patients. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005537. DOI: 10.1002/14651858.CD005537.pub2.

Ongoing trials: The Preventative Role of Exogenous Melatonin Administration in Patients With Advanced Cancer Who Are at Risk of Delirium: a Feasibility Study. NCT02200172   

Early recognition and optimal treatment of acute confusion in patients with advanced cancer. NCT01539733  

The Effect of Cognitive Behavior Intervention on Psychological Distress of Cancer Patients and Their Family Members  NCT00279474
Health Research Classification System category  Generic
Extra information provided by this PSP
Original uncertainty examples What sort of help works best - control of pain and other symptoms, ensuring no restlessness or distress  End stage liver and lung cancer in a younger person question.  ~  The agitation could not be controlled in the final days, I have spoken to many others where this happened. More information about the extreme side of end of a life should be available to help plan better.
Submitted by Bereaved Carers x 2
Outcomes to be measured Patient Satisfaction; health related quality of life; health related cost; change in symptoms; change in management of symptoms.
PSP information
PSP unique ID 0026
PSP name Palliative and end of life care
Total number of uncertainties identified by this PSP. 83  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 21 November 2014