Perceived shared decision-making among patients undergoing lower-limb amputation and their care teams: A qualitative...

Area of Science:

• Vascular Surgery
• Patient Care
• Decision-Making

Background:

• Shared decision-making (SDM) is increasingly important in vascular surgery.
• Investigated patient and provider experiences with SDM for lower-extremity amputation decisions in Veterans with chronic limb-threatening ischemia (CLTI).

Purpose of the Study:

• To understand patient and provider perspectives on shared decision-making (SDM) for lower-extremity amputation and level selection in Veterans with chronic limb-threatening ischemia (CLTI).

Main Methods:

• Semistructured interviews were conducted with 22 male Veterans with CLTI and 21 vascular surgeons, physical medicine and rehabilitation physicians, and podiatric surgeons.
• Interview data were analyzed using team-based content analysis to identify themes concerning amputation-level decisions.

Main Results:

• Providers acknowledge the importance of patient preferences in amputation-level decisions.
• Patients reported not feeling included as equal partners in decisions regarding amputation or level.
• Providers identified obstacles to patient involvement, while patients described facilitators for their participation in SDM.

Conclusions:

• Patients often felt their opinions were not solicited during amputation decision-making, despite its recognized importance.
• Provider-perceived challenges in the clinical context of amputation may hinder SDM.
• Patients highlighted the need for clear information and empathetic communication to enhance SDM.