Agitated delirium is common but challenging to manage at the end of life. Sedation with medications called sedatives can be used, but this eliminates the patient’s ability to interact with others. Dexmedetomidine is a sedative, but provides rousable sedation, which means patients can remain alert while still managing their delirium. This study evaluates the safety, feasibility, and efficacy of using dexmedetomidine to manage agitated delirium among 50 palliative care patients in hospital. We will monitor their dosing, side effects, agitation, and delirium. We will also evaluate family caregiver distress and interview 30 caregivers and nurses of trial participants to understand their perceptions of the acceptability of using dexmedetomidine, and if it had any effect on their distress or ability to care for the patient. Dexmedetomidine could improve delirium management for patients without causing excess sedation, allowing patients to interact with others at the end of life and reduce caregiver distress.