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

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Title: Physicians' perspectives of prognosis and goals of care discussions after hip fracture.
Authors: Murthy, Sushila (AUTHOR), Clapp, Justin T. (AUTHOR), Burson, Randall C. (AUTHOR), Fleisher, Lee A. (AUTHOR), Neuman, Mark D. (AUTHOR)
Source: Journal of the American Geriatrics Society. May2022, Vol. 70 Issue 5, p1487-1494. 8p.
Subjects: Hip fractures, Prognosis, Physicians' attitudes, Goal (Psychology), Patient care, Quality of life, Medical communication
Abstract: Background: Hip fracture often represents a major transition in patients' health, with a 1‐year mortality rate between 25% and 30% and a challenging recovery course. Caring for hip fracture patients presents opportunities for goals of care discussions that include prognostic information and guidance about functional dependence. Methods: We conducted qualitative, semi‐structured interviews with 23 attending physicians involved with the care of hip fracture patients, including orthopedic surgeons, anesthesiologists, internists, and geriatricians, across 13 health systems in the United States and Canada. Questions addressed knowledge and interpretation of prognosis, discussing prognosis and goals of care, and timing and prioritization of surgery. Interviews were analyzed using a constructivist grounded theory approach to identify themes and develop a coding taxonomy. Results: Physicians agreed that hip fracture had a considerable 1‐year mortality, felt that it was important to discuss prognostic outcomes and the recovery process, wanted to elucidate patients' priorities, and often promoted timely surgery. Physicians perceived challenges when discussing mortality data with new patients in an acute setting. They more easily discussed outcomes related to functional dependence and quality of life. Some physicians used iterative communication as a strategy to have in‐depth conversations in a busy perioperative setting. Conclusion: Providing timely, compassionate care for hip fracture patients is challenging. There are opportunities to study iterative communication to encourage dialogue at key points of patient care to better discuss prognosis and recovery and bolster coordinated multidisciplinary care that focuses on patients' goals and values. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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DbLabel: Psychology and Behavioral Sciences Collection
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PubType: Academic Journal
PubTypeId: academicJournal
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  Data: Physicians' perspectives of prognosis and goals of care discussions after hip fracture.
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  Data: <searchLink fieldCode="AR" term="%22Murthy%2C+Sushila%22">Murthy, Sushila</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Clapp%2C+Justin+T%2E%22">Clapp, Justin T.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Burson%2C+Randall+C%2E%22">Burson, Randall C.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fleisher%2C+Lee+A%2E%22">Fleisher, Lee A.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Neuman%2C+Mark+D%2E%22">Neuman, Mark D.</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+the+American+Geriatrics+Society%22">Journal of the American Geriatrics Society</searchLink>. May2022, Vol. 70 Issue 5, p1487-1494. 8p.
– Name: Subject
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  Data: <searchLink fieldCode="DE" term="%22Hip+fractures%22">Hip fractures</searchLink><br /><searchLink fieldCode="DE" term="%22Prognosis%22">Prognosis</searchLink><br /><searchLink fieldCode="DE" term="%22Physicians'+attitudes%22">Physicians' attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Goal+%28Psychology%29%22">Goal (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+care%22">Patient care</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+of+life%22">Quality of life</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+communication%22">Medical communication</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Hip fracture often represents a major transition in patients' health, with a 1‐year mortality rate between 25% and 30% and a challenging recovery course. Caring for hip fracture patients presents opportunities for goals of care discussions that include prognostic information and guidance about functional dependence. Methods: We conducted qualitative, semi‐structured interviews with 23 attending physicians involved with the care of hip fracture patients, including orthopedic surgeons, anesthesiologists, internists, and geriatricians, across 13 health systems in the United States and Canada. Questions addressed knowledge and interpretation of prognosis, discussing prognosis and goals of care, and timing and prioritization of surgery. Interviews were analyzed using a constructivist grounded theory approach to identify themes and develop a coding taxonomy. Results: Physicians agreed that hip fracture had a considerable 1‐year mortality, felt that it was important to discuss prognostic outcomes and the recovery process, wanted to elucidate patients' priorities, and often promoted timely surgery. Physicians perceived challenges when discussing mortality data with new patients in an acute setting. They more easily discussed outcomes related to functional dependence and quality of life. Some physicians used iterative communication as a strategy to have in‐depth conversations in a busy perioperative setting. Conclusion: Providing timely, compassionate care for hip fracture patients is challenging. There are opportunities to study iterative communication to encourage dialogue at key points of patient care to better discuss prognosis and recovery and bolster coordinated multidisciplinary care that focuses on patients' goals and values. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/jgs.17642
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        Text: English
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              Text: May2022
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