Satisfaction regarding shared decision-making for operative and non-operative hip fracture treatment in frail older adults from a proxy-perspective: a mixed methods study
8 affiliations
- 1Department of Trauma Surgery, St Antonius Hospital, Utrecht, The Netherlands
- 2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- 3Department of Internal Medicine and Geriatrics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- 4Department of Orthopedics and Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
- 5Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- 6Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- 7Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
- 8Department of Clinical Geriatrics, Rijnstate Hospital, Arnhem, The Netherlands
Abstract
Objectives: Shared decision-making (SDM) is essential in hip fracture treatment, as both operative and non-operative management are viable options in a select group of frail older adults with a very limited life expectancy. The aim of this study is to evaluate patient and proxy satisfaction with SDM and their final decision and to gain insight into their experiences.
Design: A multicentre study with a concurrent mixed methods design.
Setting: The study was conducted in 14 hospitals across the Netherlands.
Participants: Proxies from a select group of frail older adults, with a limited life expectancy, with a hip fracture. Of the 167 patients and proxies who engaged in SDM, 1 patient and 79 proxies were interviewed.
Interventions: SDM regarding operative and non-operative hip fracture treatment.
Primary and secondary outcome measures: Patient-specific and treatment-specific characteristics were collected from the Dutch Hip Fracture Audit. Semistructured interviews provided quantitative and qualitative data regarding satisfaction, information and attention for patients wishes.
Results: The median age was 87 years (P ₂₅ -P ₇₅ 82–92), and 55 (69%) were female. In 52 patients, non-operative management was the final decision. The median satisfaction score regarding the chosen treatment was 8 out of 10 (P ₂₅ -P ₇₅ 7–9). Contributing factors include acknowledging patients’ frailty and ensuring treatment consistency. Access to adequate and honest information and sufficient time allocated was crucial. In 23/78 (30%) cases, participants missed information on technical details and aftercare.
Conclusions: After SDM with frail older hip fracture patients and their proxies, most participants were satisfied with the final decision. However, there are several considerations to improve SDM. This study describes practical insights and recommendations to guide healthcare providers during the SDM process.
Trial registration number: NCT06079905 .
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BibTeX
@article{oosterwijk2026satisfaction,
title = {{Satisfaction regarding shared decision-making for operative and non-operative hip fracture treatment in frail older adults from a proxy-perspective: a mixed methods study}},
author = {Paulieke C Oosterwijk and Miliaan L Zeelenberg and Henk J Schuijt and Detlef Van der Velde and Dennis Den Hartog and Taco Gosens and Pieter Joosse and Sverre A I Loggers and Thomas M P Nijdam and Johannes J M van Delden and Hugo H Wijnen and Michael H J Verhofstad and Esther M M Van Lieshout and Hanna C Willems},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-117789},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-117789},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Satisfaction regarding shared decision-making for operative and non-operative hip fracture treatment in frail older adults from a proxy-perspective: a mixed methods study
AU - Paulieke C Oosterwijk
AU - Miliaan L Zeelenberg
AU - Henk J Schuijt
AU - Detlef Van der Velde
AU - Dennis Den Hartog
AU - Taco Gosens
AU - Pieter Joosse
AU - Sverre A I Loggers
AU - Thomas M P Nijdam
AU - Johannes J M van Delden
AU - Hugo H Wijnen
AU - Michael H J Verhofstad
AU - Esther M M Van Lieshout
AU - Hanna C Willems
PY - 2026
DA - 2026/10/06
JO - BMJ Open
DO - 10.1136/bmjopen-2026-117789
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-117789
AB - Objectives: Shared decision-making (SDM) is essential in hip fracture treatment, as both operative and non-operative management are viable options in a select group of frail older adults with a very limited life expectancy. The aim of this study is to evaluate patient and proxy satisfaction with SDM and their final decision and to gain insight into their experiences. Design: A multicentre study with a concurrent mixed methods design. Setting: The study was conducted in 14 hospitals across the Netherlands. Participants: Proxies from a select group of frail older adults, with a limited life expectancy, with a hip fracture. Of the 167 patients and proxies who engaged in SDM, 1 patient and 79 proxies were interviewed. Interventions: SDM regarding operative and non-operative hip fracture treatment. Primary and secondary outcome measures: Patient-specific and treatment-specific characteristics were collected from the Dutch Hip Fracture Audit. Semistructured interviews provided quantitative and qualitative data regarding satisfaction, information and attention for patients wishes. Results: The median age was 87 years (P ₂₅ -P ₇₅ 82–92), and 55 (69%) were female. In 52 patients, non-operative management was the final decision. The median satisfaction score regarding the chosen treatment was 8 out of 10 (P ₂₅ -P ₇₅ 7–9). Contributing factors include acknowledging patients’ frailty and ensuring treatment consistency. Access to adequate and honest information and sufficient time allocated was crucial. In 23/78 (30%) cases, participants missed information on technical details and aftercare. Conclusions: After SDM with frail older hip fracture patients and their proxies, most participants were satisfied with the final decision. However, there are several considerations to improve SDM. This study describes practical insights and recommendations to guide healthcare providers during the SDM process. Trial registration number: NCT06079905 .
SN - 2044-6055
SN - 2044-6055
ER -