PDF(Pubmed)
Abstract：
OBJECTIVE: For geriatric hip fracture patients, the decision between surgery and palliative, non-operative management is made through shared decision making (SDM). For this conversation, a physician must be familiar with the patient\'s goals of care (GOC). These are predominantly unknown for hip fracture patients and challenging to assess in acute setting. The objective was to explore these GOC of geriatric patients in case of a hip fracture.
METHODS: An expert panel gathered possible outcomes after a hip fracture, which were transformed into statements where participants indicated their relative importance on a 100-point scoring scale during interviews. These GOC were ranked using medians and deemed important if the median score was 90 or above. Patients were aged 70 years or older with a hip contusion due to similarities with the hip fracture population. Three cohorts based on frailty criteria and the diagnosis of dementia were made.
RESULTS: Preserving cognitive function, being with family and being with partner scored in all groups among the most important GOC. Both non-frail and frail geriatric patients scored return to pre-fracture mobility and maintaining independence among the most important GOC, where proxies of patients with a diagnosis of dementia scored not experiencing pain as the most important GOC.
CONCLUSIONS: All groups scored preserving cognitive function, being with family and being with partner among the most important GOC. The most important GOC should be discussed when a patient is presented with a hip fracture. Since patients preferences vary, a patient-centered assessment of the GOC remains essential.
METHODS: An expert panel gathered possible outcomes after a hip fracture, which were transformed into statements where participants indicated their relative importance on a 100-point scoring scale during interviews. These GOC were ranked using medians and deemed important if the median score was 90 or above. Patients were aged 70 years or older with a hip contusion due to similarities with the hip fracture population. Three cohorts based on frailty criteria and the diagnosis of dementia were made.
RESULTS: Preserving cognitive function, being with family and being with partner scored in all groups among the most important GOC. Both non-frail and frail geriatric patients scored return to pre-fracture mobility and maintaining independence among the most important GOC, where proxies of patients with a diagnosis of dementia scored not experiencing pain as the most important GOC.
CONCLUSIONS: All groups scored preserving cognitive function, being with family and being with partner among the most important GOC. The most important GOC should be discussed when a patient is presented with a hip fracture. Since patients preferences vary, a patient-centered assessment of the GOC remains essential.
摘要：
目的：对于老年髋部骨折患者，手术和姑息治疗之间的决定，非经营性管理是通过共享决策(SDM)进行的。为了这次谈话,医生必须熟悉患者的护理目标（GOC）。对于髋部骨折患者，这些主要是未知的，并且在急性环境中进行评估具有挑战性。目的是探讨老年髋部骨折患者的GOC。
方法：专家小组收集了髋部骨折后的可能结果，将其转化为陈述，其中参与者在访谈期间在100分得分量表上表明了他们的相对重要性。使用中位数对这些GOC进行排名，如果中位数得分为90或以上，则认为这些GOC很重要。由于与髋部骨折人群的相似性，患者年龄在70岁或以上，患有髋部挫伤。根据虚弱标准和痴呆的诊断进行了三个队列。
结果：保持认知功能，在最重要的GOC中，与家人在一起，与伴侣在所有组中得分。在最重要的GOC中，非虚弱和虚弱的老年患者均恢复了骨折前的活动性并保持了独立性，其中被诊断为痴呆症的患者的代理评分为未经历疼痛是最重要的GOC。
结论：所有组得分保持认知功能，与家人在一起，与最重要的GOC伙伴在一起。当患者出现髋部骨折时，应讨论最重要的GOC。由于患者的偏好不同，以患者为中心的GOC评估仍然至关重要.
方法：专家小组收集了髋部骨折后的可能结果，将其转化为陈述，其中参与者在访谈期间在100分得分量表上表明了他们的相对重要性。使用中位数对这些GOC进行排名，如果中位数得分为90或以上，则认为这些GOC很重要。由于与髋部骨折人群的相似性，患者年龄在70岁或以上，患有髋部挫伤。根据虚弱标准和痴呆的诊断进行了三个队列。
结果：保持认知功能，在最重要的GOC中，与家人在一起，与伴侣在所有组中得分。在最重要的GOC中，非虚弱和虚弱的老年患者均恢复了骨折前的活动性并保持了独立性，其中被诊断为痴呆症的患者的代理评分为未经历疼痛是最重要的GOC。
结论：所有组得分保持认知功能，与家人在一起，与最重要的GOC伙伴在一起。当患者出现髋部骨折时，应讨论最重要的GOC。由于患者的偏好不同，以患者为中心的GOC评估仍然至关重要.
