Making decisions about amputation for chronic limb threatening ischaemia.

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.