Miliaan L Zeelenberg, Sverre A I Loggers, Pieter Joosse, Esther M M Van Lieshout, Taco Gosens
{"title":"住院和非住院体弱老年(疑似)髋部骨折患者非手术临终关怀的满意度和死亡质量:一项联合队列研究","authors":"Miliaan L Zeelenberg, Sverre A I Loggers, Pieter Joosse, Esther M M Van Lieshout, Taco Gosens","doi":"10.2340/17453674.2025.42998","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and purpose: </strong> For frail institutionalized hip fracture patients who opt for nonoperative management (NOM), the additional treatment benefits of hospital admission and in-hospital diagnostics are not well evaluated. We aimed to describe and compare treatment satisfaction and quality of dying for patients who refrained from hospitalization after a hip fracture and patients who were treated nonoperatively after a short period of hospitalization.</p><p><strong>Methods: </strong>Both cohorts included very frail institutionalized hip fracture patients. The first group directly started supportive care in their own nursing home after a suspected hip fracture. The second opted for NOM during shared decision-making after admission and diagnostics at the hospital. Primary outcomes were treatment satisfaction and quality of dying measured by the Quality of Dying and Death Questionnaire (QODD). Secondary outcomes included health-related quality of life (EuroQoL-5D-5L and Qualidem), pain, and medication.</p><p><strong>Results: </strong> 20 non-hospitalized and 88 hospitalized patients were included. Overall treatment satisfaction by proxies was high for both the non-hospitalized 9 (interquartile range [IQR] 8-10) and hospitalized patients 8 (IQR 4-9). Quality of dying was rated higher in the non-hospitalized group with QODD 8.3, IQR 6.9-8.6 versus 7.0, IQR 5.7-7.8, and median difference 1.0 (95% confidence interval [CI] 0.1-1.8). Health-related quality of life, measured by the EQ-5D-5L utility score, was low in both groups but higher in non-hospitalized patients (0.30, IQR 0.15-0.32) than in hospitalized patients (0.25, IQR 0.03-0.32, median difference: 0.03, CI -0.03 to 0.09). Both groups reported similar pain levels, but hospitalized patients used higher standardized daily doses of opiates (68 mg vs 39 mg, median difference 24 mg, CI 7-42).</p><p><strong>Conclusion: </strong> Proxies of hospitalized and non-hospitalized patients report high treatment satisfaction after opting for NOM. Non-hospitalization may have a beneficial effect on quality of dying in selected patients who have pre-recorded do-not-hospitalize directives or shared decision-making after a suspected hip fracture.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"167-173"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849162/pdf/","citationCount":"0","resultStr":"{\"title\":\"Satisfaction and quality of dying with nonoperative end-of-life care for hospitalized and non-hospitalized frail older patients with (suspected) hip fractures: a combined cohort study.\",\"authors\":\"Miliaan L Zeelenberg, Sverre A I Loggers, Pieter Joosse, Esther M M Van Lieshout, Taco Gosens\",\"doi\":\"10.2340/17453674.2025.42998\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and purpose: </strong> For frail institutionalized hip fracture patients who opt for nonoperative management (NOM), the additional treatment benefits of hospital admission and in-hospital diagnostics are not well evaluated. We aimed to describe and compare treatment satisfaction and quality of dying for patients who refrained from hospitalization after a hip fracture and patients who were treated nonoperatively after a short period of hospitalization.</p><p><strong>Methods: </strong>Both cohorts included very frail institutionalized hip fracture patients. The first group directly started supportive care in their own nursing home after a suspected hip fracture. The second opted for NOM during shared decision-making after admission and diagnostics at the hospital. Primary outcomes were treatment satisfaction and quality of dying measured by the Quality of Dying and Death Questionnaire (QODD). Secondary outcomes included health-related quality of life (EuroQoL-5D-5L and Qualidem), pain, and medication.</p><p><strong>Results: </strong> 20 non-hospitalized and 88 hospitalized patients were included. Overall treatment satisfaction by proxies was high for both the non-hospitalized 9 (interquartile range [IQR] 8-10) and hospitalized patients 8 (IQR 4-9). Quality of dying was rated higher in the non-hospitalized group with QODD 8.3, IQR 6.9-8.6 versus 7.0, IQR 5.7-7.8, and median difference 1.0 (95% confidence interval [CI] 0.1-1.8). Health-related quality of life, measured by the EQ-5D-5L utility score, was low in both groups but higher in non-hospitalized patients (0.30, IQR 0.15-0.32) than in hospitalized patients (0.25, IQR 0.03-0.32, median difference: 0.03, CI -0.03 to 0.09). Both groups reported similar pain levels, but hospitalized patients used higher standardized daily doses of opiates (68 mg vs 39 mg, median difference 24 mg, CI 7-42).