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Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention.

Bullock, Laurna; Crawford-Manning, Fay; Cottrell, Elizabeth; Fleming, Jane; Leyland, Sarah; Edwards, John; Clark, Emma M; Thomas, Simon; Chapman, Stephen; Gidlow, Christopher; Iglesias, Cynthia P; Protheroe, Joanne; Horne, Robert; O’Neill, Terence W; Mallen, Christian; Jinks, Clare; Paskins, Zoe

Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention. Thumbnail


Authors

Fay Crawford-Manning

Elizabeth Cottrell

Jane Fleming

Sarah Leyland

John Edwards

Emma M Clark

Simon Thomas

Stephen Chapman

Christopher Gidlow

Cynthia P Iglesias

Robert Horne

Terence W O’Neill



Abstract

Fracture Liaison Services are recommended to deliver best practice in secondary fracture prevention. This modified Delphi survey, as part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) study, provides consensus regarding tasks for clinicians in a model Fracture Liaison Service consultation. PURPOSE: The clinical consultation is of pivotal importance in addressing barriers to treatment adherence. The aim of this study was to agree to the content of the 'model Fracture Liaison Service (FLS) consultation' within the iFraP (Improving uptake of Fracture Prevention drug Treatments) study. METHODS: A Delphi survey was co-designed with patients and clinical stakeholders using an evidence synthesis of current guidelines and content from frameworks and theories of shared decision-making, communication and medicine adherence. Patients with osteoporosis and/or fragility fractures, their carers, FLS clinicians and osteoporosis specialists were sent three rounds of the Delphi survey. Participants were presented with potential consultation content and asked to rate their perception of the importance of each statement on a 5-point Likert scale and to suggest new statements (Round 1). Lowest rated statements were removed or amended after Rounds 1 and 2. In Round 3, participants were asked whether each statement was 'essential' and percentage agreement calculated; the study team subsequently determined the threshold for essential content. RESULTS: Seventy-two, 49 and 52 patients, carers and clinicians responded to Rounds 1, 2 and 3 respectively. One hundred twenty-two statements were considered. By Round 3, consensus was reached, with 81 statements deemed essential within FLS consultations, relating to greeting/introductions; gathering information; considering therapeutic options; eliciting patient perceptions; establishing shared decision-making preferences; sharing information about osteoporosis and treatments; checking understanding/summarising; and signposting next steps. CONCLUSIONS: This Delphi consensus exercise has summarised for the first time patient/carer and clinician consensus regarding clearly defined tasks for clinicians in a model FLS consultation.

Journal Article Type Article
Acceptance Date Mar 2, 2021
Online Publication Date Mar 24, 2021
Publication Date Mar 24, 2021
Journal Archives of Osteoporosis
Print ISSN 1862-3522
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 16
Article Number 58
Pages 1- 17
DOI https://doi.org/10.1007/s11657-021-00913-w
Publisher URL https://link.springer.com/article/10.1007%2Fs11657-021-00913-w
PMID 33761007

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