What are the goals of care for geriatric hip fracture patients?

Abstract text (incl. references and figure legends)

Introduction

For the frailest, geriatric hip fracture patients with a limited life expectancy, the decision between surgery and palliative, non-operative management is made via shared decision-making. A physician must be familiar with the patient's goals of care. These goals of care are often unknown in the acute hip fracture setting. The objective of this study was to explore the most clinical relevant goals of care of geriatric hip fracture patients to support the physician in the SDM process when hip fracture patient is presented.

Material & Methods

Patients were eligible for inclusion if they were aged >70 years or above and were presented with a suspected hip fracture but were eventually diagnosed with a contusion. An expert panel articulated possible (wanted and unwanted) outcomes after hip fracture, and those outcomes were transformed into statements where participants could indicate their relative importance on a 100-point scoring scale during structured interviews. Patients were divided in groups based on cognition and frailty. For cognitive impaired patients the goals of care were proxy reported. The scores were expressed as medians and interquartile ranges.

Results

Sixty patients were subjected to the interview. The overal top three goals of care of geriatric patients were: 1) family presence, 2) maintaining cognition, 3) remaining mobile. In the frail group there was a clear decrease in scoring for rehabilitation and mobility with higher scores on quality of life over length of life. Proxies reported overall family presence and quality of life as the most important goals of care.

Conclusion

Patients considered family presence as the most important goal of care. During shared decision-making, the top three goals of care should at least be discussed when a patient is presented at the emergency department with a hip fracture. However, patients" perspective in the gathering of these goals of care remain required.

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