Screening and Detection of Delirium in the Acute Palliative Care Setting Using the "Months of The Year Backwards" Test: A Cross-Sectional Study.

INTRODUCTION Delirium is a common disorder in patients with serious illness with prevalence ranging between 9% and 57% at the time of initial palliative care (PC) consultation. If detected early, morbidity and mortality from delirium can be reduced significantly. This study aims to evaluate the performance of the Months of the Year Backwards (MOTYB) test as a promising screening tool for delirium in the acute PC setting.

METHODS This multi-site cross-sectional study included patients who received PC consultation at our institutions over 6 months. Recruiting PC professionals determined delirium status, including definite and possible diagnosis, using DSM-5-TR criteria. We assessed the ease of administration and predictive performance of the MOTYB test by comparing logistic regression models on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiving operating characteristic (ROC) curve (AUC).

RESULTS In total, 147 patients (59.2% women, 58.5% African American, mean age 65.9 years) WERE INCLUDED: 34 patients (23%) were designated with having delirium by DSM-5-TR criteria. Not reaching January or reaching January in over 90 seconds provided the highest sensitivity (93.8%) and NPV (95.7%).

DISCUSSION Different models of the MOTYB test demonstrated high prediction of delirium on initial PC consultation, with consistently high sensitivity, NPV, and AUC of the ROC. These findings support its utility as an effective screening tool for delirium in this context. The MOTYB test can be seamlessly integrated into the initial biopsychosocial and spiritual assessment in PC, significantly enhancing providers' ability to address the complex challenge of delirium in serious illness.