Developing a Model Fracture Liaison Service Consultation with Patients, Carers and Clinicians: a Delphi Survey to Inform Content of the IFraP Complex Consultation Intervention

Overview

Journal Arch Osteoporos

Publisher Springer

Date 2021 Mar 24

PMID 33761007

Citations 5

Authors

Laurna Bullock

Fay Crawford-Manning

Elizabeth Cottrell

Jane Fleming

Sarah Leyland

John Edwards

Emma M Clark

Simon Thomas

Stephen Chapman

Christopher Gidlow

Cynthia P Iglesias

Joanne Protheroe

Robert Horne

Terence W ONeill

Christian Mallen

Clare Jinks

Zoe Paskins

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Patient perceptions of osteoporosis management: a qualitative pilot study by a patient advisory group.

Javier R, Debiais F, Alliot-Launois F, Poivret D, Bosgiraud P, Barbe F Arch Osteoporos. 2025; 20(1):9.

PMID: 39812712 PMC: 11735547. DOI: 10.1007/s11657-024-01486-0.

A person-centred consultation intervention to improve shared decision-making about, and uptake of, osteoporosis medicines (iFraP): a pragmatic, parallel-group, individual randomised controlled trial protocol.

Bullock L, Nicholls E, Cherrington A, Butler-Walley S, Clark E, Fleming J NIHR Open Res. 2024; 4:14.

PMID: 39145101 PMC: 11320037. DOI: 10.3310/nihropenres.13571.1.

Exploring practice and perspectives on shared decision-making about osteoporosis medicines in Fracture Liaison Services: the iFraP development qualitative study.

Bullock L, Manning F, Hawarden A, Fleming J, Leyland S, Clark E Arch Osteoporos. 2024; 19(1):50.

PMID: 38898212 PMC: 11186902. DOI: 10.1007/s11657-024-01410-6.

Variation in UK fracture liaison service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey.

Bullock L, Abdelmagid S, Fleming J, Leyland S, Clark E, Gidlow C Arch Osteoporos. 2023; 19(1):5.

PMID: 38123745 PMC: 10733195. DOI: 10.1007/s11657-023-01361-4.

Incorporating FRAX into a nurse-delivered integrated care review: a multi-method qualitative study.

Hawarden A, Bullock L, Chew-Graham C, Herron D, Hider S, Jinks C BJGP Open. 2023; 7(2).

PMID: 36746471 PMC: 10354387. DOI: 10.3399/BJGPO.2022.0146.

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