Treating Delirium in Palliative Care: Verbal De-escalation & Medication Options

How do you handle agitation, hallucinations and drowsiness caused by delirium in a loved one with advanced illness? In Part 3 of our delirium series, Dr. Jonathan Wong explains evidence-based communication tools (SMILE approach) and medication options used to treat symptoms of delirium and to prioritize patient safety at end of life. Learn the SMILE approach for communicating with patients who may be disoriented or delirious. Learn when medications such as antipsychotics and benzodiazepines becomes necessary and learn about the important side effects to watch out for. 00:00 Intro 00:58 Declarations & Disclaimers 01:23 First steps to treat delirium 01:51 Theme of safety 02:30 Vivid dreams & hallucinations - Cultural context 03:22 SMILE approach & strategy 08:33 When to use medications to treat delirium? 09:25 What is considered not safe? 10:33 Common medications used to treat delirium - Antipsychotics 13:04 Benzodiazepines 13:46 Route of medications 14:50 Side effects to watch out for 16:37 Hypoactive forms of Delirium - Treatments 17:24 Summary Links to Parts 1 and 2 on delirium:    • What is Delirium in Palliative Care? Signs...      • How to Recognize and Prevent Delirium | 4A...   About this channel: Welcome to Palliative Care Explained - a channel aimed at answering your questions about palliative care and end of life care. My name is Dr. Jonathan Wong (MD, FRCPC) and I am a palliative care doctor based out of Winnipeg, Canada. Brought online March 28, 2025, Palliative Care Explained is a channel aimed at answering your questions about palliative care. My formal medical training is in internal medicine and palliative care and I have been working in the field of palliative care since 2011. It is my hope that this channel will better inform viewers about palliative care, end of life care and living with a serious illness. Intro music written & recorded by: Jonathan Wong Committee advisors and content reviewers: Dr. P. Daeninck MD, MSc, FRCPC Dr. E. Giannouli MD, FRCPC Dr. J. Strutinsky-Mason MD, MSc, MRCP (UK) Dr. J. Webb MD, CCFP-PC Disclaimer and medical-legal statements: *As a medical professional speaking to you, I hereby declare that I do not have any conflicts of interest that would compromise the integrity of the presented information. *I do not have any financial sponsors nor am I receiving any funding from the pharmaceutical industry. *This channel and its production, is my own undertaking, with support from other palliative care experts. *This video series is for educational purposes only and is intended for audiences in Canada. *The presented information may not be applicable to all viewers. *I am not providing any direct medical treatment or advice to the viewer. *These videos are not meant to imply or establish a therapeutic relationship with the viewer. *These videos are not to replace or subvert the advice from the viewer’s own doctor or health care provider team. *Any further questions should be directed to the medical team most familiar with the viewer’s unique situation. References and further reading: SMILE approach - Regional Geriatric Program of Toronto Delirium/Restlessness. Fraser Health Hospice Palliative Care Program Symptom Guidelines Delirium in Palliative Care. Bramati & Bruera. Cancers 2021, 13, 5893 Benzodiazepines for Agitation in Patients with Delirium. Selecting the right patient, right time and right indication. Hui, D. Curr Opin Support Palliat Care. 2018 Dec; 12(4):489-494. Hospice Patients' End-of-life dreams and visions: A Systematic Review of Qualitative Studies. Rabitti et al. American J of Hospice & Palliative Medicine 2024, Vol 4(1)99-112 Culture and Hallucinations: Overview and Future Directions Laroi et al. Schizophrenia Bulletin Vo 40 suppl. no.4 S213-220 Impacting Outcomes in the Hospitalized Oncology Patient: Evidence-Informed Quality and Safety Project to Implement Routine Screening for Delirium. Vonnes C et al. Patient Safety Vol 4, No3, Sept 2022 Effectiveness of non-pharmacological and pharmacological interventions in preventing delirium in older adults: A systematic review and meta-analysis of randomized controlled trials. Sanchez A et al. Age and Ageing, Vol. 55, No 3, March 2026 Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Burton JK et al. Cochrane Database Syst Rev. 2021 Nov 26; 11(11) Delirium: Prevention, diagnosis and management in hospital and long-term care. NICE (National Institute for Health and Care Excellence) Guideline. July 28 2010 & 2023. Palliative Medicine – A Cased Based Manual Fourth Edition MacDonald S, Herx L, Boyle A Copyright Oxford University Press 2022. Published by Oxford University Press. Oxford Textbook of Palliative Medicine Sixth Edition Cherny N, Fallon M, Kaasa S, Portenoy R, Currow D. Copyright Oxford University Press 2021. Published by Oxford University Press.