CAN YOU SEE FRAILTY? AN EXPLORATORY STUDY OF THE USE OF A PATIENT PHOTOGRAPH IN THE TRANSCATHETER AORTIC VALVE IMPLANTATION PROGRAM

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Frailty is a multisystem clinical syndrome characterized by the loss of physiological reserves and accumulation of physical deficits. The measurement of frailty is an important assessment to inform treatment decision, peri-procedure planning, post-operative care, and transition home. This is of pivotal importance in the management of elderly patients referred for transcatheter aortic valve implantation (TAVI). To this end, frailty is routinely measured in our centre at the time of assessment using the Essential Frailty Toolset (EFT), while a patient photograph is taken to document overall health status. Documentation of frailty is used as an adjunctive source of information to augment multimodality assessment. We sought to understand how the standardized use of a patient photograph is associated with an objective measure of frailty, and how clinicians use the photograph to form impressions about patients considered for TAVI. We conducted a mixed methods exploratory study to (1) examine the relationship between the EFT, a validated and sensitive frailty score, and health care providers’ (HCPs) assessment of frailty as determined by the patient’s photograph, and (2) investigate how clinicians use patient photographs to form impressions about frailty and clinical care. To this end, we prospectively recruited patients and HCPs. HCPs rated a set of patient photographs between 0 (not frail) and 6 (very frail); median HCP scores were compared to the objective EFT score, across all disciplines, and between nurses and physicians. Using content analysis informed by an interpretive description approach, we conducted semi-structured interviews with HCPs directly involved in TAVI treatment decisions to explore how they form impressions of frailty. We recruited 40 patients who agreed to have their photograph included in the study; their EFT score ranged from 0 to 6. Individual variations in photo ratings were observed; median ratings were higher than EFT scores. Patients’ use of a mobility aid was associated with higher ratings. Nursing and physician ratings were generally aligned. HCPs’ impressions were informed by patients’ visible attributes, the inferences made, and the cautious clinical conclusions drawn. The routine use of a patient photograph augments multimodality assessment but requires recommendations for use to inform clinical care. Cardiovascular nurses can play a pivotal role in the development of a nursing protocol to document patients’ photograph and provide leadership for the multidisciplinary team to critically examine its use in practice.