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

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.