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Trauma Providers' Perceptions of Frailty Assessment: A Mixed-Methods Analysis of Knowledge, Attitudes, and Beliefs
Thomas H Shoultz1, Megan Moore1, May J Reed1
1From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington.
Objectives:
Quality improvement in geriatric trauma depends on timely identification of frailty, yet little is known about providers' knowledge and beliefs about frailty assessment. This study sought to understand trauma providers' understanding, beliefs, and practices for frailty assessment.
Methods:
We developed a 20-question survey using the Health Belief Model of health behavior and surveyed physicians, advanced practice providers, and trainees on the trauma services at a single institution that does not use formal frailty screening of all injured seniors. Results were analyzed via mixed methods.
Results:
One hundred fifty-one providers completed the survey (response rate 92%). Respondents commonly included calendar age as an integral factor in their determinations of frailty but also included a variety of other factors, highlighting limited definitional consensus. Respondents perceived frailty as important to older adult patient outcomes, but assessment techniques were varied because only 24/151 respondents (16%) were familiar with current formal frailty assessment tools. Perceived barriers to performing a formal frailty screening on all injured older adults included the burdensome nature of assessment tools, insufficient training, and lack of time. When prompted for solutions, 20% of respondents recommended automation of the screening process by trained, dedicated team members.
Conclusions:
Providers seem to recognize the impact that a diagnosis of frailty has on outcomes, but most lack a working knowledge of how to assess for frailty syndrome. Some providers recommended screening by designated, formally trained personnel who could notify decision makers of a positive screen result.