Dr Annmarie Hosie is Postdoctoral Research Fellow, Palliative Care Clinical Trials Collaborative. From 1999-2015, Dr Hosie worked as a clinician in acute, sub-acute, community and residential aged care settings, including in advance nursing practice and coordination roles. Her doctoral research, competed in 2015, contributed to knowledge of delirium epidemiology and the need for interdisciplinary systems to improve its recognition and assessment in inpatient palliative care units. Dr Hosie’s postdoctoral research is focused on delirium recognition, prevention and management in advanced illness, and strategies to promote ethical research participation by older people with cognitive impairment. In 2017-18, she co-led the PRESERVE pilot study, a phase II cluster randomised clinical trial of a multi-component non-pharmacological intervention to prevent delirium in people with advanced cancer in four palliative care units.
- Palliative Care Clinical Trials Collaborative Trials Committee
- Palliative Care Clinical Trials Collaborative Mood and Cognitive Disorder Symptom Node Sub-Committee
- Palliative Care Nurses Australia Committee
- Australasian Delirium Association Committee
- BUPA Health Foundation Emerging Health Researcher 2018 Commendation Award
- Journal of Gerontological Nursing Editorial Board
- Palliative aged care
- Delirium and cognitive impairment
- Non-pharmacological interventions for symptoms in advanced illness
- Mixed methods research
Hosie, A, Siddiqi, N, Featherstone, I, Johnson, M, Lawlor, PG, Bush, SH, Amgarth-Duff, I, Edwards, L, Cheah, SL, Phillips, J & Agar, M 2019, 'Inclusion, characteristics and outcomes of people requiring palliative care in studies of non-pharmacological interventions for delirium: A systematic review.', Palliative medicine, p. 269216319853487.View/Download from: Publisher's site
BACKGROUND:Delirium is common, distressing, serious and under-researched in specialist palliative care settings. OBJECTIVES:To examine whether people requiring palliative care were included in non-pharmacological delirium intervention studies in inpatient settings, how they were characterised and what their outcomes were. DESIGN:Systematic review (PROSPERO 2017 CRD42017062178). DATA SOURCES:Systematic search in March 2017 for non-pharmacological delirium intervention studies in adult inpatients. Database search terms were 'delirium', 'hospitalisation', 'inpatient', 'palliative care', 'hospice', 'critical care' and 'geriatrics'. Scottish Intercollegiate Guidelines Network methodological checklists guided risk of bias assessment. RESULTS:The 29 included studies were conducted between 1994 and 2015 in diverse settings in 15 countries (9136 participants, mean age = 76.5 years (SD = 8.1), 56% women). Most studies tested multicomponent interventions (n = 26) to prevent delirium (n = 19). Three-quarters of the 29 included studies (n = 22) excluded various groups of people requiring palliative care; however, inclusion criteria, participant diagnoses, illness severity and mortality indicated their presence in almost all studies (n = 26). Of these, 21 studies did not characterise participants requiring palliative care or report their specific outcomes (72%), four reported outcomes for older people with frailty, dementia, cancer and comorbidities, and one was explicitly focused on people receiving palliative care. Study heterogeneity and limitations precluded definitive determination of intervention effectiveness and only allowed interpretations of feasibility for people requiring palliative care. Acceptability outcomes (intervention adverse events and patients' subjective experience) were rarely reported overall. CONCLUSION:Non-pharmacological delirium interventions have frequently excluded and under-characterised people requiring palliative care and infrequently reported ...
