Background: Delirium is a common and serious complication in people living with cancer (1). While most delirium research has focused on inpatient settings, a substantial proportion of cancer care is delivered in outpatient environments where delirium remains under-recognised and under-studied (2,3). This study explored clinicians’ perspectives regarding delirium in outpatient cancer care, including identifying opportunities for improving delirium prevention, detection and management in this setting.
Methods: A qualitative study involving online focus groups or semi-structured interviews with clinicians who worked in any outpatient cancer care setting in Australia (with an initial target of n=20). Participants were recruited through professional networks, social media, and snowball sampling to maximise disciplinary diversity. Recruitment continued until data saturation was achieved. Discussions were audio-recorded, transcribed verbatim, and analysed thematically.
Results: Fifteen clinicians (cancer nurse n=9, allied health n=2, oncologist n=1, palliative physician n=1, nurse practitioner n=1, radiation therapist n=1) participated across two focus groups and five interviews. Five themes emerged: (1) Delirium perceived as clinically complex, often overlapping with treatment-related symptoms (e.g. ‘chemo-brain’); the episodic nature of outpatient care further limits timely detection; (2) Outpatient systems lack the infrastructure required for delirium care, such as integrated assessment tools, referral pathways, and outpatient-specific models of care; (3) Structural limitations contribute to the de-prioritisation of delirium, with competing cancer-related concerns often taking precedence; (4) In the absence of formal pathways, delirium care relies on informal, ad hoc and clinician-driven processes to assess and manage delirium in the community; (5) Opportunities for improvement centred on embedding delirium in day 1 patient education and implementing outpatient-specific pathways, tools, and resources to facilitate early recognition and management.
Conclusion: Delirium care in outpatient cancer settings is constrained by clinical complexity, structural barriers, and low prioritisation, highlighting the need for outpatient-specific approaches to prevention, recognition, and management.