Title: Understanding and improving patient experiences of diagnosis for vertebral fracture: a qualitative study
Funder: Department of Health and Social Care

Abstract: Background Osteoporosis involves the thinning of the bones making them more prone to fracture. The most common osteoporotic fracture is a vertebral fracture (OVF) which involves the collapsing of a vertebrae in the spine; affecting 12% of people in Europe. People with OVFs are at high risk of further fractures such as hip fracture which have high rates of mortality. The National Institute for Health and Care Excellence (NICE) recommends prescribing bone protection therapies to people who have experienced a fracture, to reduce the risk of further fractures by 30-50%. However, many patients fail to receive a diagnosis and it has been estimated that over two-thirds remain undiagnosed. Factors that act as barriers and facilitators to diagnosis include patient-related factors, such as the interpretation of symptoms and system-level factors such as the ability of clinicians to recognise the clinical presentation. Our team s previous research has found that some GPs are unsure of the symptoms of OVFs. Nevertheless, there are likely to be other factors that we are not aware of and can only be understood by exploring the perspectives of GPs and patients in further detail. This information will provide information to help identify OVFs more effectively in the future. Aims and objectives This study aims to help develop more effective and clearly defined pathways to diagnosis and improve subsequent management of osteoporotic fracture risk. To achieve these, our objectives are: To understand GPs and patients experiences and views of diagnosis for osteoporotic vertebral fractures, to identify barriers and facilitators to diagnosis To develop a series of recommendations to identify osteoporotic vertebral fractures more effectively Use knowledge mobilisation strategies to co-produce a knowledge sharing resource for patients and/ or healthcare professionals to help identify osteoporotic vertebral fractures Methods This study will consist of three work packages: Use in-depth interviews with GPs and patients to understand experiences and views of diagnosis for OVFs, using behavioural theory to understand barriers and facilitators to diagnosis. Present our taxonomy of barriers and facilitators to a stakeholder group of 20 participants including patients, healthcare professionals and representatives from charities. Based on findings, this group will suggest ways of identifying OVFs more effectively. The nominal group technique will be used to identify 10 final recommendations. Hold two workshops with 10 participants including patients, healthcare professionals and charity representatives, along with professional educators and IT multimedia specialists, to co-produce knowledge sharing resource(s). The first workshop will explore types of resources needed to target different groups and co-produce the structure of our knowledge sharing resource(s). Based on findings, consultants will design prototype resources. The second workshop will refine resources and finalise our dissemination strategy. Anticipated impact and dissemination We will produce an educational resource for patients and/ or healthcare professionals. Resources will be disseminated through contacts in existing clinical networks and through the Royal Osteoporosis Society, a UK-wide organisation that provides resources to help manage osteoporosis. We are confident that the research has the potential to improve practice and aid in the effective identification of OVFs.

Lay abstract: Background Osteoporosis is a common disease in the over 50s that causes bones to become thinner and break (fracture). The most common osteoporotic fracture is a vertebral fracture (OVF), a break in one of the bones in the spine; affecting 12% of people in Europe. These people are at high risk of breaking other bones such as their hips NHS guidelines recommend prescribing bone protection therapies to people who have experienced a fracture, to reduce the risk of further fractures by 30-50%. However, over two-thirds of people with OVF remain undiagnosed. An important reason for this is that patients may not visit their healthcare professionals as they do not recognise that they have had an injury. Our team s previous research has found that some GPs find it difficult to recognise the symptoms of OVFs. Nevertheless, there are likely to be other factors that help or hinder diagnosis that we are unaware of and can only be understood by asking GPs and patients. This information will to help identify OVFs more effectively in the future. Aims and objectives To understand GPs and patients experiences and views of diagnosis for OVFs to identify factors that help of hinder diagnosis Use information to develop a series of recommendations to identify OVFs more effectively Co-produce an educational resource for patients and/ or healthcare professionals to help identify OVFs Methods We will: Conduct in-depth interviews with 20 - 26 patients aged over 50 who have been diagnosed with an OVF and 20 &ndash; 26 GPs, to gain a comprehensive understanding of their experiences and views of diagnosis. Findings will be used to develop a list of factors that help or hinder diagnosis. Present factors that help or hinder diagnosis to a group of 20 people including patients, their partners and/ or carers and healthcare professionals. Based on these findings, this group will suggest ways of identifying OVFs more effectively. Suggestions from the group will be ordered to identify 10 final recommendations. Hold two workshops with 10 people including patients, carers, healthcare professionals and representatives from charities. The first workshop will use study findings and recommendations to co-produce an educational resource. The second workshop will refine resources and decide the best ways of sharing this information. Patient and public involvement This proposal arose from a request from participants in a previous project, and an in-depth meeting with two patients living with osteoporosis helped to shape this study. We have budgeted for the continued involvement of patients to help shape all aspects of the project including aims, data collection materials and ways of sharing findings. Dissemination We will produce an educational resource for patients and/ or healthcare professionals and share this information through a UK-wide charity.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: MUSCULOSKELETAL