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Comparing Patient and Provider Priorities Around Amputation Level Outcomes Using Multiple Criteria Decision Analysis.

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This summary is machine-generated.

Patients undergoing lower-limb amputation value limb preservation and mobility differently than providers. Understanding these differences can improve shared decision-making for amputation levels.

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Area of Science:

  • Orthopedics and Rehabilitation
  • Vascular Surgery
  • Health Services Research

Background:

  • Chronic limb-threatening ischemia often necessitates transmetatarsal amputation (TMA) or transtibial amputation (TTA).
  • TMA preserves more limb and potentially enhances mobility but carries a higher risk of healing complications and further surgeries.
  • Discrepancies in prioritizing amputation outcomes between patients and providers can impact functional results and shared decision-making.

Purpose of the Study:

  • To compare patient priorities with provider perceptions of patient priorities in amputation level decision-making.
  • To utilize Multiple Criteria Decision Analysis (MCDA) to quantify and compare these priorities.

Main Methods:

  • Employed the Analytic Hierarchy Process (AHP) MCDA method for its low cognitive burden and ease of implementation.
  • Included five key criteria: ability to walk, surgical healing, rehabilitation intensity, limb length, and prosthetic/orthotic device usability.
  • Recruited a national sample of dysvascular lower-limb amputees and healthcare providers from the Veterans Health Administration for online and telephonic surveys.

Main Results:

  • Twenty-six patients and 38 providers participated; 50% of patients had undergone TMA, and 50% had TTA.
  • Patients prioritized TMA higher (72%) than providers (63%).
  • Key outcome priorities differed: patients valued walking (47%) and prosthesis use (17%) more, while providers emphasized healing (28%).

Conclusions:

  • Provider perceptions generally aligned with patient preferences regarding amputation level but showed variability in the importance assigned to specific outcomes.
  • Identified differences in patient values and provider perceptions highlight the need for enhanced shared decision-making strategies.
  • Integrating the MCDA framework into decision aids could facilitate more effective patient-provider discussions regarding amputation choices.