Goals of Care Discussions in Orthopaedic Surgery: Geriatric Hip Fractures

Background Due to the severity of hip fracture complications in the geriatric population, including major morbidity and mortality, it is crucial to establish treatment goals and manage expectations as a patient-centered multidisciplinary team. Goals of care (GOC) are personalized treatment programs designed to align with the individual patient’s values and preferences. There is a paucity of literature on the topic of GOC discussions, especially regarding orthopaedic injuries. Therefore, this narrative review aims to provide an account of GOC discussions related to geriatric hip fractures. Methods We reviewed articles published on GOC between 1978 and 2024. The articles were identified by searching PubMed and Google Scholar. We utilized the search terms: goals of care discussions and hip fracture, with additional descriptors including arthroplasty and geriatric. Results There were 11 articles that met selection criteria and were published between 1978 and 2024. Five articles were published on GOC discussions in orthopaedic surgery, while the remaining six articles were published in non-orthopaedic fields. There was one systematic review, two narrative reviews, six observational studies, and two descriptive studies. Supplemental commentary from non-orthopaedic specialties and the fields of law and medical ethics was included to assist in highlighting barriers to GOC discussions and to explore potential strategies to enhance GOC discussions. Conclusion Goals of care discussions provide a framework for treatment decisions based on an individual patient’s values and cultural beliefs; however, these conversations may be limited by perceived time constraints, patient healthcare literacy, and physicians’ misconceptions of what is most important to discuss. While no clear consensus was identified regarding strategies for improving GOC discussions in geriatric patients who have hip fractures, the authors recommend standardized training programs, expedited family meetings, multidisciplinary team involvement, assistive technology such as OPT, and the incorporation of GOC discussions into institutional hip fracture pathways.