Fischer, T, Hosie, A, Luckett, T, Agar, M & Phillips, J 2019, 'Strategies for pain assessment in adult patients with delirium: a scoping review.', Journal of pain and symptom management.View/Download from: Publisher's site
CONTEXT:Pain and delirium are highly prevalent in the same patient groups. Disturbances in attention, awareness and cognition are characteristic for delirium and can compromise pain assessment. OBJECTIVES:The aim of this review was to examine and map models and understandings of pain and delirium as well as pain assessment instruments and strategies for adult patients with delirium. METHODS:A scoping review of all publications that reported on pain assessment in adult patients with delirium was conducted with no time and language constraints, searching Medline, CINAHL, Scopus, Embase and Psycinfo and systematically assessing for inclusion. Standardised data extraction and a narrative synthesis followed. RESULTS:Ninety publications were included in the final analysis. Despite being recommended for practice, no evidence for the use of self-report or behavioural pain assessment instruments in patients with delirium were identified, with the exception of limited evidence for the validity of the CPOT and BPS in delirious intensive care patients. Proxy ratings of pain and comprehensive pain assessment hierarchies were also recommended, but not supported by evidence. Current models and/or understandings of pain and delirium were not applied in most publications. CONCLUSION:The current literature is insufficient to guide clinical practice in pain assessment in patients with delirium. Future research will need to address the validity of existing pain assessment instruments, apply theoretical and conceptual understandings of pain and delirium, and build on prior studies to close evidence gaps.
Lawlor, PG, Rutkowski, NA, MacDonald, AR, Ansari, MT, Sikora, L, Momoli, F, Kanji, S, Wright, DK, Rosenberg, E, Hosie, A, Pereira, JL, Meagher, D, Rice, J, Scott, J & Bush, SH 2019, 'A Scoping Review to Map Empirical Evidence Regarding Key Domains and Questions in the Clinical Pathway of Delirium in Palliative Care.', Journal of pain and symptom management, vol. 57, no. 3, pp. 661-681.e12.View/Download from: UTS OPUS or Publisher's site
CONTEXT:Based on the clinical care pathway of delirium in palliative care (PC), a published analytic framework (AF) formulated research questions in key domains and recommended a scoping review to identify evidence gaps. OBJECTIVES:To produce a literature map for key domains of the published AF: screening, prognosis and diagnosis, management, and the health-related outcomes. METHODS:A standard scoping review framework was used by an interdisciplinary study team of nurse- and physician-delirium researchers, an information specialist, and review methodologists to conduct the review. Knowledge user engagement provided context in refining 19 AF questions. A peer-reviewed search strategy identified citations in Medline, PsycINFO, Embase, and CINAHL databases between 1980 and 2018. Two reviewers independently screened records for inclusion using explicit study eligibility criteria for the population, design, delirium diagnosis, and investigational intent. RESULTS:Of 104 studies reporting empirical data and meeting eligibility criteria, most were conducted in patients with cancer (73.1%) and in inpatient PC units (52%). The most frequent study design was a one or more group, nonrandomized trial or cohort (67.3%). Evidence gaps were identified: delirium risk prediction; comparative effectiveness and harms of prevention, variability in delirium management across PC settings, advanced directive and substitute decision-maker input, and transition of care location; and estimating delirium reversibility. Future rigorous primary studies are required to address these gaps and preliminary concerns regarding the quality of extant literature. CONCLUSION:Substantial evidence gaps exist, providing opportunities for future research regarding the assessment, prognosis, and management of delirium in PC settings.
Marra, A, Kotfis, K, Hosie, A, MacLullich, AMJ, Pandharipande, PP, Ely, EW & Pun, BT 2019, 'DELIRIUM MONITORING: YES OR NO? THAT IS THE QUESTION', AMERICAN JOURNAL OF CRITICAL CARE, vol. 28, no. 2, pp. 127-135.View/Download from: Publisher's site
Watt, CL, Momoli, F, Ansari, MT, Sikora, L, Bush, SH, Hosie, A, Kabir, M, Rosenberg, E, Kanji, S & Lawlor, PG 2019, 'The incidence and prevalence of delirium across palliative care settings: A systematic review.', Palliative medicine, p. 269216319854944.View/Download from: Publisher's site
BACKGROUND:Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed. AIM:Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings. DESIGN:This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment. DATA SOURCES:Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included. RESULTS:Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer ( n = 34) and mixed diagnoses ( n = 8) were represented. Delirium point prevalence estimates were 4%-12% in the community, 9%-57% across hospital palliative care consultative services, and 6%-74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings ( n = 8) was 42%-88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29-0.40, n = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used. CONCLUSION:Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.
