Patient and Caregiver Understanding of Prognosis After Hip Fracture
Keywords:hip fracture, shared decision-making, prognosis, informed consent
Hip fracture (HF) is common and requires communication between patient, family, surgeons, and hospitalists. Patient and family understanding of the seriousness of HF is unclear.
We interviewed older patients (age > 65 years) hospitalized with HF at two Canadian academic hospitals, or their surrogate decision-makers (SDMs). We used qualitative methods to explore understanding of HF treatment options and prognosis. Participants estimated probability of mortality and living independently 30 days after surgery. Results were compared with estimates from the National Surgery Quality Improvement Program (NSQIP) surgical risk calculator.
9 patients and 3 SDMs were interviewed. Mean age of 12 patients was 82.5 years (75% female). Participants were uncertain about recovery timeline and degree of functional recovery, as well as content and duration of rehabilitation. Participants’ mean estimated 30-day mortality of 6.7% did not differ significantly from estimated mortality predicted by NSQIP (7.5%; p = .88). Participants’ mean estimated probability of living independently 30 days after surgery was 90.8% (range 65–100%).
Older patients and SDMs lack understanding about prognosis and functional recovery even after providing informed consent for HF surgery. Clinical teams should improve communication of prognosis and recovery information to patients and surrogates.
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