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Making decisions about amputation for chronic limb threatening ischaemia.

Susan Monaro1, Sandra West2, Janice Gullick2

  • 1Vascular Clinical Nurse Consultant, Concord Repatriation General Hospital, Clinical Senior Lecturer, Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, New South Wales, Australia.

Journal of Vascular Nursing : Official Publication of the Society for Peripheral Vascular Nursing
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PubMed
Summary

Patients and families struggle with amputation decisions for chronic limb threatening ischaemia. Clinicians should engage in authentic discourse to support shared decision-making and help patients own their choices.

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Area of Science:

  • Medical Humanities
  • Qualitative Health Research
  • Surgical Decision-Making

Background:

  • Chronic limb threatening ischaemia (CLTI) presents significant challenges, including pain, functional loss, and complex wounds.
  • While minimally invasive revascularisation improves options for frail patients, determining when to proceed to amputation remains difficult.
  • Amputation decisions are emotionally taxing for patients and their families, impacting clinical outcomes and patient-acceptable results.

Purpose of the Study:

  • To explore patient and family experiences in decision-making for chronic limb threatening ischaemia.
  • To provide a philosophical understanding of the decision-making process surrounding amputation for CLTI.

Main Methods:

  • A longitudinal qualitative study employing Heideggerian phenomenology.
  • Participants (patients and families) were recruited from three clinical sites.
  • Semi-structured interviews were conducted at two time points: post-amputation advice and six months post-operatively.

Main Results:

  • Decision-making involved initial irresoluteness, characterized by neglecting or renouncing choices.
  • Participants eventually reached a state of resoluteness, choosing either to proceed with or turn away from amputation.
  • Patients opting for amputation often reported better-than-anticipated outcomes.

Conclusions:

  • Patients and families face significant difficulties in making amputation decisions for CLTI.
  • Clinicians play a crucial role in shared decision-making through authentic discourse and presence.
  • Allowing patients and families more time to process the experience aids in decision ownership.