Important outcomes for patients with frailty admitted to hospital with peripheral arterial disease, their caregivers and their health professionals: A Nominal Group Technique study

• Making treatment decisions with frail older vascular surgery patients is complex. • What matters most to patients, caregivers and healthcare professionals? • We used Nominal Group Technique to facilitate prioritisation of health outcomes. • Independence, wellbeing and quality of life were prioritised by all. • Communication and relationship outcomes were important to patients and caregivers. This study aimed to identify outcomes that are important to older patients with frailty admitted to hospital with peripheral arterial disease (PAD), informal caregivers and health professionals, and to ascertain the attitudes, values and beliefs underpinning prioritisation of these outcomes. Focus groups using Nominal Group Technique were conducted with older adult patients with frailty and PAD, informal caregivers, vascular surgeons, nurses, and allied health professionals (AHPs). The 10 highest ranked outcomes for each group were identified, and qualitative data were thematically analysed. Six patients, four caregivers, six surgeons, four nurses and four AHPs participated in six focus groups and identified 88 outcomes. Outcomes relating to independence, wellbeing and quality of life were prioritised by all groups. Discharge home and pain relief were highly prioritised by patients, nurses, AHPs and surgeons. Communication and relationship-centred outcomes were important to patients and caregivers. Outcomes unique to caregivers related to knowledge gain and future planning. Six themes related to the prioritisation of clinical outcomes (including ‘importance of getting home’ and ‘restoring and maintaining independence’) and five themes related to the experience of being, or caring for, a frail patient with PAD (including complexity of making the ‘right’ decisions’, and ‘importance of relationships and communication’). Knowledge about prioritised outcomes may optimise shared decision-making with this vulnerable group and may guide the implementation and evaluation of new models of vascular surgery care such as geriatric co-management.