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Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity.
J Surg Res. 2020 12; 256:368-373.JS

Abstract

BACKGROUND

The shared decision-making process between surgical providers and patients relies on a joint understanding about the risks of different treatment options based on a patient's individual health state. However, it is unclear whether a patient's perception of their own condition is congruent with the health state assigned by their surgical providers. This study was designed to compare provider assessment of frailty versus patient-reported outcome (PRO) measures of their own frailty status, physical function, and social activity level.

METHODS

We prospectively assessed patients presenting to a vascular surgery clinic at an academic institution between May 2018 and June of 2019. Before clinic examination, patients completed PROs of their frailty status (Frail Non-Disabled survey), physical function (patient-reported outcome measurement information system [PROMIS] v1.2), and social activity level (PROMIS v2.0). Next, each patient's frailty status and overall health were scored by a surgical provider using the 9-point Clinical Frailty Scale, a validated frailty assessment tool that incorporates their functional status and level of activity. The correlation between the provider and PROs for frailty, physical function, and social activity was determined using the Spearman rank test, sensitivity/specificity tests, and receiver operating curves. Logistic regression models were used to predict 1-y mortality after assessment.

RESULTS

A total of 118 patients were evaluated in clinic (50% male with mean age of 60 y), including 35 (30%) who were categorized as being frail by the surgical provider. In comparison, the same patients were much more likely to self-report as having low physical function (73%), being frail or disabled (79%), and/or unable to engage in social activities (78%). Although there was high sensitivity (89%) between a provider's and PROs for frailty, the specificity was low (26%) resulting in a receiver operating curve area of 0.57. Overall, there was low correlation between PROs for frailty (r = 0.16), physical function (r = 0.21), and social activities (r = 0.21) when compared with a provider's assessment of patient frailty. Models using PROs for frailty had better discrimination for predicting 1-y mortality (c-statistic: 0.72) than those using the Clinical Frailty Scale (c-statistic: 0.62).

CONCLUSIONS

Patients are more likely to self-report being frail, having low physical function, and limited social activity than what is detected by their surgical providers. These findings suggest that low levels of patient activity and its associated risk may often be underappreciated by surgical providers. Efforts are needed to improve how PROs are incorporated into surgical decision-making and outcome assessment.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: benjamin.brooke@hsc.utah.edu.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

32739620

Citation

Holeman, Teryn A., et al. "Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity." The Journal of Surgical Research, vol. 256, 2020, pp. 368-373.
Holeman TA, Peacock J, Beckstrom JL, et al. Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity. J Surg Res. 2020;256:368-373.
Holeman, T. A., Peacock, J., Beckstrom, J. L., & Brooke, B. S. (2020). Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity. The Journal of Surgical Research, 256, 368-373. https://doi.org/10.1016/j.jss.2020.06.059
Holeman TA, et al. Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity. J Surg Res. 2020;256:368-373. PubMed PMID: 32739620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity. AU - Holeman,Teryn A, AU - Peacock,Jordan, AU - Beckstrom,Julie L, AU - Brooke,Benjamin S, Y1 - 2020/07/30/ PY - 2020/02/28/received PY - 2020/06/08/revised PY - 2020/06/16/accepted PY - 2020/8/3/pubmed PY - 2021/3/13/medline PY - 2020/8/3/entrez KW - Frailty KW - Patient-reported outcomes KW - Risk-assessment KW - Shared decision-making SP - 368 EP - 373 JF - The Journal of surgical research JO - J Surg Res VL - 256 N2 - BACKGROUND: The shared decision-making process between surgical providers and patients relies on a joint understanding about the risks of different treatment options based on a patient's individual health state. However, it is unclear whether a patient's perception of their own condition is congruent with the health state assigned by their surgical providers. This study was designed to compare provider assessment of frailty versus patient-reported outcome (PRO) measures of their own frailty status, physical function, and social activity level. METHODS: We prospectively assessed patients presenting to a vascular surgery clinic at an academic institution between May 2018 and June of 2019. Before clinic examination, patients completed PROs of their frailty status (Frail Non-Disabled survey), physical function (patient-reported outcome measurement information system [PROMIS] v1.2), and social activity level (PROMIS v2.0). Next, each patient's frailty status and overall health were scored by a surgical provider using the 9-point Clinical Frailty Scale, a validated frailty assessment tool that incorporates their functional status and level of activity. The correlation between the provider and PROs for frailty, physical function, and social activity was determined using the Spearman rank test, sensitivity/specificity tests, and receiver operating curves. Logistic regression models were used to predict 1-y mortality after assessment. RESULTS: A total of 118 patients were evaluated in clinic (50% male with mean age of 60 y), including 35 (30%) who were categorized as being frail by the surgical provider. In comparison, the same patients were much more likely to self-report as having low physical function (73%), being frail or disabled (79%), and/or unable to engage in social activities (78%). Although there was high sensitivity (89%) between a provider's and PROs for frailty, the specificity was low (26%) resulting in a receiver operating curve area of 0.57. Overall, there was low correlation between PROs for frailty (r = 0.16), physical function (r = 0.21), and social activities (r = 0.21) when compared with a provider's assessment of patient frailty. Models using PROs for frailty had better discrimination for predicting 1-y mortality (c-statistic: 0.72) than those using the Clinical Frailty Scale (c-statistic: 0.62). CONCLUSIONS: Patients are more likely to self-report being frail, having low physical function, and limited social activity than what is detected by their surgical providers. These findings suggest that low levels of patient activity and its associated risk may often be underappreciated by surgical providers. Efforts are needed to improve how PROs are incorporated into surgical decision-making and outcome assessment. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/32739620/Patient_Surgeon_Agreement_in_Assessment_of_Frailty_Physical_Function_&_Social_Activity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(20)30453-4 DB - PRIME DP - Unbound Medicine ER -