Healthcare professionals' perspectives on early sling removal following conservatively managed proximal humerus...

DesignA qualitative study using uni-professional focus groups, forming the first stage of a multi-phase co-design project to develop a model of care for early sling removal after conservatively managed proximal humerus fracture.SettingFocus groups were conducted online via Microsoft Teams with participants from a wide geographical spread across multiple United Kingdom National Health Service Trusts.ParticipantsHealthcare professionals (n = 23), including orthopaedic surgeons, therapists (physio and occupational), and nurses, recruited through purposive sampling.InterventionThree focus groups explored healthcare professionals' perspectives on early sling removal in the non-operative management of proximal humerus fractures. Patient and public involvement and engagement work informed study design, identifying the need to first understand professionals' viewpoints before engaging patients and progressing to consensus co-design.Main measuresData were collected through focus groups supported by pre-session forms and analysed thematically following Braun and Clarke's framework using NVivo software.ResultsThree overarching themes were identified: Navigating pain and fear, clinician confidence, and early engagement. Fear of patient harm and high pain levels in the early weeks were barriers to early sling removal. Confidence was influenced by experience, fracture severity and limited evidence, with hierarchical decision-making by surgeons. Participants considered enablers to be consistent messaging, early education, and reassurance to support both clinicians and patients.ConclusionsWhilst healthcare professionals recognise benefits of earlier sling removal, implementation is limited by pain, uncertainty, and hierarchical decision-making. These findings highlight the need for multidisciplinary, co-designed pathways. There is a need next to explore patient perspectives to inform future co-designed pathways.