Hip Fracture in the Setting of Limited Life Expectancy: The Importance of Considering Goals of Care and Prognosis
AffiliationUniv Arizona, Coll Med, Dept Med
MetadataShow full item record
PublisherMARY ANN LIEBERT, INC
CitationC. Bree Johnston, Amanda Holleran, Thuan Ong, Ursula McVeigh, and Elizabeth Ames. Journal of Palliative Medicine. Aug 2018. http://doi.org/10.1089/jpm.2018.0029
JournalJOURNAL OF PALLIATIVE MEDICINE
RightsCopyright © 2018, Mary Ann Liebert, Inc.
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at email@example.com.
AbstractImportance: 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.
Note12 month embargo; published online: 1 August 2018
VersionFinal accepted manuscript
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