IndraLab
Statements
sparser
"In this issue of CCM, Fiest et at [ref] present results from a diagnostic accuracy study in which they test two family administered delirium screening tools, the Family Confusion Assessment Method (FAM-CAM) ( xref ), and the Sour Seven ( xref ) against the diagnosis of delirium according to the Diagnosis and Statistical Manual of Mental Disorders, Edition 5 (DSM-5)."
sparser
"There are three existing tools that can be independently completed by family caregivers – the FAM-CAM, the informant Assessment of Geriatric Delirium (I-AGeD) and the Sour Seven. xref – xref A strength of the FAM-CAM is that it allows families to systematically report their observations of features of delirium, as well as to detail when the changes (i.e., whether or not the changes were acute or progressive) began and if they have been getting better or worse (items 8 to 11)."
sparser
"As for informant-based tools such as the Single Question in Delirium (SQiD) which asks ‘ Is this patient more confused than before ’, the FAM-CAM has the benefit of including information on additional features of delirium while not adding burden to the clinicians in the ED. xref The FAM-CAM may be especially helpful in cases when patients present with ‘confusion’ or altered mental status’ as the chief complain associated with the ED visit, common in our cohort, and in patients with dementia where confusion may be part of the patient’s baseline."
sparser
"The sensitivity of delirium detection by ED providers may be as low as 20%, and other tools that have been examined, such as the modified Richmond Agitation Sedation Scale, have also demonstrated moderate to low sensitivity in the ED setting (70%; 95% CI: 48%; 85%), especially among patients with dementia (55%; 95% CI: 28%; 79%) and there is no family-member equivalent to augment clinician assessments. xref , xref Although the sensitivity and likelihood ratios of the FAM-CAM were modest, it shows promise in increasing delirium detection if supplemented to current systematic screening strategies suggested in best practice guidelines."
sparser
"Although FAM-CAM screening would require approximately an hour of staff training and additional per-patient time to distribute the FAM-CAM to families and interpret the results, it is a relatively simple tool and interpretation is quick and straightforward since the FAM-CAM is designed for use by non-medically trained caregivers."
sparser
"In this pre-test post-test quasi-experimental study, consecutive eligible family members of critically ill patients admitted to an ICU completed an ICU Family Education Delirium intervention in two parts: 1) six-minute video on ICU delirium (risk factors, prevention/management, symptoms, communication with the ICU care team), and 2) two case vignettes to practice detecting delirium using family-administered delirium detection questionnaires (Family Confusion Assessment Method [FAM-CAM] and Sour Seven)."
sparser
"Dans cette étude quasi expérimentale avant après, les membres éligibles consécutifs de familles de patients en état critique admis dans une USI ont pris part à une formation familiale sur le delirium à deux volets : 1) le visionnement d’une vidéo de six minutes sur le delirium à l’USI (facteurs de risque, prévention/prise en charge, symptômes, communication avec l’équipe de soins de l’USI), et 2) deux vignettes pour pratiquer le dépistage du delirium à l’aide de questionnaires de dépistage du delirium administrés par la famille (Méthode d’évaluation de la confusion par la famille [FAM-CAM] et Questionnaire de dépistage du delirium ‘ Sour Seven ’)."
sparser
"The fact that the FAM-CAM performed with 77% specificity (compared to 83% specificity for the CAM-ICU) suggests that within the ICU setting, family proxies using this screening tool have a capacity to identify acute delirium that approaches that of experienced and trained providers."
sparser
"For family-based interventions, the following measures will be reported: cumulative time family members spent with patients, proportion of daily tasks (e.g., assistance with glasses/hearing aids, handwashing), successfully completed, length of time spent on stimulating activity, and overall agreement of the FAM-CAM with interview-rated CAM assessments."
sparser
"The CAM was initially designed for evaluating an acute confusion state, called delirium, among older hospitalized patients to decrease their morbidity and mortality, and then the FAM-CAM was further developed to be less time intensive and more user-friendly, which could be administered to FCPs either in person, by telephone, or electronically based on their observations ( xref )."
sparser
"In the present study we found that combining results from family assessments had higher sensitivity and specificity compared to either the FAM-CAM or Sour Seven used alone, which were also higher compared to estimates reported from our earlier diagnostic accuracy study in this sample [ xref ]."
sparser
"Analysis comparing delirium assessments showed there is an observed agreement beyond chance of 79.7 % with a kappa of 0.33 between the assessments by Generalized Linear Mixed Modeling with repeated measures, treating patients and raters as random effects, with FAM-CAM being more likely to report a positive delirium outcome."
sparser
"In preliminary research, the FAM-CAM has been shown to have good agreement with the CAM [ xref – xref ] and has been applied across various settings, including the community, emergency department, ICU, skilled nursing centers, intermediate and post-acute care settings in multiple countries [ xref – xref ] While available evidence supports the FAM-CAM’s strong performance in detecting delirium in adults across these settings, studies specifically examining its performance in postoperative hospital settings and after hospital discharge are limited [ xref , xref ]."
sparser
"The sensitivity of the Chinese version of the FAM-CAM was 0.880, specificity was 0.890, positive predictive value was 0.928, negative predictive value was 0.823, and area under the receiver operating characteristic curve was 0.881 (95% confidence interval: 0.872-0.935, P < 0.01)."
sparser
"The overall postoperative delirium incidence by researchers’ ascertainment defined by at least one positive delirium assessment (CAM or CAM-ICU) in these patients was 18.8 % (154/817), while the overall detection of possible delirium symptoms by the FAM-CAM survey defined by at least one positive FAM-CAM was 22.4 % (183/817)."