</p><p><strong>Conclusion: </strong> Proxies of hospitalized and non-hospitalized patients report high treatment satisfaction after opting for NOM. Non-hospitalization may have a beneficial effect on quality of dying in selected patients who have pre-recorded do-not-hospitalize directives or shared decision-making after a suspected hip fracture.</p>\",\"PeriodicalId\":6916,\"journal\":{\"name\":\"Acta Orthopaedica\",\"volume\":\"96 \",\"pages\":\"167-173\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-02-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849162/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta Orthopaedica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2340/17453674.2025.42998\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Orthopaedica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2340/17453674.2025.42998","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的:对于选择非手术治疗(NOM)的体弱住院髋部骨折患者,住院和住院诊断的额外治疗益处尚未得到很好的评估。我们的目的是描述和比较髋部骨折后不住院的患者和在短期住院后接受非手术治疗的患者的治疗满意度和死亡质量。方法:两个队列均包括非常虚弱的住院髋部骨折患者。第一组在疑似髋部骨折后直接在自己的养老院开始支持性护理。第二组在入院和医院诊断后共同决策时选择了NOM。主要结局为治疗满意度和死亡质量(QODD)。次要结局包括与健康相关的生活质量(EuroQoL-5D-5L和Qualidem)、疼痛和药物。结果:纳入非住院患者20例,住院患者88例。非住院患者9(四分位间距[IQR] 8-10)和住院患者8 (IQR 4-9)的代理总体治疗满意度均较高。非住院组的死亡质量评分较高,QODD为8.3,IQR为6.9-8.6,IQR为7.0,IQR为5.7-7.8,中位差为1.0(95%可信区间[CI] 0.1-1.8)。以EQ-5D-5L效用评分衡量的健康相关生活质量在两组中均较低,但非住院患者(0.30,IQR 0.15-0.32)高于住院患者(0.25,IQR 0.03-0.32,中位差:0.03,CI -0.03 - 0.09)。两组报告的疼痛程度相似,但住院患者使用的阿片类药物标准日剂量更高(68 mg vs 39 mg,中位差24 mg, CI 7-42)。结论:住院和非住院患者在选择NOM后报告了较高的治疗满意度。非住院可能对预先记录不住院指示或共同决策的疑似髋部骨折患者的死亡质量有有益的影响。
Satisfaction and quality of dying with nonoperative end-of-life care for hospitalized and non-hospitalized frail older patients with (suspected) hip fractures: a combined cohort study.
Background and purpose: For frail institutionalized hip fracture patients who opt for nonoperative management (NOM), the additional treatment benefits of hospital admission and in-hospital diagnostics are not well evaluated. We aimed to describe and compare treatment satisfaction and quality of dying for patients who refrained from hospitalization after a hip fracture and patients who were treated nonoperatively after a short period of hospitalization.
Methods: Both cohorts included very frail institutionalized hip fracture patients. The first group directly started supportive care in their own nursing home after a suspected hip fracture. The second opted for NOM during shared decision-making after admission and diagnostics at the hospital. Primary outcomes were treatment satisfaction and quality of dying measured by the Quality of Dying and Death Questionnaire (QODD). Secondary outcomes included health-related quality of life (EuroQoL-5D-5L and Qualidem), pain, and medication.
Results: 20 non-hospitalized and 88 hospitalized patients were included. Overall treatment satisfaction by proxies was high for both the non-hospitalized 9 (interquartile range [IQR] 8-10) and hospitalized patients 8 (IQR 4-9). Quality of dying was rated higher in the non-hospitalized group with QODD 8.3, IQR 6.9-8.6 versus 7.0, IQR 5.7-7.8, and median difference 1.0 (95% confidence interval [CI] 0.1-1.8). Health-related quality of life, measured by the EQ-5D-5L utility score, was low in both groups but higher in non-hospitalized patients (0.30, IQR 0.15-0.32) than in hospitalized patients (0.25, IQR 0.03-0.32, median difference: 0.03, CI -0.03 to 0.09). Both groups reported similar pain levels, but hospitalized patients used higher standardized daily doses of opiates (68 mg vs 39 mg, median difference 24 mg, CI 7-42).
Conclusion: Proxies of hospitalized and non-hospitalized patients report high treatment satisfaction after opting for NOM. Non-hospitalization may have a beneficial effect on quality of dying in selected patients who have pre-recorded do-not-hospitalize directives or shared decision-making after a suspected hip fracture.
期刊介绍:
Acta Orthopaedica (previously Acta Orthopaedica Scandinavica) presents original articles of basic research interest, as well as clinical studies in the field of orthopedics and related sub disciplines. Ever since the journal was founded in 1930, by a group of Scandinavian orthopedic surgeons, the journal has been published for an international audience. Acta Orthopaedica is owned by the Nordic Orthopaedic Federation and is the official publication of this federation.