Hosie, A, Phillips, J, Lam, L, Kochovska, S, Noble, B, Brassil, M, Kurrle, SE, Cumming, A, Caplan, GA, Chye, R, Le, B, Ely, EW, Lawlor, PG, Bush, SH, Davis, JM, Lovell, M, Brown, L, Fazekas, B, Cheah, SL, Edwards, L & Agar, M 2019, 'Multicomponent non-pharmacological intervention to prevent delirium for hospitalised people with advanced cancer: study protocol for a phase II cluster randomised controlled trial.', BMJ open, vol. 9, no. 1, pp. e026177-e026177.View/Download from: UTS OPUS or Publisher's site
INTRODUCTION:Delirium is a significant medical complication for hospitalised patients. Up to one-third of delirium episodes are preventable in older inpatients through non-pharmacological strategies that support essential human needs, such as physical and cognitive activity, sleep, hydration, vision and hearing. We hypothesised that a multicomponent intervention similarly may decrease delirium incidence, and/or its duration and severity, in inpatients with advanced cancer. Prior to a phase III trial, we aimed to determine if a multicomponent non-pharmacological delirium prevention intervention is feasible and acceptable for this specific inpatient group. METHODS AND ANALYSIS:The study is a phase II cluster randomised wait-listed controlled trial involving inpatients with advanced cancer at four Australian palliative care inpatient units. Intervention sites will introduce delirium screening, diagnostic assessment and a multicomponent delirium prevention intervention with six domains of care: preserving natural sleep; maintaining optimal vision and hearing; optimising hydration; promoting communication, orientation and cognition; optimising mobility; and promoting family partnership. Interdisciplinary teams will tailor intervention delivery to each site and to patient need. Control sites will first introduce only delirium screening and diagnosis, later implementing the intervention, modified according to initial results. The primary outcome is adherence to the intervention during the first seven days of admission, measured for 40 consecutively admitted eligible patients. Secondary outcomes relate to fidelity and feasibility, acceptability and sustainability of the study intervention, processes and measures in this patient population, using quantitative and qualitative measures. Delirium incidence and severity will be measured to inform power calculations for a future phase III trial. ETHICS AND DISSEMINATION:Ethical approval was obtained for all four sites. Trial r...
Phillips, J & Hosie, A 2018, 'Imprecise communication and perceptions of palliative care', International Journal of Palliative Nursing, vol. 24, no. 2, p. 55.View/Download from: UTS OPUS or Publisher's site
Luckett, T, Phillips, J, Agar, M, Lam, L, Davidson, PM, McCaffrey, N, Boyle, F, Shaw, T, Currow, DC, Read, A, Hosie, A & Lovell, M 2018, 'Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial', BMC HEALTH SERVICES RESEARCH, vol. 18.View/Download from: UTS OPUS or Publisher's site
Hosie, A, Agar, M, Lobb, E, Davidson, PM & Phillips, J 2017, 'Improving delirium recognition and assessment for people receiving inpatient palliative care: a mixed methods meta-synthesis', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 75, pp. 123-129.View/Download from: UTS OPUS or Publisher's site
Goligher, EC, Ely, EW, Sulmasy, DP, Bakker, J, Raphael, J, Volandes, AE, Patel, BM, Payne, K, Hosie, A, Churchill, L, White, DB & Downar, J 2017, 'Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues', CRITICAL CARE MEDICINE, vol. 45, no. 2, pp. 149-155.View/Download from: UTS OPUS or Publisher's site
Hosie, A, Agar, M & Phillips, J 2016, 'Re-thinking our approach to care of the dying person with delirium: Time for a new care paradigm', International Journal of Palliative Nursing, vol. 22, no. 10, pp. 472-473.View/Download from: UTS OPUS or Publisher's site
Hosie, A, Lobb, E, Agar, M, Davidson, P, Chye, R, Lam, L & Phillips, J 2016, 'Measuring delirium point-prevalence in two Australian palliative care inpatient units', INTERNATIONAL JOURNAL OF PALLIATIVE NURSING, vol. 22, no. 1, pp. 13-21.View/Download from: UTS OPUS
