Challenges of recruiting hospice inpatients with advanced cancer to research: Reflections on a delirium screening study

Introduction: Delirium research in palliative care, particularly in the dying phase, is possible but is frequently met with ethical and methodological challenges. This paper describes the challenges faced in a previous delirium screening study.

Methods: Within 72 hours of admission to an acute inpatient specialist palliative care unit, 100 consecutive patients over 18 years of age with advanced cancer were invited to be screened for delirium using validated screening tools.

Results: Of the 100 consecutive admissions, 49 patients were unable to participate including 7 who did not meet the inclusion criteria and 9 (6 families and 3 patients) who withheld consent. The remaining 33 patients were more unwell and closer to death than those who were recruited. Reasons for non-participation included being too unwell/gate keeping (10), unresponsive (9), died (2) or discharged (3) before recruitment, and exceeding the 72 hour time limit (9).

Conclusion: Gate keeping and physical condition of patients were the main obstacles to recruitment and is consistent with barriers faced in previous studies involving palliative care and dying patients. While it is possible and necessary to conduct studies in palliative care, including the terminal phase, as reflective practitioners, we must maintain the balance between the demands for evidence-based practice and our compassion and respect for our most vulnerable of patients.