Emily Hladkowicz1, Kristin Dorrance1, Gregory L Bryson1,2,3, Alan Forster3,4, Sylvain Gagne1,2, Allen Huang3,4, Manoj M Lalu1,2,3, Luke T Lavallée3,5, Husein Moloo3,6, Janet Squires3,7,8, Daniel I McIsaac9,10,11,12,13. 1. Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. 2. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. 3. Ottawa Hospital Research Institute, Ottawa, ON, Canada. 4. Departments of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada. 5. Division of Urology, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada. 6. Division of General Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada. 7. School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. 8. School of Nursing, University of Ottawa, Ottawa, ON, Canada. 9. Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. dmcisaac@toh.ca. 10. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. dmcisaac@toh.ca. 11. Ottawa Hospital Research Institute, Ottawa, ON, Canada. dmcisaac@toh.ca. 12. School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. dmcisaac@toh.ca. 13. Department of Anesthesiology, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave., Ottawa, ON, K1Y 4E9, Canada. dmcisaac@toh.ca.
Abstract
PURPOSE: Preoperative frailty assessment is recommended by multiple practice guidelines and may improve outcomes, but it is not routinely performed. The barriers and facilitators of routine preoperative frailty assessment have not been formally assessed. Our objective was to perform a theory-guided evaluation of barriers and facilitators to preoperative frailty assessment. METHODS: This was a research ethics board-approved qualitative study involving physicians who perform preoperative assessment (consultant and resident anesthesiologists and consultant surgeons). Semistructured interviews were conducted by a trained research assistant informed by the Theoretical Domains Framework to identify barriers and facilitators to frailty assessment. Interview transcripts were independently coded by two research assistants to identify specific beliefs relevant to each theoretical domain. RESULTS: We interviewed 28 clinicians (nine consultant anesthesiologists, nine consultant surgeons, and ten anesthesiology residents). Six domains (Knowledge [100%], Social Influences [96%], Social Professional Role and Identity [96%], Beliefs about Capabilities [93%], Goals [93%], and Intentions [93%]) were identified by > 90% of respondents. The most common barriers identified were prioritization of other aspects of assessment (e.g., cardio/respiratory) and a lack of awareness of evidence and guidelines supporting frailty assessment. The most common facilitators were a high degree of familiarity with frailty, recognition of the importance of frailty assessment, and strong intentions to perform frailty assessment. CONCLUSION: Barriers and facilitators to preoperative frailty assessment are multidimensional, but generally consistent across different types of perioperative physicians. Knowledge of barriers and facilitators can guide development of evidence-based strategies to increase frailty assessment.
PURPOSE: Preoperative frailty assessment is recommended by multiple practice guidelines and may improve outcomes, but it is not routinely performed. The barriers and facilitators of routine preoperative frailty assessment have not been formally assessed. Our objective was to perform a theory-guided evaluation of barriers and facilitators to preoperative frailty assessment. METHODS: This was a research ethics board-approved qualitative study involving physicians who perform preoperative assessment (consultant and resident anesthesiologists and consultant surgeons). Semistructured interviews were conducted by a trained research assistant informed by the Theoretical Domains Framework to identify barriers and facilitators to frailty assessment. Interview transcripts were independently coded by two research assistants to identify specific beliefs relevant to each theoretical domain. RESULTS: We interviewed 28 clinicians (nine consultant anesthesiologists, nine consultant surgeons, and ten anesthesiology residents). Six domains (Knowledge [100%], Social Influences [96%], Social Professional Role and Identity [96%], Beliefs about Capabilities [93%], Goals [93%], and Intentions [93%]) were identified by > 90% of respondents. The most common barriers identified were prioritization of other aspects of assessment (e.g., cardio/respiratory) and a lack of awareness of evidence and guidelines supporting frailty assessment. The most common facilitators were a high degree of familiarity with frailty, recognition of the importance of frailty assessment, and strong intentions to perform frailty assessment. CONCLUSION: Barriers and facilitators to preoperative frailty assessment are multidimensional, but generally consistent across different types of perioperative physicians. Knowledge of barriers and facilitators can guide development of evidence-based strategies to increase frailty assessment.
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