Patient and caregiver experiences on care transitions for adults with a hip fracture: a scoping review

Figures & data

Figure 1. Flowchart of article selection.

Table 1. Characteristics of studies identified in scoping review (n = 11).

Author, (year), Country study was conducted	Objective	Study design	Sample characteristics	Total sample size
Elliott, (2014), Canada [9]	To examine caregivers’ experiences with information sharing and to describe the facilitators and barriers that influence information sharing between patients, caregivers and health care providers.	Qualitative	Patients:n = 11 (8 females, 3 males), mean age 80.4 years Caregivers:n = 8 (5 females, 3 males), mean age 57.5 years	43
Giosa, (2014), Canada [22]	To explore the experiences of caregivers during the transition of care for patients between hospital and home.	Qualitative	Case Managers:n = 6, mean age 42 years Caregivers: n = 10** (7 females, 5 males), mean age 58.75 years	18*
Glenny, (2013), Canada [23]	To understand the perspectives of health care providers and caregivers on communication during care transitions for older patients with hip fracture.	Qualitative	Health Care Providers:n = 26 Caregivers:n = 6 (6 females), (range 40-70) years	32
Groene, (2015), Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey [24]	To evaluate the effect of hospital quality management strategies on patient experiences.	Quantitative	Patients:n = 1,503** (1,008 females, 427 males)***, mean age 76.0 years ± 13.2	6,536*
Jensen, (2017), Denmark [25]	To explore the experiences of hip fracture patients with the care pathway and their ability to perform self-care after a short-term stay in the hospital.	Qualitative	Patients:n = 10 (8 females, 2 males) range: 67-92 years Health Care Providers:n = 15 Caregivers:n = 4	29
Killington, (2016), Australia [10]	To describe the experiences of nursing home residents after sustaining a hip fracture and their perspectives on a hospital outreach rehabilitation program.	Qualitative	Patients:n = 28 (24 females, 4 males), mean age 87.5 years (range 70-97 years)	28
Nahm, (2010), United States [26]	To present the experiences of caregivers who provide care to older adults for six months following a hip fracture injury.	Qualitative	Patients:n = 10 (8 females, 2 males), mean age 85.1 ± 4.7 (range 80-93) Caregivers:n = 10 (9 female, 1 male), mean age 64.8 ± 13.1 (range 49-86)	20
Schiller, (2015), Canada [27]	To explore patient perspectives on the recovery phase following a hip fracture injury.	Qualitative	Patients:n = 11 (10 females, 1 male), ages**** 60-65 (n = 2), ages 66-70 (n = 3), ages 71-75 (n = 2), ages 81-85 (n = 5), ages 86-90 (n = 3) Caregivers:n = 8 (4 females, 4 males)	19
Storm, (2014), Norway [28]	To describe issues affecting the quality of care transitions in elderly patients.	Qualitative	Patients:n = 41 (total number of hip fracture patients not identified), (range 75-97)	41*
Toscan, (2012), Canada [8]	To investigate the care coordination of hip fracture patients from the perspective of patients, caregivers and health care providers.	Qualitative	Patients:n = 6 (3 females, 3 males), mean age 83 years (range 71-94 years) Health Care Providers:n= 18 Caregivers:n = 6 females (range 40-70 years)	30
Toscan, (2013), Canada [7]	To describe the care transition experience of a single hip fracture patient from different perspectives.	Qualitative	Patients:n = 1 (1 female), mid-80's Health Care Providers:n = 10 Caregivers:n = 2	13

* Study includes more than one type of patient population.

** Number of participants with hip fracture or caring for participants with hip fracture in mixed population studies.

*** The authors did not report the gender of 68 participants.

**** Includes individuals with incidence of hip fracture as reported by caregivers.

Case Managers, provide an initial home assessment and work with patients and caregivers to construct a treatment plan.

Table 2. Common themes and author recommendations identified in the included studies.

