Physicians’ Beliefs and Attitudes Toward Hypoactive Delirium in The Last Days of Life

Context: The perspective toward hypoactive delirium in the last days of life could be different among physicians. Objectives: To clarify the attitudes, beliefs, and opinions of palliative care physicians and liaison psychiatrists toward hypoactive delirium in the last days of life and to explore the association among these factors. Methods: A nationwide cross-sectional questionnaire survey was conducted among 1667 physicians who were either certified palliative care specialists or liaison psychiatrists. Physicians' agreement with the appropriateness of pharmacological management (e.g., antipsychotics) (one item), their beliefs (11 items), and their opinions (four items) were measured. Results: 787 (47%) physicians responded. 481 (62%) agreed to use of medications for hypoactive delirium in the last days of life, whereas 296 (38.1%) disagreed. More than 95% agreed with “hypoactive delirium at the end of life can be considered as a part of natural dying process.” Multivariate analysis identified two belief subscales of “hypoactive delirium at the end of life is a natural dying process” and “antipsychotics are futile and harmful in managing hypoactive delirium” had a significant negative correlation with the use of medications. On the other hand, one belief subscale of “hypoactive delirium can be distressing even if patients’ consciousness is impaired” had significant positive correlations with the use of medications. Conclusion: Pharmacological management of hypoactive delirium in the last days of life differs depending on physicians’ beliefs. Future research is needed to clarify the efficacy and safety of pharmacological management of hypoactive delirium.