Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study
Objective The objective of this study was to explore the experiences from the period after the choice was made for palliative, non-operative management for geriatric patients with a hip fracture, to the most important factors in the process, as reported by a proxy.Design Semistructured interviews we...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/8/e063007.full |
| _version_ | 1811216511008768000 |
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| author | Detlef van der Velde Thomas Marcus Paulus Nijdam Duco Willem Pieter Marie Laane Jelle Friso Spierings Henk Jan Schuijt Diederik Pieter Johan Smeeing |
| author_facet | Detlef van der Velde Thomas Marcus Paulus Nijdam Duco Willem Pieter Marie Laane Jelle Friso Spierings Henk Jan Schuijt Diederik Pieter Johan Smeeing |
| author_sort | Detlef van der Velde |
| collection | DOAJ |
| description | Objective The objective of this study was to explore the experiences from the period after the choice was made for palliative, non-operative management for geriatric patients with a hip fracture, to the most important factors in the process, as reported by a proxy.Design Semistructured interviews were conducted between 1 August 2020 and 1 April 2021 to investigate by-proxy reported patient experiences of non-operative management after hip fracture. Interviews followed a topic guide, recorded and transcribed per word. Thematic analysis was used to identify themes in the data.Setting and participants Patients were retrospectively identified from the electronic patient record. Relatives (proxies) of the patients who underwent palliative, non-operative management were contacted and were asked to participate in a semistructured interview and were named participants. The participants were proxies of the patients since patients were expected to be deceased during the timing of the interview.Results A total of 26 patients were considered eligible for inclusion in this study. The median age of the patients was 88 years (IQR 83–94). The 90-day mortality rate was 92.3%, with a median palliative care period of 11 days (IQR 4–26). A total of 19 participants were subjected to the interview. After thematic analysis, four recurring themes were identified: (1) the decision-making process, (2) pain experience, (3) patient–relative interaction and (4) the active dying.Conclusions With the introduction of shared decision-making in an acute setting for geriatric patients with hip fracture, proxies reported palliative, non-operative management as an acceptable and adequate option for patients with high risk of adverse outcomes after surgery. The emerged themes in palliative care for patients with hip fracture show great similarity with severe end-stage disease palliative care, with pain identified as the most important factor influencing comfort of the patient and their environment after hip fracture. Future research should focus on further improving targeted analgesia for these patients focusing on acute pain caused by the fracture. |
| first_indexed | 2024-04-12T06:40:18Z |
| format | Article |
| id | doaj.art-4d563876af534bd287223a239c495edc |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-12T06:40:18Z |
| publishDate | 2022-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-4d563876af534bd287223a239c495edc2022-12-22T03:43:45ZengBMJ Publishing GroupBMJ Open2044-60552022-08-0112810.1136/bmjopen-2022-063007Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative studyDetlef van der Velde0Thomas Marcus Paulus Nijdam1Duco Willem Pieter Marie Laane2Jelle Friso Spierings3Henk Jan Schuijt4Diederik Pieter Johan Smeeing5Department of Surgery, Sint Antonius Ziekenhuis, Utrecht, The NetherlandsDepartment of Surgery, St Antonius Ziekenhuis Locatie Utrecht, Utrecht, The NetherlandsDepartment of Surgery, St Antonius Ziekenhuis Locatie Utrecht, Utrecht, The NetherlandsDepartment of Surgery, St Antonius Ziekenhuis Locatie Utrecht, Utrecht, The NetherlandsDepartment of Surgery, St Antonius Ziekenhuis Locatie Utrecht, Utrecht, The NetherlandsDepartment of Surgery, St Antonius Ziekenhuis Locatie Utrecht, Utrecht, The NetherlandsObjective The objective of this study was to explore the experiences from the period after the choice was made for palliative, non-operative management for geriatric patients with a hip fracture, to the most important factors in the process, as reported by a proxy.Design Semistructured interviews were conducted between 1 August 2020 and 1 April 2021 to investigate by-proxy reported patient experiences of non-operative management after hip fracture. Interviews followed a topic guide, recorded and transcribed per word. Thematic analysis was used to identify themes in the data.Setting and participants Patients were retrospectively identified from the electronic patient record. Relatives (proxies) of the patients who underwent palliative, non-operative management were contacted and were asked to participate in a semistructured interview and were named participants. The participants were proxies of the patients since patients were expected to be deceased during the timing of the interview.Results A total of 26 patients were considered eligible for inclusion in this study. The median age of the patients was 88 years (IQR 83–94). The 90-day mortality rate was 92.3%, with a median palliative care period of 11 days (IQR 4–26). A total of 19 participants were subjected to the interview. After thematic analysis, four recurring themes were identified: (1) the decision-making process, (2) pain experience, (3) patient–relative interaction and (4) the active dying.Conclusions With the introduction of shared decision-making in an acute setting for geriatric patients with hip fracture, proxies reported palliative, non-operative management as an acceptable and adequate option for patients with high risk of adverse outcomes after surgery. The emerged themes in palliative care for patients with hip fracture show great similarity with severe end-stage disease palliative care, with pain identified as the most important factor influencing comfort of the patient and their environment after hip fracture. Future research should focus on further improving targeted analgesia for these patients focusing on acute pain caused by the fracture.https://bmjopen.bmj.com/content/12/8/e063007.full |
| spellingShingle | Detlef van der Velde Thomas Marcus Paulus Nijdam Duco Willem Pieter Marie Laane Jelle Friso Spierings Henk Jan Schuijt Diederik Pieter Johan Smeeing Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study BMJ Open |
| title | Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study |
| title_full | Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study |
| title_fullStr | Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study |
| title_full_unstemmed | Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study |
| title_short | Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study |
| title_sort | proxy reported experiences of palliative non operative management of geriatric patients after a hip fracture a qualitative study |
| url | https://bmjopen.bmj.com/content/12/8/e063007.full |
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