Abstract
Objectives
Shared decision-making (SDM) is essential in hip fracture treatment, as both operative and non-operative management are viable options in a select group of frail older adults with a very limited life expectancy. The aim of this study is to evaluate patient and proxy satisfaction with SDM and their final decision and to gain insight into their experiences.
Design
A multicentre study with a concurrent mixed methods design.
Setting
The study was conducted in 14 hospitals across the Netherlands.
Participants
Proxies from a select group of frail older adults, with a limited life expectancy, with a hip fracture. Of the 167 patients and proxies who engaged in SDM, 1 patient and 79 proxies were interviewed.
Interventions
SDM regarding operative and non-operative hip fracture treatment.
Primary and secondary outcome measures
Patient-specific and treatment-specific characteristics were collected from the Dutch Hip Fracture Audit. Semistructured interviews provided quantitative and qualitative data regarding satisfaction, information and attention for patients wishes.
Results
The median age was 87 years (P
25
-P
75
82–92), and 55 (69%) were female. In 52 patients, non-operative management was the final decision. The median satisfaction score regarding the chosen treatment was 8 out of 10 (P
25
-P
75
7–9). Contributing factors include acknowledging patients’ frailty and ensuring treatment consistency. Access to adequate and honest information and sufficient time allocated was crucial. In 23/78 (30%) cases, participants missed information on technical details and aftercare.
Conclusions
After SDM with frail older hip fracture patients and their proxies, most participants were satisfied with the final decision. However, there are several considerations to improve SDM. This study describes practical insights and recommendations to guide healthcare providers during the SDM process.
Trial registration number
NCT06079905
.