Using Nominal Group Technique to Gather Recommendations in the Decision-Making for Amputation Due to Diabetes

A lower extremity amputation has traditionally been considered as a last resort treatment option for people with a diabetes-related foot ulcer (DFU). However, some people will opt for an earlier amputation to overcome the daily lifestyle challenges from ongoing conservative wound management. Even so, making the decision for non-emergency amputation is challenging due to the lack of clear recommendations or evidence-based resources. Therefore, this study aimed to gather recommendations from people with lived experience of a DFU or amputation, family members, health practitioners, and experts to guide decision-making for amputation due to diabetes.

Nominal group technique was used to gather and vote on recommendations to support people making decisions for amputation. This technique allows all voices to participate and inform ideas. Two separate cohorts were recruited, one group was comprised people with lived experience (of DFU or amputation due to diabetes) and family members (n = 4 participants). The other group consisted of health practitioners and experts (n = 5 participants). During these workshops, research findings from a previous scoping review (94 papers) and interviews with people with lived experience and health experts (n = 26) were presented to participants to gather iterative feedback. Recommendations were constructed using the previous findings and the participants' experience and expertise, which were voted on and later analysed using summative content analysis.

A total of 13 recommendations were established by the people with lived experience and their family members, and 15 recommendations from health experts. Seven categories were established from these combined recommendations which described the priority considerations: 'Consider timing, with early discussions to move forward', 'Address every element of quality of life', 'Understand individual goals and priorities to make personalised decisions', 'Collaborate with support networks', 'Provide information and options', 'Communicate with respect and transparency', and 'Offer functional person-centred systems'.

The recommendations highlight the need for early and transparent discussions that prioritise individual goals, quality of life needs and collaboration with support networks, to enable person-centred and evidence-based decisions. These recommendations provide a foundation for the development of guidelines to support timely and informed collaborative decisions in the future.