Abstract
Introduction:
The mortality of patients with neck-of-femur fractures remains high, with increasing recognition of a sub group of patients with predictable mortality. The role of palliative care in this group is poorly understood and under-developed. This research aims to investigate current clinician attitudes towards palliative care for patients with neck-of-femur fracture, and explore processes in place for early identification for patients nearing the end of life.
Materials and Methods:
An online survey was constructed with reference to NICE end-of-life guidelines (CG13) and distributed to multi-disciplinary teams involved in the care of neck-of-femur fracture patients in 4 hospitals of contrasting size and location in the United Kingdom.
Results:
Forty healthcare professionals with a broad range of seniority and roles responded. The palliative care team was felt to have several potential roles in the care of neck-of-femur fracture patients, but there was difference of opinion between specialties about what these were. A number of barriers to palliative referral were identified, including stigma and active surgical management. The majority (75%) felt that all neck-of-femur fracture patients should have a discussion about ceiling of care, with difference of opinion about who should do so, and at when.
Discussion
As the elderly population has grown, so too has the volume of neck-of-femur fracture patients. It is increasingly important to identify and escalate patients who have poor prognosis following hip fracture and ensure they benefit from palliative care where appropriate. This survey demonstrates a barrier to addressing the care of these patients and a lack of consensus on identification and referral to appropriate palliative care planning.
Conclusions
There should be close communication between specialties with regard to requirements for palliative care in neck-of-femur fracture patients, with ongoing education and clear local and national guidance to ensure they receive the right care at the right time.
The mortality of patients with neck-of-femur fractures remains high, with increasing recognition of a sub group of patients with predictable mortality. The role of palliative care in this group is poorly understood and under-developed. This research aims to investigate current clinician attitudes towards palliative care for patients with neck-of-femur fracture, and explore processes in place for early identification for patients nearing the end of life.
Materials and Methods:
An online survey was constructed with reference to NICE end-of-life guidelines (CG13) and distributed to multi-disciplinary teams involved in the care of neck-of-femur fracture patients in 4 hospitals of contrasting size and location in the United Kingdom.
Results:
Forty healthcare professionals with a broad range of seniority and roles responded. The palliative care team was felt to have several potential roles in the care of neck-of-femur fracture patients, but there was difference of opinion between specialties about what these were. A number of barriers to palliative referral were identified, including stigma and active surgical management. The majority (75%) felt that all neck-of-femur fracture patients should have a discussion about ceiling of care, with difference of opinion about who should do so, and at when.
Discussion
As the elderly population has grown, so too has the volume of neck-of-femur fracture patients. It is increasingly important to identify and escalate patients who have poor prognosis following hip fracture and ensure they benefit from palliative care where appropriate. This survey demonstrates a barrier to addressing the care of these patients and a lack of consensus on identification and referral to appropriate palliative care planning.
Conclusions
There should be close communication between specialties with regard to requirements for palliative care in neck-of-femur fracture patients, with ongoing education and clear local and national guidance to ensure they receive the right care at the right time.
| Original language | English |
|---|---|
| Number of pages | 7 |
| Journal | Geriatric Orthopaedic Surgery & Rehabilitation |
| Volume | 11 |
| DOIs | |
| Publication status | Published - 16 Apr 2020 |
Keywords
- HIP FRACTURE
- palliative care