Golder, B, Ely, EW, Raphael, J, Fernandes, AK & Hosie, A 2016, 'Assisted Nutrition and Hydration as Supportive Care during Illness', The National Catholic Bioethics Quarterly, vol. 16, no. 3, pp. 435-448.View/Download from: UTS OPUS or Publisher's site
Luckett, T, Disler, R, Hosie, A, Johnson, M, Davidson, P, Currow, D, Sumah, A & Phillips, J 2016, 'Content and quality of websites supporting self-management of chronic breathlessness in advanced illness: a systematic review', NPJ PRIMARY CARE RESPIRATORY MEDICINE, vol. 26.View/Download from: UTS OPUS or Publisher's site
Hosie, A, Lobb, E, Agar, M, Davidson, PM, Chye, R & Phillips, J 2015, 'Nurse perceptions of the Nursing Delirium Screening Scale in two palliative care inpatient units: a focus group study', JOURNAL OF CLINICAL NURSING, vol. 24, no. 21-22, pp. 3276-3285.View/Download from: UTS OPUS or Publisher's site
Lobb, EA, Lacey, J, Kearsley, J, Liauw, W, White, L & Hosie, A 2015, 'Living with advanced cancer and an uncertain disease trajectory: an emerging patient population in palliative care?', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 5, no. 4, pp. 352-357.View/Download from: UTS OPUS or Publisher's site
Hosie, A & Phillips, J 2014, 'Editorial: Nurses' role in improving interdisciplinary delirium care in inpatient settings: steps for action', JOURNAL OF CLINICAL NURSING, vol. 23, no. 21-22, pp. 2995-2997.View/Download from: UTS OPUS or Publisher's site
Hosie, A, Agar, M, Lobb, E, Davidson, PM & Phillips, JL 2014, 'Palliative care nurses' recognition and assessment of delirium symptoms: a qualitative study using Critical Incident Technique.', International Journal of Nursing Studies, vol. 51, no. 10, pp. 1353-1365.View/Download from: UTS OPUS or Publisher's site
Delirium is prevalent in palliative care inpatient settings and management is often challenging. Despite nurses integral patient care role, little is known about palliative care nurses capacity to recognise, assess and respond to patients delirium symptoms.
Hosie, A, Lobb, E, Agar, M, Davidson, PM & Phillips, J 2014, 'Identifying the barriers and enablers to palliative care nurses' recognition and assessment of delirium symptoms: a qualitative study.', Journal of pain and symptom management, vol. 48, no. 5, pp. 815-830.View/Download from: UTS OPUS or Publisher's site
CONTEXT: Delirium is underrecognized by nurses, including those working in palliative care settings where the syndrome occurs frequently. Identifying contextual factors that support and/or hinder palliative care nurses' delirium recognition and assessment capabilities is crucial, to inform development of clinical practice and systems aimed at improving patients' delirium outcomes. OBJECTIVES: The aim of the study was to identify nurses' perceptions of the barriers and enablers to recognizing and assessing delirium symptoms in palliative care inpatient settings. METHODS: A series of semistructured interviews, guided by critical incident technique, were conducted with nurses working in Australian palliative care inpatient settings. A hypoactive delirium vignette prompted participants' recall of delirium and identification of the perceived factors (barriers and enablers) that impacted on their delirium recognition and assessment capabilities. Thematic content analysis was used to analyze the qualitative data. RESULTS: Thirty participants from nine palliative care services provided insights into the barriers and enablers of delirium recognition and assessment in the inpatient setting that were categorized as patient and family, health professional, and system level factors. Analysis revealed five themes, each reflecting both identified barriers and current and/or potential enablers: 1) value in listening to patients and engaging families, 2) assessment is integrated with care delivery, 3) respecting and integrating nurses' observations, 4) addressing nurses' delirium knowledge needs, and 5) integrating delirium recognition and assessment processes. CONCLUSION: Supporting the development of palliative care nursing delirium recognition and assessment practice requires attending to a range of barriers and enablers at the patient and family, health professional, and system levels.
