C Bree Johnston1, Amanda Holleran2, Thuan Ong3, Ursula McVeigh4, Elizabeth Ames5. 1. 1 Department of Medicine, University of Arizona College of Medicine , Tucson, Arizona. 2. 2 Orthopedics and Rehabilitation, University of Vermont College of Medicine , Burlington, Vermont. 3. 3 Geriatrics, University of Washington , Seattle, Washington. 4. 4 Providence Alaska Medical Group, WWAMI Regional Division, University of Washington School of Medicine , Anchorage, Alaska. 5. 5 Department of Orthopedics and Rehabilitation, University of Vermont College of Medicine , Burlington, Vermont.
Abstract
IMPORTANCE: Many older patients with a limited life expectancy experience fragility fracture of the hip, and this event is associated with increased risk of premature mortality, functional decline, and institutionalization. The treating team, in collaboration with patients and their families, must determine whether a surgical or conservative approach is in the patient's best interest when a patient has limited life expectancy. OBSERVATION: Goals of care discussions appear to be rare in the setting of fragility fracture. The urgent nature of the problem makes such discussions challenging. We believe that many physicians have not considered goals of care discussions to be a standard component of fragility fracture management. CONCLUSIONS: We propose that physicians caring for patients with limited life expectancy and fragility fracture of the hip should initiate a goals of care discussion to help determine whether operative repair will be the most patient-centered approach. Training on conducting goals of care discussions should be a standard part of surgical training programs. Goals of care discussions should include prognosis, patient values and preferences, pain, likelihood for functional recovery, and burdens and benefits of surgical versus nonsurgical management. Multidisciplinary input is required, and many patients will benefit from geriatric and/or palliative care team involvement.
IMPORTANCE: Many older patients with a limited life expectancy experience fragility fracture of the hip, and this event is associated with increased risk of premature mortality, functional decline, and institutionalization. The treating team, in collaboration with patients and their families, must determine whether a surgical or conservative approach is in the patient's best interest when a patient has limited life expectancy. OBSERVATION: Goals of care discussions appear to be rare in the setting of fragility fracture. The urgent nature of the problem makes such discussions challenging. We believe that many physicians have not considered goals of care discussions to be a standard component of fragility fracture management. CONCLUSIONS: We propose that physicians caring for patients with limited life expectancy and fragility fracture of the hip should initiate a goals of care discussion to help determine whether operative repair will be the most patient-centered approach. Training on conducting goals of care discussions should be a standard part of surgical training programs. Goals of care discussions should include prognosis, patient values and preferences, pain, likelihood for functional recovery, and burdens and benefits of surgical versus nonsurgical management. Multidisciplinary input is required, and many patients will benefit from geriatric and/or palliative care team involvement.
Entities:
Keywords:
goals of care; hip fracture; limited life expectancy
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