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. 2024 Apr 17;14(4):e083429.
doi: 10.1136/bmjopen-2023-083429.

Shared decision-making for non-operative management versus operative management of hip fractures in selected frail older adults with a limited life expectancy: a protocol for a nationwide implementation study

Miliaan L Zeelenberg #  1 , Paulieke C Oosterwijk #  2 , Hanna C Willems  3 , Taco Gosens  4 , Dennis Den Hartog  1 , Pieter Joosse  5 , Sverre A I Loggers  5 , Thomas Mp Nijdam  6 , Ruth E Pel-Littel  7 , Suzanne Polinder  8 , Henk Jan Schuijt  9 , Hugo H Wijnen  10 , Detlef Van der Velde  11 , Esther M M Van Lieshout  12 , Michael H J Verhofstad  1 ; NOM-Implementation study group
Collaborators, Affiliations

Shared decision-making for non-operative management versus operative management of hip fractures in selected frail older adults with a limited life expectancy: a protocol for a nationwide implementation study

Miliaan L Zeelenberg et al. BMJ Open. .

Abstract

Background and purpose: Recent research has highlighted non-operative management (NOM) as a viable alternative for frail older adults with hip fractures in the final phase of life. This study aims to guide Dutch physicians and hospitals nationwide in a standardised implementation of shared decision-making regarding surgery or NOM in selected frail older adults with a hip fracture.

Methods and analysis: The patient population for implementation includes frail older adults aged ≥70 years with an acute proximal femoral fracture, nursing home care or a similar level of care elsewhere and at least one additional criterion (ie, malnutrition, severe mobility impairment or ASA≥4). The 2-year implementation study will be conducted in four phases. In phases 1 and 2, barriers and facilitators for implementation will be identified and an implementation protocol, educational materials and patient information will be developed. Phase 3 will involve an implementation pilot in 14 hospitals across the Netherlands. The protocol and educational material will be improved based on healthcare provider and patient experiences gathered through interviews. Phase 4 will focus on upscaling to nationwide implementation and the effect of the implementation on NOM rate will be measured using data from the Dutch Hip Fracture Audit.

Ethics and dissemination: The study was exempted by the local Medical Research Ethics Committee (MEC-2023-0270, 10 May 2023) and Medical Ethics Committee United (W23.083, 26 April 2023). The study's results will be submitted to an open access international peer-reviewed journal. Its protocols, tools and results will be presented at several national and international academic conferences of relevant orthogeriatric (scientific) associations.

Trial registration number: NCT06079905 .

Keywords: Frailty; GERIATRIC MEDICINE; Hip; Implementation Science; ORTHOPAEDIC & TRAUMA SURGERY.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Schematic overview of the implementation process in four phases. DHFA, Dutch Hip Fracture Audit; NOM, non-operative management. FRAIL-HIP study8
Figure 2
Figure 2
Map of participating hospitals during the initial implementation in selected hospitals (phase 3).
See this image and copyright information in PMC

References

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