A multicentre survey investigating the knowledge, behaviour, and attitudes of surgical healthcare professionals to frailty assessment in emergency surgery: DEFINE(surgery)

• Published in: European geriatric medicine Vol. 15; no. 4; pp. 1047 - 1053
• Main Authors: Braude, P., Parry, F., Warren, K., Mitchell, E., McCarthy, K., Khadaroo, R. G., Carter, B.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-08-2024
• Subjects: Adult; Aged; Attitude of Health Personnel; Cross-Sectional Studies; England; Female; Frail Elderly; Frailty - diagnosis; Geriatric Assessment - methods; Geriatrics/Gerontology; Health Knowledge, Attitudes, Practice; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Research Paper; Scotland; Surgeons; Surgical Procedures, Operative; Surveys and Questionnaires; Wales; England; Scotland; Wales; Attitudes; Frailty; Perioperative medicine; Surgery; National survey
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-024-00962-7

Key summary points
Aims
This study aimed to assess the knowledge, behaviour, and attitudes of healthcare professionals to frailty assessment in emergency surgical admissions.
Findings
Frailty assessment is well supported by healthcare professionals working in surgery. However, in clinical practice, standardised tools are not routinely being used and only half of respondents were able to accurately identify frailty from clinical vignettes.
Message
Better education around frailty assessment is needed for healthcare professionals working in surgery to improve perioperative pathway for people living with frailty.
Purpose
Screening for frailty in people admitted with emergency surgical pathology can initiate timely referrals to enhanced perioperative services such as intensive care and geriatric medicine. However, there has been little research exploring surgical healthcare professionals' opinions to frailty assessment, or accuracy in identification. This study aimed to assess the knowledge, behaviour, and attitudes of healthcare professionals to frailty assessment in emergency surgical admissions.
Methods
We designed a cross-sectional multicentre study developed by a multiprofessional team of surgeons, geriatricians, and supported by patients. A semi-structured survey examined attitudes and behaviours. Knowledge was assessed by comparing respondents’ accuracy in scoring twenty-two surgical case vignettes using the Clinical Frailty Scale.
Results
Eleven hospitals across England, Wales, and Scotland participated. Two hundred and eleven clinicians responded—20.4% junior doctors, 43.6% middle grade doctors, 24.2% senior doctors, 11.4% nurses and physician associates. Respondents strongly supported perioperative frailty assessment. Most were already assessing for frailty, although frequently not using a standardised tool. There was a strong call for more frailty education. Participants scored 2175 vignettes with 55.4% accurately meeting the gold standard; accuracy improved to 87.3% when categorised into “not frail/mildly frail/severely frail” and 94% when dichotomised to “not frail/frail”.
Conclusion
Frailty assessment is well supported by healthcare professionals working in surgery. However, standardised tools are not routinely being used, and only half of respondents could accurately identify frailty. Better education around frailty assessment is needed for healthcare professionals working in surgery to improve perioperative pathway for people living with frailty.