Delirium is a common neuropsychiatric syndrome in patients at end of life; with both a cancer and non-cancer diagnosis. The prevalence of which increases significantly in the last hours or days of life. Terminal agitation is a symptom of delirium and can be challenging to understand what is causing it.
Anecdotally, working in end of life care, in past clinical role as an end of life care facilitator, I would often see patients in their last days of life with symptoms of terminal agitation. Pharmacological approaches were primarily used to manage this. I found the symptom distressing for some patients themselves, but more so for the patients’ loved ones and really challenging for nursing staff to bear witness and support.
To research terminal agitation as an article for the 外网天堂i’s , made me question everything I thought I knew about agitation and realise the intrinsic connection to delirium.
Comprehensive and holistic assessment, using validated delirium assessment tools are essential to identify reversible causes where possible. Prioritising nonpharmacological approaches is vital as some medicines cause or perpetuate delirium. Shared decision making with the patient (and where consent is gained) and those important to them is key, considering what matters to them and their family. Compassionate communication is essential to support patients and their loved ones; explaining clearly end of life delirium, symptoms of terminal agitation and treatment and management approaches.
I hope the article highlights the connections of delirium with terminal agitation, the need for comprehensive assessment and management prioritising nonpharmacological approaches. Finally, I hope it emphasises support for families and coping strategies for nurses working with patients at end of life.
If you are passionate about a subject or inquisitive to understand more, I also encourage you to consider writing an article for publication. Undertaking this article has made me see aspects in a new light, question assumptions I held and uncover new ideas and evidence I now use in my practice. I found the publication process quite challenging, more so to find the time to set aside to do it. It was a rigorous process and I’ve learnt a lot from it but also one I would definitely do again.
Reference
Monks, S (2025) Terminal agitation as a symptom of delirium in patients with advanced cancer at the end of life. Cancer Nursing Practice. doi: 10.7748/cnp.2025.e1888
