Perception of Goals and Expected Outcomes in Older Hip Fracture Patients and Their Medical Staff: A Cross Sectional Study

Hanna S Schroeder; Avi Israeli; Meir Iri Liebergall; Omer Or; Wiessam Abu Ahmed; Ora Paltiel; Dan Justo; Eyal Zimlichman

doi:10.1177/21514593231202735

Perception of Goals and Expected Outcomes in Older Hip Fracture Patients and Their Medical Staff: A Cross Sectional Study

Geriatr Orthop Surg Rehabil. 2023 Sep 22:14:21514593231202735. doi: 10.1177/21514593231202735. eCollection 2023.

Authors

Hanna S Schroeder^{1

2}, Avi Israeli^{3

4

5}, Meir Iri Liebergall⁶, Omer Or⁶, Wiessam Abu Ahmed², Ora Paltiel², Dan Justo^{7

8}, Eyal Zimlichman^{8

9}

Affiliations

¹ Department of Nursing at the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
² Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
³ Dr. Julien Rozan Professor of Healthcare, Hebrew University - Hadassah Medical School, Jerusalem, Israel.
⁴ Hadassah University Medical Center, Jerusalem, Israel.
⁵ Israel Ministry of Health, Jerusalem, Israel.
⁶ Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel.
⁷ Geriatrics Division, Sheba Medical Center, Ramat-Gan, Israel.
⁸ Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
⁹ Central Management, Sheba Medical Center, Ramat-Gan, Israel.

Abstract

Background: Goal-oriented patientcare is a key element in qualityhealthcare. Medical-caregiver's (MC) are expected to generate a shared decision-making process with patients regarding goals and expected health-outcomes. Hip-fracture patients (HFP) are usually older-adults with multiple health-conditions, necessitating that agreed-upon goals regarding the rehabilitation process, take these conditions into consideration. This topic has yet to be investigated by pairing and comparing the perception of expected outcomes and therapeutic goals of multidisciplinary MCs and their HF patient's. Our aim was to assess in a quantitative method whether HFPs and their multidisciplinary MCs agree upon target health-outcomes and their most important goals as they are reflected in the SF12 questionnaire.

Methods: This was a cross-sectional, multi-center, study of HFPs and their MCs. Patients and MCs were asked to rate their top three most important goals for rehabilitation from the SF12 eight subscales: physical functioning, physical role limitation, bodily pain, general health, vitality, social functioning, emotional role limitation and mental health, and indicate their expected outcome. Descriptive statistics and mixed effect logistic-regression were used to compare concordance of the ratings. Agreement between patients and MCs was assessed using interclass coefficients (ICCs).

Results: A total of 378 ratings were collected from 52 patients, 12 nurses, 12 physicians and 6 paramedical personnel. Each patient had between 3 and 9 raters. Patients considered physical functioning and physical role limitation more important than did MCs. Physicians and nurses emphasized the importance of bodily pain while patients referred to it as relatively less significant. The total ICC was low (2%) indicating poor agreement between MCs and patients. With the exception of physical-functioning, MCs predicted a less optimistic outcome in all of the SF12's subscales in comparison to HFPs.

Conclusion: Effective intervention in HFPs requires constructive communication between MCs and patients. The study suggests that caregivers have an insufficient understanding of the expectations of HFPs. More effective communication channels are required in order to better understand HFPs' needs and expectations.

Keywords: communication; goal-oriented healthcare; hip fracture; older adults; patient reported outcomes; rehabilitation.