Shared decision-making for non-operative management versus operative management of hip fractures in selected frail older adults with a limited life expectancy: a protocol for a nationwide implementation study
,
Suzanne Polinder,
Detlef van der Velde,
Taco Gosens,
Esther M M van Lieshout,
Michael H J Verhofstad,
Pieter Joosse,
K de Vries,
Dennis Den Hartog,
J. Jansen,
Ruth E Pel-Littel,
Henk Jan Schuijt,
Miliaan L Zeelenberg,
Paulieke C Oosterwijk,
Hanna C Willems,
Sverre A I Loggers,
Thomas MP Nijdam,
Hugo H Wijnen,
E. Sohl,
J.A. Jansen,
M. Leijnen,
W.A.H. Van der Stappen,
M Peters-Kop,
A.H. Van der Veen,
N.C. Schepel,
J.A.M. Wilmer,
J. Steens,
J. Winkelhagen,
N.M.F. Noorda,
H.A.A.M. Maas,
O. Wijers,
V. Vis,
D. Van der Stap,
G.R. Roukema,
E. Bosma,
T.M. Van Raaij,
A.M. Van der Knaap,
R. De Groot,
A.V.C.M. Zeegers,
H.A. Formijne Jonkers,
D.H.R. Kempen,
A.F Pull ter Gunne,
M.P. Somford,
E. Tanis,
J.H. Duits,
R.A. Zandbergen,
N.C. Leegwater,
O.C. Geraghty,
J.H. Hegeman,
E.M. Regtuijt
Affiliations
Antimicrobial Resistance Research Group, Centre for Neonatal and Paediatric Infection, St George`s University of London, London, UK
Suzanne Polinder
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
Detlef van der Velde
Department of Surgery, Sint Antonius Ziekenhuis, Utrecht, the Netherlands
Taco Gosens
Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
Esther M M van Lieshout
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
Michael H J Verhofstad
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
Pieter Joosse
Department of Trauma Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
K de Vries
Dennis Den Hartog
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
J. Jansen
Ruth E Pel-Littel
Vilans, Utrecht, the Netherlands
Henk Jan Schuijt
Department of Trauma Surgery, Sint Antonius Hospital, Utrecht, the Netherlands
Miliaan L Zeelenberg
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
Paulieke C Oosterwijk
Department of Trauma Surgery, Sint Antonius Ziekenhuis, Utrecht, the Netherlands
Hanna C Willems
Department of Geriatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
Sverre A I Loggers
Department of Trauma Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
Thomas MP Nijdam
Department of Surgery, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands
Hugo H Wijnen
Department of Clinical Geriatrics, Rijnstate, Arnhem, the Netherlands
Background and purpose Recent research has highlighted non-operative management (NOM) as a viable alternative for frail older adults with hip fractures in the final phase of life. This study aims to guide Dutch physicians and hospitals nationwide in a standardised implementation of shared decision-making regarding surgery or NOM in selected frail older adults with a hip fracture.Methods and analysis The patient population for implementation includes frail older adults aged ≥70 years with an acute proximal femoral fracture, nursing home care or a similar level of care elsewhere and at least one additional criterion (ie, malnutrition, severe mobility impairment or ASA≥4). The 2-year implementation study will be conducted in four phases. In phases 1 and 2, barriers and facilitators for implementation will be identified and an implementation protocol, educational materials and patient information will be developed. Phase 3 will involve an implementation pilot in 14 hospitals across the Netherlands. The protocol and educational material will be improved based on healthcare provider and patient experiences gathered through interviews. Phase 4 will focus on upscaling to nationwide implementation and the effect of the implementation on NOM rate will be measured using data from the Dutch Hip Fracture Audit.Ethics and dissemination The study was exempted by the local Medical Research Ethics Committee (MEC-2023-0270, 10 May 2023) and Medical Ethics Committee United (W23.083, 26 April 2023). The study’s results will be submitted to an open access international peer-reviewed journal. Its protocols, tools and results will be presented at several national and international academic conferences of relevant orthogeriatric (scientific) associations.Trial registration number NCT06079905.
