title: Patients do not have a consistent understanding of high risk for future fracture: a qualitative study of patients from a post-fracture secondary prevention program.
abstract: We examined fracture patients' understanding of "high" fracture risk after they were screened through a post-fracture secondary prevention program and educated about their risk verbally, numerically, and graphically. Our findings suggest that messages about fracture risk are confusing to patients and need to be modified to better suit patients' needs.
  
  
  BACKGROUND
  The aim of this study was to examine fracture patients' understanding of high risk for future fracture.
  
  
  METHODS
  We conducted an in-depth qualitative study in patients who were high risk for future fracture. Patients were screened through the Osteoporosis Exemplary Care Program where they were educated about fracture risk: verbally told they were "high risk" for future fracture, given a numerical prompt that they had a >20 % chance of future fracture over the next 10 years, and given a visual graph highlighting the "high risk" segment. This information about fracture risk was also relayed to patients' primary care physicians (PCPs) and specialists. Participants were interviewed at baseline (within six months of fracture) and follow-up (after visit with a PCP and/or specialist) and asked to recall their understanding of risk and whether it applied to them.
  
  
  RESULTS
  We recruited 27 patients (20 females, 7 males) aged 51-87 years old. Fractures were sustained at the wrist (n = 7), hip (n = 7), vertebrae (n = 2), and multiple or other locations (n = 11). While most participants recalled they had been labeled as "high risk" (verbal cue), most were unable to correctly recall the other elements of risk (numerical, graphical). Further, approximately half of the patients who recalled they were high risk did not believe that high risk applied, or had meaning, to them. Participants also had difficulty explaining what they were at risk for.
  
  
  CONCLUSIONS
  Our results suggest that health care providers' messages about fracture risk are confusing to patients and that these messages need to be modified to better suit patients' needs.
authors.affiliation: Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. salej@smh.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. salej@smh.ca.
authors.forename: J E M
authors.initials: JE
authors.lastname: Sale
authors.affiliation: Institute for Work and Health, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: M A
authors.initials: MA
authors.lastname: Gignac
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.|Osteoporosis Research Program, Women's College Hospital, Toronto, ON, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Hawker
authors.affiliation: Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Beaton
authors.affiliation: Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Frankel
authors.affiliation: Mobility Program, St. Michael's Hospital, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Bogoch
authors.affiliation: Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Elliot-Gibson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009864:Ontario; D058866:Osteoporotic Fractures / Q000517:prevention & control* / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards; D036301:Qualitative Research; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D055502:Secondary Prevention / Q000458:organization & administration
chemical_list: D050071:Bone Density Conservation Agents
keywords: Fracture risk; Fragility fracture; Patient perspective; Post-fracture secondary prevention; Qualitative research