Qualitative Evaluation of a Novel Educational Tool to Communicate Individualized Hip Fracture Prognostic Information to Patients and Surrogates: My Hip Fracture (My-HF)

Abstract

Introduction Mortality and morbidity are high for older adults after hip fracture (HF), but patients and surrogate decision makers (SDMs) are typically unaware of the poor prognosis. We developed a novel educational tool, My Hip Fracture (My-HF), to provide patients and SDMs of patients hospitalized with acute HF individualized estimates of their post-HF prognosis. We conducted initial usability testing of My-HF in a sample of patients with HF and SDMs. Materials and Methods My-HF provides information about: 1) anatomy and risk factors for HF; 2) Hip fracture treatment received; 3) individualized predicted risk of adverse events and 4) anticipated discharge trajectory. We conducted a qualitative usability study using a convenience sample of hospitalized, post-operative patients with acute HF or SDMs of patients who lacked decision-making capacity. We used semi-structured interviews to obtain feedback. Thematic analysis was used to identify themes and concepts. Results We conducted interviews with 8 patients and 9 SDMs (mean age of interviewees 70.1 years, 41% female). My-HF was generally well received. Thematic analysis identified legibility and visual appeal, comprehension, numeracy, utility and reflection as prominent themes. Most respondents found My-HF to be useful in improving their understanding of HF and as a potential mechanism for sharing information with other care team members (including family and professionals). Suggestions for improvement of legibility, presentation of the individualized prognosis information and content were identified. Discussion Patients and SDMs are generally accepting of My-HF and found it useful for communicating individualized prognostic information. Feedback identified areas for improvement for future iterations of the tool. Conclusion My-HF presents a means of addressing the gap in understanding of prognosis post-HF as a part of patient-centered care. Further evaluation will be needed to assess the impact of My-HF on patient and SDM reported outcomes as we transition from a paper to smart-phone enabled web application.

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

“…Additionally, in the setting of hip fracture, where many institutions are implementing hip fracture care pathways, 14,18,19 discussions about prognosis and goals of care could be incorporated along key points, 28 to show that this communication is prioritized. This would also be consistent with existing research showing that patients and families welcome additional information about prognosis after hip fracture and increased communication during transitions of care 29,30 …”

“…This would also be consistent with existing research showing that patients and families welcome additional information about prognosis after hip fracture and increased communication during transitions of care. 29,30 There were strengths and limitations to this study. The major strength of this study was that the interview design allowed us to elicit rich, deep information about complex systems and interactions.…”

Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis

“…During the postoperative period, patients with hip fracture and their caregivers receive numerous recommendations, including early ambulation, exercise and rehabilitation programs, preventing postoperative complications, modifying home hazards, and taking nutrition supplements [ 24 ]. Therefore, effective communication skills with specific feedback are crucial for delivering accurate knowledge and information and ultimately leading to positive functional outcomes [ 24 , 59 , 60 ].…”