Attitudes to Palliative Care in Patients With Neck-of-Femur Fracture—A Multicenter Survey

Abstract

Introduction: The mortality of patients with neck-of-femur (NOF) fractures remains high, with increasing recognition of a subgroup of patients with predictable mortality. The role of palliative care in this group is poorly understood and underdeveloped. This research aims to investigate current clinician attitudes toward palliative care for patients with NOF fracture, and explore processes in place for early identification for patients nearing the end of life. Materials and Methods: An online survey was constructed with reference to National Institute for Health and Clinical Excellence end-of-life guidelines (CG13) and distributed to multidisciplinary teams involved in the care of NOF fracture patients in 4 hospitals of contrasting size and location in the United Kingdom. Results: Forty health-care professionals with a broad range of seniority and roles responded. The palliative care team was felt to have several potential roles in the care of NOF fracture patients, but there was difference of opinion between specialties about what these were. A number of barriers to palliative referral were identified, including stigma and active surgical management. The majority (75%) felt that all NOF fracture patients should have a discussion about ceiling of care, with difference of opinion about who should do so, and when. Discussion: As the elderly population has grown, so too has the volume of NOF fracture patients. It is increasingly important to identify and escalate patients who have poor prognosis following hip fracture and ensure they benefit from palliative care where appropriate. This survey demonstrates a barrier to addressing the care of these patients and a lack of consensus on identification and referral to appropriate palliative care planning. Conclusions: There should be close communication between specialties with regard to requirements for palliative care in NOF fracture patients, with ongoing education and clear local and national guidance to ensure they receive the right care at the right time.

Multimorbidity and Polytherapy in Patients with Femoral Neck Fracture: A Retrospective Observational Study

“…Since most patients with femoral neck fractures are elderly, they also show other significant associated comorbidities, requiring a complex approach, with consequent high lengths of stay (LOS) in hospital, health costs for the national health system (NHS), morbidity and mortality (nearly 30% after 1 year) [ 6 ]. Femoral neck fractures are usually treated with a surgical approach, performed within 72 h upon arrival at the hospital, which is recommended in elderly patients [ 7 , 8 ].…”

The Quality of Dying in Frail Institutionalized Older Patients After Nonoperative and Operative Management of a Proximal Femoral Fracture: An In-Depth Analysis

“…8 , 9 As Harries et al have pointed out in their study on attitudes and approaches to palliative care in patients with a proximal femoral fracture, a palliative care approach should not be seen as a failure of active management but as an adjunct to holistic care. 24 Early integration of palliative care should therefore be seen as an anticipation that could only contribute to the quality of life and treatment satisfaction.…”

Assessing Preinjury Frailty in the Elderly Hip Fracture Patient to Promote Palliative Care Referral in Those at Risk for High Morbidity and Mortality

“…Including palliative care in the multidisciplinary care of frail, elderly hip fracture patients is appropriate as these injuries can pose a risk to QOL [22]. Palliative care providers assist with symptom management, QOL, and advanced care planning [23,24]. The palliative care team helps patients determine the best management or treatment options considering the patient's prognosis and can assist in providing safe and effective pain management to elderly patients [23,24].…”

“…Palliative care providers assist with symptom management, QOL, and advanced care planning [23,24]. The palliative care team helps patients determine the best management or treatment options considering the patient's prognosis and can assist in providing safe and effective pain management to elderly patients [23,24]. "Recent models of optimal palliative care integration emphasize referral at diagnosis, increasing presence as time progresses, and a shift in focus toward rehabilitation and survivorship care if a patient's illness trajectory improves or toward end-of-life care and hospice referral if their trajectory declines" [24].…”

“…This QI project is intended to improve patient and caregiver QOL and reduce healthcare costs. Palliative care assists with symptom management and advanced care planning, promoting QOL by identifying and respecting the patient's personal goals of care [23]. Palliative care is also associated with lowered healthcare utilization and costs, saving an average of $2,642 -$6,896 per patient by respecting the individual's wishes regarding the plan of care [26].…”