Editorial: Improving End of Life Care in Orthopaedics

Neuman, Mark D.

doi:10.1007/s11999-010-1763-0

Cited by 3 publications

(6 citation statements)

References 16 publications

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“…This can dovetail nicely with the American Orthopaedic Association's ''Own the Bone'' campaign, especially its emphasis on ''customized letters to the primary-care physician'' [20]. Neuman noted [12] that ''acute orthopaedic care offers distinct opportunities to improve the overall experiences of dying patients and their families in ways that may extend beyond the care they deliver for a specific, presenting injury.'' Our data suggest that, at least during the acute hospitalization period, these opportunities are not exploited with high frequency.…”

Section: Discussionmentioning

confidence: 99%

End-of-life Care Planning and Fragility Fractures of the Hip: Are We Missing a Valuable Opportunity?

Dunn

Ahn

Bernstein

2016

Clinical Orthopaedics &Amp; Related Research

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Background Approximately 20% of all geriatric patients who sustain low-energy hip fractures will die within 1 year of the injury, and approximately 3% will die during the initial inpatient hospital stay. Accordingly, the event of a geriatric hip fracture might be an apt prompt for discussing end-of-life care: in light of the risk of death after this injury, the topic of mortality certainly is germane. However, it is not clear to what degree physicians and patients engage in end-of-life planning even when faced with a hospital admission for this potentially life-threatening condition. Questions/purposes We assessed the frequency with which end-of-life care discussions were documented among a sample of geriatric patients admitted for hip fracture surgery. Methods We studied 150 adult patients, 70 years and older, admitted between September 2008 and July 2012 for the care of an isolated low-energy hip fracture, who did not have documented evidence of end-of-life care planning before the time of admission. For each patient, the medical record was scrutinized to identify documentation of end-oflife care discussions, an order changing ''code status,'' or a progress note memorializing a conversation related to the topic of end-of-life care planning. Results Of the 150 subjects who had no documented evidence of end-of-life care planning at the time of admission, 17 (11%) had their code status changed during the initial hospitalization for hip fracture, and an additional four patients (3%) had a documented conversation regarding end-of-life care planning without a subsequent change in code status. Accordingly, there were 129 (86%) patients who had no record of any attention to end-of-life care planning during the hospital stay for hip fracture surgery. Conclusions Our findings suggest that physicians may be missing a valuable opportunity to help patients and their families be better prepared for potential future health issues. End-of-life care planning respects patient autonomy and enhances the quality of care. Accordingly, we recommend that discussion of goals, expectations, and preferences should be initiated routinely when patients present with a fragility fracture of the hip. Level of Evidence Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

End-of-life Care Planning and Fragility Fractures of the Hip: Are We Missing a Valuable Opportunity?

Dunn

Ahn

Bernstein

2016

Clinical Orthopaedics &Amp; Related Research

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“…Several attempts have been made to identify elderly patients at risk of having a hip fracture and those likely to have poor outcomes after hip fracture. 1,[26][27][28] This has resulted in the identification of some risk factors, such as dementia and end-stage renal disease 4 ; however, current screening criteria are not yet concise and accurate enough to identify the most at-risk patients. 28 In brief, admission for hip fracture is a unique opportunity to have informed discussions and to update and document the preferences of high-risk, vulnerable elderly patients before it is too late.…”

Section: Introductionmentioning

confidence: 99%

“…1 –3 Because of the high incidence and poor prognosis of elderly patients with hip fracture, hospital admission provides a unique opportunity to evaluate and update patients’ preferred code status and advance directives. 4 Neuman and colleagues postulate that “providers of orthopaedic care therefore may serve as important points of contact with the healthcare system for patients near the end of life, and may engage with patients in decisions regarding healthcare services, such as surgery, with implications for the duration and quality of life. For these reasons, acute orthopaedic care offers distinct opportunities to improve the overall experiences of dying patients and their families in ways that may extend beyond the care they deliver for a specific, presenting injury.” 4(p898) While the idea of discussing death and dying may be disconcerting to both the patient and the provider in the perioperative period, there is an alternative perspective to be considered.…”

Section: Introductionmentioning

confidence: 99%

“…4 Neuman and colleagues postulate that “providers of orthopaedic care therefore may serve as important points of contact with the healthcare system for patients near the end of life, and may engage with patients in decisions regarding healthcare services, such as surgery, with implications for the duration and quality of life. For these reasons, acute orthopaedic care offers distinct opportunities to improve the overall experiences of dying patients and their families in ways that may extend beyond the care they deliver for a specific, presenting injury.” 4(p898) While the idea of discussing death and dying may be disconcerting to both the patient and the provider in the perioperative period, there is an alternative perspective to be considered. Similar to preparing a will while in good health, admission for hip fracture represents an opportunity for elderly patients and their families to have informed discussions and document updated preferences in an acute, nonemergent setting before the patient is gravely ill or imminently dying.…”

Section: Introductionmentioning

confidence: 99%

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Hip Fracture in the Elderly Patients: A Sentinel Event

Koso

Sheets²,

Richardson

et al. 2017

Am J Hosp Palliat Care

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“…[1][2][3][4][5] In this setting, experts have advocated for goals of care discussions that include prognostic information and guidance about functional dependence. [6][7][8] A potential barrier to goals of care discussions with hip fracture patients is the acute nature of patients' presentations. The American Academy of Orthopedic Surgeons (AAOS) recommends surgery within 48 h of patient presentation.…”

Section: Introductionmentioning

confidence: 99%

Physicians' perspectives of prognosis and goals of care discussions after hip fracture

Murthy

Clapp

Burson

et al. 2022

J American Geriatrics Society

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Background Hip fracture often represents a major transition in patients' health, with a 1‐year mortality rate between 25% and 30% and a challenging recovery course. Caring for hip fracture patients presents opportunities for goals of care discussions that include prognostic information and guidance about functional dependence. Methods We conducted qualitative, semi‐structured interviews with 23 attending physicians involved with the care of hip fracture patients, including orthopedic surgeons, anesthesiologists, internists, and geriatricians, across 13 health systems in the United States and Canada. Questions addressed knowledge and interpretation of prognosis, discussing prognosis and goals of care, and timing and prioritization of surgery. Interviews were analyzed using a constructivist grounded theory approach to identify themes and develop a coding taxonomy. Results Physicians agreed that hip fracture had a considerable 1‐year mortality, felt that it was important to discuss prognostic outcomes and the recovery process, wanted to elucidate patients' priorities, and often promoted timely surgery. Physicians perceived challenges when discussing mortality data with new patients in an acute setting. They more easily discussed outcomes related to functional dependence and quality of life. Some physicians used iterative communication as a strategy to have in‐depth conversations in a busy perioperative setting. Conclusion Providing timely, compassionate care for hip fracture patients is challenging. There are opportunities to study iterative communication to encourage dialogue at key points of patient care to better discuss prognosis and recovery and bolster coordinated multidisciplinary care that focuses on patients' goals and values.

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Editorial: Improving End of Life Care in Orthopaedics

Cited by 3 publications

References 16 publications

End-of-life Care Planning and Fragility Fractures of the Hip: Are We Missing a Valuable Opportunity?

End-of-life Care Planning and Fragility Fractures of the Hip: Are We Missing a Valuable Opportunity?

Hip Fracture in the Elderly Patients: A Sentinel Event

Physicians' perspectives of prognosis and goals of care discussions after hip fracture

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