“Shared decision-making is widely advocated in policy and practice, but how it is to be applied in a high-stakes clinical decision such as major lower-limb amputation due to chronic limb-threatening ischemia or diabetic foot is unclear,” the authors of a recent study wrote. They then explored the communication, consent, risk prediction, and decision-making process with a shared decision-making medical team.
The healthcare professionals who participated in the research included vascular surgeons, anesthetists, specialist physiotherapists, specialist vascular nurses, occupational therapists, geriatricians, and rehabilitation physicians. The study was conducted at vascular centers in three United Kingdom hospitals from October 1, 2020, through September 30, 2022.
The qualitative study, done as part of a broader mixed-methods study, used semistructured interviews with a purposive sample of 18 patients for whom major lower-limb amputation was considered or carried out. Interviews were conducted before or within four months of amputation and four to six months after amputation. The 20 participating healthcare professionals (including eight surgeons) were involved in supporting or conducting the decision-making.
The researchers identified five categories that highlighted the challenges of ensuring shared decision-making associated with major lower limb amputation: patients’ limited understanding, variable patient attitudes to decision-making, healthcare professionals’ perceived challenges to sharing decision-making, surgeons’ paternalism, and patients’ and healthcare professionals’ decisional regret/possible consequences of challenges.
While prosthetists were not included in the participating group, a physiotherapist commented on patients’ perceptions that a prosthesis is “going to be a fix to all their problems almost and that their mobility is going to be sometimes better than what it was before amputation, which is hard for us to try and manage I’d say.” Patient grievances related to a lack of rehabilitation services and equipment and the wait for a prosthetic limb.
The researchers concluded that training healthcare professionals how to participate in a shared decision-making environment would address any limitations and help patients to feel confident in being adequately informed about the treatment decisions that they make.
The open-access study, “Challenges in shared decision-making about major lower limb amputation: the PERCEIVE qualitative study,” was published in BMJ Open.
