BMJ open · 2025
Experience with hip denervation in non-operative hip fracture care for frail older patients in the Netherlands: an interview study.
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Kroes Thamar, van Breugel Johanna M, Smits Rachel, Jan Schuijt Henk, Van der Velde Detlef, Willems Hanna C, Dutch PENG Study Group
Аннотация
OBJECTIVE: The objective was to explore treatment experience of hip denervation via PEricapsular Nerve Group block with phenol in non-operative management and end-of-life (EOL) care after hip fractures.
DESIGN: A qualitative study was conducted with semistructured interviews. The interviews were analysed using thematic discourse analysis.
SETTING AND PARTICIPANTS: The study was conducted in a large regional hospital in the Netherlands. Proxies (first-contact person, often a first-degree or second-degree relative) of frail older adults treated between January 2022 and June 2023 were included, as patients had either cognitive impairment or were deceased.
RESULTS: The process surrounding hip denervation was emotionally charged due to the EOL setting and preceding discussion on whether or not to operate. The EOL setting impaired information uptake in participants and complicated communication. Hip denervation was experienced as a partial source of comfort. Logistics and aftercare were described as suboptimal. Participants emphasised the importance of a dignified and autonomous EOL phase.
CONCLUSIONS: This study describes treatment experience from the patient-proxy perspective. It highlights the importance of a provider setting attuned to EOL care needs. Adequate pain management, effective communication and realistic autonomy for patients and proxies are warranted.
DESIGN: A qualitative study was conducted with semistructured interviews. The interviews were analysed using thematic discourse analysis.
SETTING AND PARTICIPANTS: The study was conducted in a large regional hospital in the Netherlands. Proxies (first-contact person, often a first-degree or second-degree relative) of frail older adults treated between January 2022 and June 2023 were included, as patients had either cognitive impairment or were deceased.
RESULTS: The process surrounding hip denervation was emotionally charged due to the EOL setting and preceding discussion on whether or not to operate. The EOL setting impaired information uptake in participants and complicated communication. Hip denervation was experienced as a partial source of comfort. Logistics and aftercare were described as suboptimal. Participants emphasised the importance of a dignified and autonomous EOL phase.
CONCLUSIONS: This study describes treatment experience from the patient-proxy perspective. It highlights the importance of a provider setting attuned to EOL care needs. Adequate pain management, effective communication and realistic autonomy for patients and proxies are warranted.