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

Inge Spronk; Sverre A.I. Loggers; Pieter Joosse; Hanna C. Willems; Romke Van Balen; Taco Gosens; Kornelis J. Ponsen; Jeroen Steens; L. C.P.Marc Van de Ree; Rutger G. Zuurmond; Michael H.J. Verhofstad; Esther M.M. Van Lieshout; Suzanne Polinder

doi:10.1093/ageing/afac174

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

Inge Spronk^*, Sverre A.I. Loggers, Pieter Joosse, Hanna C. Willems, Romke Van Balen, Taco Gosens, Kornelis J. Ponsen, Jeroen Steens, L. C.P.Marc Van de Ree, Rutger G. Zuurmond, Michael H.J. Verhofstad, Esther M.M. Van Lieshout, Suzanne Polinder

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

6 Citations (Scopus)

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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.

Original language	English
Article number	afac174
Journal	Age and Ageing
Volume	51
Issue number	8
DOIs	https://doi.org/10.1093/ageing/afac174
Publication status	Published - 1 Aug 2022

Bibliographical note

Declaration of Sources of Funding: The Netherlands
Organization for Health Research and Development
(ZonMw; ref. no. 843,004,120) and Osteosynthesis and
Trauma Care Foundation (ref. no. 2019-PJKP) funded
this study but did not play a role in the design and
conduct of the study; collection, management, analysis and
interpretation of the data; preparation, review or approval of
the manuscript; and decision to submit the manuscript for
publication.

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: [email protected].

Funding Information:
The Netherlands Organization for Health Research and Development (ZonMw; ref. no. 843,004,120) and Osteosynthesis and Trauma Care Foundation (ref. no. 2019-PJKP) funded this study but did not play a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2022 The Author(s).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ageing/afac174Licence: CC BY-NC

afac174Final published version, 0.99 MBLicence: CC BY-NC

Cite this

Spronk, I., Loggers, S. A. I., Joosse, P., Willems, H. C., Van Balen, R., Gosens, T., Ponsen, K. J., Steens, J., Van de Ree, L. C. P. M., Zuurmond, R. G., Verhofstad, M. H. J., Van Lieshout, E. M. M., & Polinder, S. (2022). Shared decision-making for the treatment of proximal femoral fractures in frail institutionalised older patients: healthcare providers' perceived barriers and facilitators. Age and Ageing, 51(8), Article afac174. https://doi.org/10.1093/ageing/afac174

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title = "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.",

author = "Inge Spronk and Loggers, {Sverre A.I.} and Pieter Joosse and Willems, {Hanna C.} and {Van Balen}, Romke and Taco Gosens and Ponsen, {Kornelis J.} and Jeroen Steens and {Van de Ree}, {L. C.P.Marc} and Zuurmond, {Rutger G.} and Verhofstad, {Michael H.J.} and {Van Lieshout}, {Esther M.M.} and Suzanne Polinder",

note = "Declaration of Sources of Funding: The Netherlands Organization for Health Research and Development (ZonMw; ref. no. 843,004,120) and Osteosynthesis and Trauma Care Foundation (ref. no. 2019-PJKP) funded this study but did not play a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: [email protected]. Funding Information: The Netherlands Organization for Health Research and Development (ZonMw; ref. no. 843,004,120) and Osteosynthesis and Trauma Care Foundation (ref. no. 2019-PJKP) funded this study but did not play a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2022 The Author(s).",

year = "2022",

month = aug,

day = "1",

doi = "10.1093/ageing/afac174",

language = "English",

volume = "51",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "8",

}

Spronk, I , Loggers, SAI, Joosse, P, Willems, HC, Van Balen, R, Gosens, T, Ponsen, KJ, Steens, J, Van de Ree, LCPM, Zuurmond, RG, Verhofstad, MHJ , Van Lieshout, EMM & Polinder, S 2022, 'Shared decision-making for the treatment of proximal femoral fractures in frail institutionalised older patients: healthcare providers' perceived barriers and facilitators', Age and Ageing, vol. 51, no. 8, afac174. https://doi.org/10.1093/ageing/afac174

Shared decision-making for the treatment of proximal femoral fractures in frail institutionalised older patients: healthcare providers' perceived barriers and facilitators. / Spronk, Inge ; Loggers, Sverre A.I.; Joosse, Pieter et al.
In: Age and Ageing, Vol. 51, No. 8, afac174, 01.08.2022.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Shared decision-making for the treatment of proximal femoral fractures in frail institutionalised older patients

T2 - healthcare providers' perceived barriers and facilitators

AU - Spronk, Inge

AU - Loggers, Sverre A.I.

AU - Joosse, Pieter

AU - Willems, Hanna C.

AU - Van Balen, Romke

AU - Gosens, Taco

AU - Ponsen, Kornelis J.

AU - Steens, Jeroen

AU - Van de Ree, L. C.P.Marc

AU - Zuurmond, Rutger G.

AU - Verhofstad, Michael H.J.

AU - Van Lieshout, Esther M.M.

AU - Polinder, Suzanne

N1 - Declaration of Sources of Funding: The Netherlands Organization for Health Research and Development (ZonMw; ref. no. 843,004,120) and Osteosynthesis and Trauma Care Foundation (ref. no. 2019-PJKP) funded this study but did not play a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: [email protected]. Funding Information: The Netherlands Organization for Health Research and Development (ZonMw; ref. no. 843,004,120) and Osteosynthesis and Trauma Care Foundation (ref. no. 2019-PJKP) funded this study but did not play a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © 2022 The Author(s).

PY - 2022/8/1

Y1 - 2022/8/1

N2 - 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.

AB - 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.

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U2 - 10.1093/ageing/afac174

DO - 10.1093/ageing/afac174

M3 - Article

C2 - 35930725

AN - SCOPUS:85135600212

SN - 0002-0729

VL - 51

JO - Age and Ageing

JF - Age and Ageing

IS - 8

M1 - afac174

ER -

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

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Bibliographical note

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