Author, (year)	Themes identified	Examples	Author recommendations
Elliott, (2014) [9]	Challenges Lack of information sharing	Caregivers expressed the need for additional information on topics such as: rehabilitation procedures, medication use, aides for the patient and home care services.	Discussions between patients, caregivers and clinicians about the care trajectory should be documented in an electronic health information system.
	Suggestions Increasing written communication Using technology for facilitating communication	Caregivers described that an information guide or brochure about rehabilitation techniques, assistive devices or what to expect after the injury would help prepare for discharge and transitions. It was noted that the addition of telecommunications technology (e.g., Skype) in rural health care settings would be valuable.
Giosa, (2014) [22]	Challenges Lack of information sharing Role confusion	Participants experienced information-sharing errors due to information being shared verbally. Participants felt that their ability to take the role of the primary caregiver was impacted by multiple family members being involved in providing patient care.	Tools should be developed to help clinicians obtain information about a caregivers’ family situation, medical knowledge and finances.
	Suggestions Increasing written communication	Caregivers suggested that health care providers collaborate with caregivers to create a written care outline, describing caregivers’ care responsibilities in the home.
Glenny, (2013) [23]	Challenges Lack of information sharing Disorganized discharge planning	Caregivers noted hospital policies as a barrier to obtaining information about the patient and were frustrated about the lack of education on navigating hospital privacy procedures. Participants believed that patients were moved between settings too rapidly and that the patient transfer process was lacking in patient and caregiver involvement.	Information sharing should be promoted by policies regulating discharge planning. Providing patients and caregivers access to medical records can help build relationships between care providers and clinicians.
	Suggestions Using technology for facilitating communication	It was suggested that video conferencing or messaging services be incorporated into care planning in order to remove barriers due to geographic distance and time.
Groene, (2015) [24]	Not Applicable	Not Applicable	Hospitals should implement strategies to improve patient experience without compromising clinicians’ interactions with patients.
Jensen, (2017) [25]	Challenges Disorganized discharge planning	Patients experienced difficulties understanding clinicians’ instructions at discharge which made patients feel insecure about the discharge process.	Patients should be given access to information about their treatment and prognosis at the right time in their care trajectory.
	Suggestions Increasing written communication	Clinicians should provide patients with oral and written information about self-care especially during a short time stay in hospital.
Killington, (2016) [10]	Challenges Disorganized discharge planning	Caregivers believed that a lack of coordination during discharge resulted in poor pain management after care transition. Nursing home staff was ill prepared to undertake patient transfers which resulted in patients not receiving appropriate early mobilization therapy.	Integrated care pathways should be developed and implemented for hip fracture patients who also have dementia.
	Suggestions Increasing geriatrician involvement	Caregivers recognized that geriatrician input was particularly valuable especially when dealing with concerns about polypharmacy and pain management.
Nahm, (2010) [26]	Challenges Lack of information sharing	Caregivers conveyed frustration at the lack of information provided by clinicians about caregiving activities.	To optimize rehabilitation outcomes, caregivers and patients need to discuss rehabilitation expectations through the care trajectory.
	Suggestions Increasing written communication Using technology for facilitating communication	Caregivers wanted in-depth, individualized resource materials that could be accessed at their convenience. It was recommended that an online resource center be developed to allow for individualized discussions between caregivers and health care professionals.
Schiller, (2015) [27]	Challenges None Identified		Clinicians should provide patients and caregivers with opportunities to ask questions, articulate goals and communicate their preferences.
	Suggestions Increasing written communication Offering a patient representative role	Participants highlighted that a “recovery map” or a guide containing information to define stages of the recovery process could be beneficial to their recovery. Several patients and caregivers suggested that a patient advocate would be helpful to facilitate discussion with health professionals.
Storm, (2014) [28]	Challenges Lack of information sharing Disorganized discharge planning	Caregivers expressed difficulty obtaining information about admission and discharge, patient’s use of medication, follow-up resources in the community. Caregivers felt that the discharge was very sudden, and as a result felt unprepared to provide care after patients were discharged from the hospital.	Future research should investigate the care trajectory and long-term care plan for patients with complex medical illnesses. Improvement measures should be presented to clinicians to improve their delivery of care during transitions.
	Suggestions Increasing geriatrician involvement	It was suggested that geriatric consultations, comprehensive assessments and a patient-centered approach may improve patient recovery after discharge.
Toscan, (2012) [8]	Challenges Lack of information sharing Role confusion Disorganized discharge planning	Caregivers were unsure about how to initiate conversations with health care professionals about care, which often left them waiting for information. Patients experienced difficulty identifying the roles of members of the care team due to standardized uniforms and unclear name tags. Patients felt rushed to recover due to health care professionals’ emphasis on rapid discharge. Some patients also expressed feeling distressed due to their lack of involvement in facilitating their own discharge.	A clear role for the patient and caregiver should be defined and incorporated into collaborative practice.
	Suggestions Offering a patient representative role	It was recommended that the introduction of a system navigator role could help improve coordination and management of care for patients across settings.
Toscan, (2013) [7]	Challenges Lack of information sharing Role confusion Disorganized discharge planning	Caregivers described that poor information exchange between health care providers and caregivers resulted in family tension. The hospital environment and the quick turnover of staff made it difficult for caregivers and patients to identify and direct questions to the appropriate health care providers. The patient described feeling distressed due to the rushed nature of the transition between the acute care setting and inpatient rehabilitation setting.	Defining care responsibilities for caregivers, using best practice guidelines and decision-making tools can lead to greater integration of care.
	Suggestions Offering a patient representative role	It was suggested that a patient navigator could alleviate stressors, facilitate information exchange and support patients and their families during care transitions.

