Shared decision-making for the treatment of proximal femoral fractures in frail institutionalised older patients: healthcare providers’ perceived barriers and facilitators

Abstract

Introduction Proximal femoral fractures are common in frail institutionalised older patients. No convincing evidence exists regarding the optimal treatment strategy for those with a limited pre-fracture life expectancy, underpinning the importance of shared decision-making (SDM). This study investigated healthcare providers’ barriers to and facilitators of the implementation of SDM. Methods Dutch healthcare providers completed an adapted version of the Measurement Instrument for Determinants of Innovations questionnaire to identify barriers and facilitators. If ≥20% of participants responded with ‘totally disagree/disagree’, items were considered barriers and, if ≥80% responded with ‘agree/totally agree’, items were considered facilitators. Results A total of 271 healthcare providers participated. Five barriers and 23 facilitators were identified. Barriers included the time required to both prepare for and hold SDM conversations, in addition to the reflective period required to allow patients/relatives to make their final decision, and the number of parties required to ensure optimal SDM. Facilitators were related to patients’ values, wishes and satisfaction, the importance of SDM for patients/relatives and the fact that SDM is not considered complex by healthcare providers, is considered to be part of routine care and is believed to be associated with positive patient outcomes. Conclusion Awareness of identified facilitators and barriers is an important step in expanding the use of SDM. Implementation strategies should be aimed at managing time constraints. High-quality evidence on outcomes of non-operative and operative management can enhance implementation of SDM to address current concerns around the outcomes.

Rib Fixation for Multiple Rib Fractures: Healthcare Professionals Perceived Barriers and Facilitators to Clinical Implementation

“…Continuous variables were reported as median and quartiles, and categorical variables as numbers with percentages. Conform previous studies [24][25][26], positively worded statements to which C 20% of the HCPs responded '(totally) disagree' were considered barriers. Positively worded statements to which C 80% of the HCPs responded '(totally) agree' were considered facilitators.…”

Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery?

“…Furthermore, we found that preferences for P-NOM generally increased with perceived mortality risks. These findings underline and confirm that comorbidities leading to increased mortality risk are some of the strongest indicators to favour P-NOM over surgery [ 8 , 66 ].…”

Shared decision-making for non-operative management versus operative management of hip fractures in selected frail older adults with a limited life expectancy: a protocol for a nationwide implementation study

“…Based on the evidence-based ‘Measurement Instrument for Determinants of Innovations’)18 19 and the ‘Barriers and Facilitators Assessment Instrument’, 20 a survey has been developed, aimed to identify the facilitators and barriers for applying SDM and NOM for selecting the best treatment for individual patients of the target population and identified five barriers and 23 facilitators 9. The patient perspective was not included in this study but was explored in another study 11.…”

“…The FRAIL-HIP study has confirmed that non-operative management (NOM) can be a good alternative to operative management in select frail older adults with a limited life expectancy 5 8–10. Quality of life after NOM was valued non-inferiorly and the majority of the next-of-kin rated the quality of dying of their relative as very good 5 8.…”

“…Central to NOM is the shared decision-making (SDM) process, involving patients and their families in treatment decisions aligned with the patients’ preferences and needs. Based on the results of the FRAIL-HIP study and other literature, an implementation protocol has been drafted, piloted and refined based on experiences of healthcare professionals 7 9 12. This protocol version will serve as the starting point for the iterative process towards nationwide implementation.…”