• Annmarie Hosie, Meera Agar, Gideon A Caplan, Brian Draper, Stephen Hedger, Debra Rowett, Penny Tuffin, Seong Leang Cheah, Jane L Phillips, Linda Brown, Manraaj Sidhu, and David C Currow.
• The University of Notre Dame Australia, School of Nursing and Midwifery, Darlinghurst, NSW, Australia.
• Palliat Med. 2021 Sep 1; 35 (8): 1553-1563.

BackgroundRecent studies cast doubt on the net effect of antipsychotics for delirium.AimTo investigate the influence of these studies and other factors on clinicians' delirium treatment practice and practice change in palliative care and other specialties using the Theoretical Domains Framework.DesignAustralia-wide online survey of relevant clinicians.Setting/ParticipantsRegistered nurses (72%), doctors (16%), nurse practitioners (6%) and pharmacists (5%) who cared for patients with delirium in diverse settings, recruited through health professionals' organisations.ResultsMost of the sample (n = 475): worked in geriatrics/aged (31%) or palliative care (30%); in hospitals (64%); and saw a new patient with delirium at least weekly (61%). More (59%) reported delirium practice change since 2016, mostly by increased non-pharmacological interventions (53%). Fifty-five percent reported current antipsychotic use for delirium, primarily for patient distress (79%) and unsafe behaviour (67%). Common Theoretical Domains Framework categories of influences on respondents' delirium practice were: emotion (54%); knowledge (53%) and physical (43%) and social (21%) opportunities. Palliative care respondents more often reported: awareness of any named key study of antipsychotics for delirium (73% vs 39%, p < 0.001); changed delirium treatment (73% vs 53%, p = 0.017); decreased pharmacological interventions (60% vs 15%, p < 0.001); off-label medication use (86% vs 51%, p < 0.001: antipsychotics 79% vs 44%, p < 0.001; benzodiazepines 61% vs 26%, p < 0.001) and emotion as an influence (82% vs 39%, p < 0.001).ConclusionClinicians' use of antipsychotic during delirium remains common and is primarily motivated by distress and safety concerns for the patient and others nearby. Supporting clinicians to achieve evidence-based delirium practice requires further work.

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