sparser
"Preoperative education on recognizing delirium symptoms prepares family members to identify postoperative delirium and reduces caregiver distress. xref , xref The Family Confusion Assessment Method (FAM-CAM) xref is an adaptation of the Confusion Assessment Method (CAM), xref a widely-used delirium screening tool."
sparser
"First, there is a potential bias as one
of the authors (S.K.I.) is a creator or co-creator of four delirium identification
instruments found in our review [CAM, Chart Delirium Identification (CHART-DEL),
Family-Confusion Assessment Method (FAM-CAM), and 3-Minute Diagnostic Assessment
(3D-CAM)]."
sparser
"One drawback of the FAM-CAM is that it requires subsequent confirmation with a formal delirium rating, however, the use of systematic caregiver observations to detect acute changes over time, and to augment other delirium instruments may aid significantly in accurately diagnosing DSD."
sparser
"Further development of caregiver rating instruments like the FAM-CAM that provide a detailed description of the baseline characteristics of a patient with moderate or severe dementia will greatly improve detection and discrimination of an episode of delirium from a patient’s baseline fluctuation of symptoms."
sparser
"Furthermore, the inability to comprehensively report missing data for patients without concurrent researcher delirium assessments and FAM-CAM surveys, or for those not administered a FAM-CAM, may introduce selection and information bias, potentially affecting the accuracy and generalizability of the findings."
sparser
"Participants’ knowledge of the intervention and post-surgical management was tested via Knowledge Expectations of significant others (KEso) and Received Knowledge of significant others (RKso) [ xref ]; confusion assessment method (CAM) and family version (FAM-CAM) [ xref ] were used to measure empowering by knowledge."
sparser
"The SQiD asks, “Do you think [name of patient] has been more
confused lately?” and has comparable diagnostic test characteristics (77%
sensitive and 88% specific for ED delirium). xref Mailhot et al note that one of the benefits of
the FAM-CAM over the SQiD is that the FAM-CAM provides information on all 4 domains of
delirium, whereas the SQiD only provides information on the first feature in delirium,
namely an acute change in cognition."
sparser
"While a larger sample size would significantly improve the power of the study, this was not possible due to (1); a high proportion of patient-carer pairs not providing consent, and (2); factors which did not allow for the FAM-CAM interview to be administered 24–48 h pre and post procedure (i.e. procedures being brought forward)."
sparser
"Recent studies showed that administering two family-administered delirium detection tools (Family Confusion Assessment Method [FAM-CAM] and Sour Seven) among critically ill patients is feasible but has fair but lower diagnostic accuracy than clinical assessments using the Intensive Care Unit Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for the ICU (CAM-ICU). xref Nevertheless, perspectives and expectations of family members and the ICU team on delirium detection by the family have not been explored."
sparser
"The Confusion Assessment Method (CAM) is the most widely used standardized method for the identification of delirium with high sensitivity (94–100%) and specificity (90–95%). xref A version of the CAM for family members and informal caregivers, the Family Confusion Assessment Method (FAM-CAM), has been validated in outpatient and medical inpatient settings. xref , xref The FAM-CAM is completed by family caregivers with the goal of guiding them through describing their observations on the key symptoms of delirium."
sparser
"Among patients with dementia, the FAM-CAM showed higher sensitivity (with dementia, 61%; 95% CI: 41 % - 81% versus without dementia, 43%; 95% CI: 6% - 80%) and lower specificity (with dementia, 74%; 95% CI: 60% - 89% versus without dementia, 91%; 95% CI: 82% - 99%; xref ) and lower LR+ (with dementia 2.2; 95% CI: 0.7 – 3.6 versus without dementia 5.6 95% CI: −1.1, - 12.3)."
sparser
"Among older persons with pre-existing cognitive impairment, Steis et al reported high sensitivity (88%, 95% CI: 47–99) and specificity (98%, 95% CI: 86–100) of the FAM-CAM against the CAM. xref Similarly, among hospitalised older patients, Martins et al used the Portuguese version of the FAM-CAM and also observed high sensitivity (91%, 95% CI:74–97) and specificity (91%, 95% CI:74–97) against the CAM and against the DSM-IV-TR criteria (sensitivity: 75%, 95% CI:35–95; specificity: 86%, 95% CI:42–99). xref Finally, in a study conducted by Bull et al among post-knee or hip surgery patients, a Kappa of 0.47 was observed between the FAM-CAM and the CAM. xref The current study differs from these previous studies in several ways, in particular with regards to the training of family caregivers who completed the FAM-CAM and the blinding of assessors."
sparser
"In contrast, both the Steis and Martins teams offered intensive training for family caregivers that would not be practical in an ED setting. xref , xref In the Bull study, family caregivers were trained in the three weeks before their family member’s elective surgery, to increase their knowledge of delirium and the use of the FAM-CAM. xref Another important distinction between our study and the previous validations of the FAM-CAM was our double blinding of ratings of caregivers and research staff."
sparser
"In adjusted models controlling for age, sex, IQCODE, Emergency Severity Index at triage, and Charlson score, patients who had a hospitalization over the next 6 months were more than three times as likely to have had a positive FAM-CAM score than those who did not have a hospitalization (OR = 3.24, 95% CI = 1.2, 8.9) ( xref )."
sparser
"Inattention, which is easily measured at the bedside, was identified as a symptom of delirium that family members have difficulty identifying and was responsible for 66% of family members’ missed cases of delirium. xref In addition, the sensitivity of the FAM-CAM was higher in patients with dementia compared to those without dementia, highlighting the ability of family members to detect delirium manifestations (e.g., acute change) in a population that is challenging to assess in the ED."