A multicentre survey investigating the knowledge, behaviour, and attitudes of surgical healthcare professionals to frailty assessment in emergency surgery: DEFINE(surgery)

doi:10.1007/s41999-024-00962-7

Multicenter Study

. 2024 Aug;15(4):1047-1053.

doi: 10.1007/s41999-024-00962-7. Epub 2024 Apr 18.

A multicentre survey investigating the knowledge, behaviour, and attitudes of surgical healthcare professionals to frailty assessment in emergency surgery: DEFINE(surgery)

P Braude^{1

2}, F Parry³, K Warren⁴, E Mitchell³, K McCarthy⁵, R G Khadaroo⁶, B Carter⁷; CLARITY (collaborative ageing research) group

Collaborators, Affiliations

Collaborators

CLARITY (collaborative ageing research) group:
Nia Humphry, Sara Long, Heeam Nassa, Arturo Vilches-Moraga, Nahida Bashir, Ashly Thomas, Frances Rickard, Mike Sellick, Paolo Buscemi, Hwei Jene Ng, Terry Quinn, Katrina Knight, Eilidh Bruce, Phyo Kyaw Myint

Affiliations

¹ CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Bristol, UK. philip2.braude@live.uwe.ac.uk.
² Centre for Health and Clinical Research, University of the West of England, Bristol, UK. philip2.braude@live.uwe.ac.uk.
³ CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Bristol, UK.
⁴ Department of Urology, North Bristol NHS Trust, Bristol, UK.
⁵ Colorectal Cancer and Surgery, North Bristol NHS Trust, Bristol, UK.
⁶ Department of Surgery and Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁷ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.

PMID: 38637467
PMCID: PMC11377612
DOI: 10.1007/s41999-024-00962-7

Multicenter Study

A multicentre survey investigating the knowledge, behaviour, and attitudes of surgical healthcare professionals to frailty assessment in emergency surgery: DEFINE(surgery)

P Braude et al. Eur Geriatr Med. 2024 Aug.

. 2024 Aug;15(4):1047-1053.

doi: 10.1007/s41999-024-00962-7. Epub 2024 Apr 18.

Authors

P Braude^{1

2}, F Parry³, K Warren⁴, E Mitchell³, K McCarthy⁵, R G Khadaroo⁶, B Carter⁷; CLARITY (collaborative ageing research) group

Collaborators

CLARITY (collaborative ageing research) group:
Nia Humphry, Sara Long, Heeam Nassa, Arturo Vilches-Moraga, Nahida Bashir, Ashly Thomas, Frances Rickard, Mike Sellick, Paolo Buscemi, Hwei Jene Ng, Terry Quinn, Katrina Knight, Eilidh Bruce, Phyo Kyaw Myint

Affiliations

¹ CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Bristol, UK. philip2.braude@live.uwe.ac.uk.
² Centre for Health and Clinical Research, University of the West of England, Bristol, UK. philip2.braude@live.uwe.ac.uk.
³ CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Bristol, UK.
⁴ Department of Urology, North Bristol NHS Trust, Bristol, UK.
⁵ Colorectal Cancer and Surgery, North Bristol NHS Trust, Bristol, UK.
⁶ Department of Surgery and Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁷ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.

PMID: 38637467
PMCID: PMC11377612
DOI: 10.1007/s41999-024-00962-7

Abstract

Purpose: Screening for frailty in people admitted with emergency surgical pathology can initiate timely referrals to enhanced perioperative services such as intensive care and geriatric medicine. However, there has been little research exploring surgical healthcare professionals' opinions to frailty assessment, or accuracy in identification. This study aimed to assess the knowledge, behaviour, and attitudes of healthcare professionals to frailty assessment in emergency surgical admissions.

Methods: We designed a cross-sectional multicentre study developed by a multiprofessional team of surgeons, geriatricians, and supported by patients. A semi-structured survey examined attitudes and behaviours. Knowledge was assessed by comparing respondents' accuracy in scoring twenty-two surgical case vignettes using the Clinical Frailty Scale.

Results: Eleven hospitals across England, Wales, and Scotland participated. Two hundred and eleven clinicians responded-20.4% junior doctors, 43.6% middle grade doctors, 24.2% senior doctors, 11.4% nurses and physician associates. Respondents strongly supported perioperative frailty assessment. Most were already assessing for frailty, although frequently not using a standardised tool. There was a strong call for more frailty education. Participants scored 2175 vignettes with 55.4% accurately meeting the gold standard; accuracy improved to 87.3% when categorised into "not frail/mildly frail/severely frail" and 94% when dichotomised to "not frail/frail".

