Study aims with specific action points per targeted group for the four study phases
| Points of action per phase | Targeted group | Aim/outcome |
| Phase 1 | ||
| Qualitative research on patient experiences and perceived barriers and facilitators for SDM on NOM | Patients, next-of-kin and healthcare providers* | Enriching the implementation protocol with recent research on patient/healthcare provider experiences regarding SDM on NOM versus operative treatment. Providing insight into barriers and facilitators on the local and individual level |
| Phase 2 | ||
| Development of educational material on SDM with frail older adults with hip fractures for patients and healthcare providers Implementing SDM on NOM in the curriculum for (orthopaedic) surgeons in training | Patients, next-of-kin and healthcare providers* | Increasing (practical) knowledge on performing SDM on NOM in healthcare providers. Providing healthcare providers with tools to prepare patients and next-of-kin for SDM on NOM vs operative treatment |
| Phase 3 | ||
| Presentations of the implementation protocol and included tools at annual meetings of the involved scientific associations | Healthcare providers*, members of associated scientific associations | Creating awareness and a sense of urgency for SDM implementation and identifying local drivers of change for future implementation |
| Implementation of the NOM implementation protocol and evaluation through interviews with patients and healthcare providers in 14 selected Dutch hospitals | Local project teams and drivers of change in 14 Dutch hospitals and patients/next-of-kin | Evaluating and improving the implementation protocol and educational modules based on local experiences, barriers and facilitators through patient and healthcare provider interviews |
| Phase 4 | ||
| Maintaining and improving awareness through conference and regional trauma network presentations Identification of local ambassadors/drivers of change Dissemination of the implementation protocol/educational tools through a dedicated website, scientific publications and media coverage | Healthcare providers*, and specifically, local drivers of change, in all Dutch hospitals treating frail older adults with hip fractures | Upscaling of the implementation to all hospitals in the Netherlands that treat the targeted patient group |
| Measuring the effect of implementation, changes in NOM rate, through the DHFA database | Dutch patients and hospitals through the DHFA database | Evaluating changes in practice after implementation |
*Healthcare providers include (orthopaedic) trauma surgeons, geriatricians, acute care physicians, anaesthesiologists, residents and physician assistants directly involved in (acute) care for frail older adults with a hip fracture in Dutch hospitals.
DHFA, Dutch Hip Fracture Audit; NOM, non-operative management; SDM, shared decision-making.