Bush, SH, Leonard, MM, Agar, M, Spiller, JA, Hosie, A, Wright, DK, Meagher, DJ, Currow, DC, Bruera, E & Lawlor, PG 2014, 'End-of-life delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase.', Journal of Pain and Symptom Management, vol. 48, no. 2, pp. 215-230.View/Download from: UTS OPUS or Publisher's site
CONTEXT: In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase. OBJECTIVES: To review delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. METHODS: We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO, and CINAHL) to inform this narrative review. RESULTS: The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high-level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health-care staff, clear communication, education, and emotional support are vital components to assist with decision making and direct the treatment care plan. CONCLUSION: Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement is needed in this patient population.
Lawlor, PG, Davis, DHJ, Ansari, M, Hosie, A, Kanji, S, Momoli, F, Bush, SH, Watanabe, S, Currow, DC, Gagnon, B, Agar, M, Bruera, E, Meagher, DJ, de Rooij, SEJA, Adamis, D, Caraceni, A, Marchington, K & Stewart, DJ 2014, 'An analytical framework for delirium research in palliative care settings: integrated epidemiologic, clinician-researcher, and knowledge user perspectives.', Journal of Pain and Symptom Management, vol. 48, no. 2, pp. 159-175.View/Download from: UTS OPUS or Publisher's site
CONTEXT: Delirium often presents difficult management challenges in the context of goals of care in palliative care settings. OBJECTIVES: The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research. METHODS: We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions. RESULTS: Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of "very" or "extremely" important confirmed their priority. CONCLUSION: Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings.
Hosie, A, Davidson, PM, Agar, M, Sanderson, CR & Phillips, JL 2013, 'Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review', Palliative Medicine, vol. 27, no. 6, pp. 486-498.View/Download from: UTS OPUS or Publisher's site
Background: Delirium is a serious neuropsychiatric syndrome frequently experienced by palliative care inpatients. This syndrome is under-recognized by clinicians. While screening increases recognition, it is not a routine practice. Aim and design: This systematic review aims to examine methods, quality, and results of delirium prevalence and incidence studies in palliative care inpatient populations and discuss implications for delirium screening.
Hosie, A, Fazekas, B, Shelby-James, T, Mills, E, Byfieldt, N, Margitanovic, V, Hunt, J & Phillips, JL 2011, 'Palliative Care Clinical Trials: How nurses are contributing to ethical, integrated and evidence based care of palliative care patients participating in clinical trials', International Journal of Palliative Nursing, vol. 17, no. 5, pp. 224-230.View/Download from: UTS OPUS or Publisher's site
The aim of this paper is to describe the emerging role of the palliative care clinical trials nurse in an era of evidence-based practice and increasing clinical trial activity in palliative care settings across Australia. An overview of the current clinical trials work is provided, with a focus on three aspects of clinical trials nursing practice that have significant implications for patients: managing the consent process, integrating clinical trials into multidisciplinary care, and establishing and building the evidence base to inform practice in palliative care settings. Clinical trials roles provide palliative care nurses with an opportunity to contribute to clinical research, help expand palliative care's evidence base, and develop their own research capabilities.
This chapter outlines how health professionals may best prevent, recognise, assess, manage and support people with palliative diagnoses who are at risk of delirium, and their families, according to best-evidence and the circumstances, needs and wishes of the person. The chapter also presents evidence-practice gaps in delirium care in palliative contexts, and briefly outlines future directions for research and clinical practice development.
Hosie, A, Phillips, J, Lam, L, Kochovska, S, Brassil, M, Noble, B, Kurrle, S, Cumming, A, Caplan, G, Chye, R, Le, B, Ely, EW, Lawlor, P, Bush, S, Davis, JM, Lovell, M, Brown, L, Fazekas, B, Cheah, SL, Edwards, L & Agar, M 2018, 'A phase II cluster randomised controlled trial of a multicomponent non-pharmacological intervention to prevent delirium for in-patients with advanced cancer (The PRESERVE pilot study)', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, WILEY, pp. 166-166.