Conclusion: Frailty assessment is well supported by healthcare professionals working in surgery. However, standardised tools are not routinely being used, and only half of respondents could accurately identify frailty. Better education around frailty assessment is needed for healthcare professionals working in surgery to improve perioperative pathway for people living with frailty.

Keywords: Attitudes; Frailty; National survey; Perioperative medicine; Surgery.

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Conflict of interest statement

The authors declare no conflict of interests.

Cited by

In-hospital outcomes of older patients with gastric cancer and their risk factors: large comprehensive institution-based study.
Huang L, Liu Y, Wang L, Rong L, Hu W. Huang L, et al. Eur Geriatr Med. 2024 Dec;15(6):1909-1927. doi: 10.1007/s41999-024-01059-x. Epub 2024 Sep 21. Eur Geriatr Med. 2024. PMID: 39305429

References

1. Parmar KL, Law J, Carter B et al (2019) Frailty in older patients undergoing emergency laparotomy: results from the UK observational emergency laparotomy and frailty (ELF) study. Ann Surg. 10.1097/SLA.000000000000340210.1097/SLA.0000000000003402 - DOI - PubMed
1. Hewitt J, Long S, Carter B et al (2018) The prevalence of frailty and its association with clinical outcomes in general surgery: a systematic review and meta-analysis. Age Ageing 47:793–800 10.1093/ageing/afy110 - DOI - PubMed
1. Lin H-S, Watts JN, Peel NM, Hubbard RE (2016) Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr 16:157. 10.1186/s12877-016-0329-8 10.1186/s12877-016-0329-8 - DOI - PMC - PubMed
1. Shipway D, Partridge J, Braude P, Vilches-Moraga A (2020) British geriatric society position statement: older patients undergoing emergency laparotomy. Age Ageing. 10.1093/ageing/afaa172 10.1093/ageing/afaa172 - DOI - PubMed
1. NHS England (2021) Consultation on 2021/22 National Tariff Payment System Annex DtC: Guidance on best practice tariffs

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[1] Parmar KL, Law J, Carter B et al (2019) Frailty in older patients undergoing emergency laparotomy: results from the UK observational emergency laparotomy and frailty (ELF) study. Ann Surg. 10.1097/SLA.000000000000340210.1097/SLA.0000000000003402 - DOI - PubMed

[2] Parmar KL, Law J, Carter B et al (2019) Frailty in older patients undergoing emergency laparotomy: results from the UK observational emergency laparotomy and frailty (ELF) study. Ann Surg. 10.1097/SLA.000000000000340210.1097/SLA.0000000000003402 - DOI - PubMed

[3] Hewitt J, Long S, Carter B et al (2018) The prevalence of frailty and its association with clinical outcomes in general surgery: a systematic review and meta-analysis. Age Ageing 47:793–800 10.1093/ageing/afy110 - DOI - PubMed

[4] Hewitt J, Long S, Carter B et al (2018) The prevalence of frailty and its association with clinical outcomes in general surgery: a systematic review and meta-analysis. Age Ageing 47:793–800 10.1093/ageing/afy110 - DOI - PubMed

[5] Lin H-S, Watts JN, Peel NM, Hubbard RE (2016) Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr 16:157. 10.1186/s12877-016-0329-8 10.1186/s12877-016-0329-8 - DOI - PMC - PubMed

[6] Lin H-S, Watts JN, Peel NM, Hubbard RE (2016) Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr 16:157. 10.1186/s12877-016-0329-8 10.1186/s12877-016-0329-8 - DOI - PMC - PubMed

[7] Shipway D, Partridge J, Braude P, Vilches-Moraga A (2020) British geriatric society position statement: older patients undergoing emergency laparotomy. Age Ageing. 10.1093/ageing/afaa172 10.1093/ageing/afaa172 - DOI - PubMed

[8] Shipway D, Partridge J, Braude P, Vilches-Moraga A (2020) British geriatric society position statement: older patients undergoing emergency laparotomy. Age Ageing. 10.1093/ageing/afaa172 10.1093/ageing/afaa172 - DOI - PubMed

[9] NHS England (2021) Consultation on 2021/22 National Tariff Payment System Annex DtC: Guidance on best practice tariffs

[10] NHS England (2021) Consultation on 2021/22 National Tariff Payment System Annex DtC: Guidance on best practice tariffs

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A multicentre survey investigating the knowledge, behaviour, and attitudes of surgical healthcare professionals to frailty assessment in emergency surgery: DEFINE(surgery)

Collaborators

Affiliations

A multicentre survey investigating the knowledge, behaviour, and attitudes of surgical healthcare professionals to frailty assessment in emergency surgery: DEFINE(surgery)

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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Abstract

Conflict of interest statement

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