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

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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 languageEnglish
Article numberafac174
JournalAge and Ageing
Issue number8
Publication statusPublished - 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

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:


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