Grant: Project Grant

With the aging population, it is estimated that the number of hip fractures will reach 6.3 million worldwide by 2050. Among hip fracture patients, 50% are frail. The mortality rate of these patients reaches 80% at one month, with poor recovery in many of those who survive beyond this period. Non-operative treatment combined with palliative care is increasingly recognized as one option to consider in frail older patients to avoid the burden of surgery and optimize their comfort at the end of life. However, the possibility of adequate pain relief without surgically repairing the fracture remains a major issue. The overarching goal of this project is to select strategies for improving pain management in frail, older hip fracture patients receiving palliative care. Specifically, we will conduct a literature review of studies on palliative care pain management strategies in older adults to identify the most promising ones. Then, we will conduct a practice survey in 1130 orthopedic surgeons and physicians providing palliative care, and perform 12 focus groups with healthcare professionals and decision makers working in acute and long-term care facilities as well as 30 individual interviews with families with lived experience to examine improvements that need to be made in actual practices and the barriers and facilitators to the implementation of pain management strategies. Finally, we will undertake a consensus study with 30 experts (healthcare professionals, decision makers and families with lived experience) to prioritize the palliative care pain management strategies to be implemented. This project will enable us to target quality improvement interventions to optimize pain management in frail, older hip fracture patients receiving palliative care, with a high probability of acceptability and sustainability. This project, therefore, has great potential to improve the end-of-life of these patients, and ultimately their quality of life and that of their families.