Elliott J, Forbes D, Chesworth BM, et al. Information sharing with rural family caregivers during care transitions of hip fracture patients. Int J Integr Care. 2014;14:e018.

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Giosa JL, Stolee P, Dupuis SL, et al. An examination of family caregiver experiences during care transitions of older adults. Can J Aging. 2014;33:137–153.

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Glenny C, Stolee P, Sheiban L, et al. Communicating during care transitions for older hip fracture patients: family caregiver and health care provider's perspectives. Int J Integr Care. 2013;13:1–13.

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Groene O, Arah OA, Klazinga NS, et al. Patient experience shows little relationship with hospital quality management strategies. PloS One. 2015;10:e0131805.

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Jensen CM, Smith AC, Overgaard S, et al. "If only had I known": a qualitative study investigating a treatment of patients with a hip fracture with short time stay in hospital. Int J Qual Stud Health Well-Being. 2017;12:1–9.

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Killington M, Walker R, Crotty M. The chaotic journey: Recovering from hip fracture in a nursing home. Arch Gerontol Geriatr. 2016;67:106–112.

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Nahm E, Resnick B, Orwig D, et al. Exploration of informal caregiving following hip fracture. Geriatr Nurs. 2010;31:254–262.

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Schiller C, Franke T, Belle J, et al. Words of wisdom - Patient perspectives to guide recovery for older adults after hip fracture: a qualitative study. Patient Prefer Adherence. 2015;9:57–64.

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Storm M, Siemsen IMD, Laugaland K, et al. Quality in transitional care of the elderly: key challenges and relevant improvement measures. Int J Integr Care. 2014;14:e013.

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Toscan J, Mairs K, Hinton S, et al. Integrated transitional care: patient, informal caregiver and health care provider perspectives on care transitions for older persons with hip fracture. Int J Integr Care. 2012;12:e13.

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Toscan J, Manderson B, Santi SM, et al. "Just another fish in the pond": the transitional care experience of a hip fracture patient. Int J Integr Care. 2013;13:e023.

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