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Nieuwstraten JA, van Doorn LP, Gebhardt WA, et al. Stakeholder Values and Preferences in Lower Limb Amputation for No-Option Chronic Limb Threatening Ischemia. Patient Prefer Adherence. 2021;15:1051-1059doi: 10.2147/PPA.S309366.
Nieuwstraten, J. A., van Doorn, L. P., Gebhardt, W. A., & Hamming, J. F. (2021). Stakeholder Values and Preferences in Lower Limb Amputation for No-Option Chronic Limb Threatening Ischemia. Patient preference and adherence, 151051-1059. https://doi.org/10.2147/PPA.S309366
Nieuwstraten, Jelle A, et al. "Stakeholder Values and Preferences in Lower Limb Amputation for No-Option Chronic Limb Threatening Ischemia." Patient preference and adherence vol. 15 (2021): 1051-1059. doi: https://doi.org/10.2147/PPA.S309366
Nieuwstraten JA, van Doorn LP, Gebhardt WA, Hamming JF. Stakeholder Values and Preferences in Lower Limb Amputation for No-Option Chronic Limb Threatening Ischemia. Patient Prefer Adherence. 2021 May 20;15:1051-1059. doi: 10.2147/PPA.S309366. eCollection 2021. PMID: 34045851; PMCID: PMC8144360.
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Patient Prefer Adherence. 2021 May 20;15:1051-1059. doi: 10.2147/PPA.S309366. eCollection 2021.

Stakeholder Values and Preferences in Lower Limb Amputation for No-Option Chronic Limb Threatening Ischemia.

Patient preference and adherence

Jelle A Nieuwstraten, Louk P van Doorn, Winifred A Gebhardt, Jaap F Hamming

Affiliations

  1. Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands.
  2. Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.

PMID: 34045851 PMCID: PMC8144360 DOI: 10.2147/PPA.S309366

Abstract

PURPOSE: This study focusses on identifying values and preferences of patients, caregivers and healthcare professionals who have dealt with lower limb amputation for no-option chronic limb threatening ischemia. No-option chronic limb threatening ischemia is defined as limb ischemia for which no treatment options exist and where lower limb amputation is necessary in the short term. The values and preferences identified in this study can help improve decision-making processes.

PATIENTS AND METHODS: This was a qualitative study, using semi-structured interviews to gather data from patients, caregivers and healthcare professionals. Participants were selected from the patient and employee population of an academic medical center in The Netherlands. Nine patients and seven caregivers who dealt with lower limb amputation for no-option chronic limb threatening ischemia six to twelve months prior to the interview and were not cognitively impaired were selected. Nine healthcare professionals dealing with patients with no-option chronic limb threatening ischemia and lower limb amputation were selected.

RESULTS: Lower limb amputation was explicitly discussed late in the disease process, sometimes during an emergency setting. Patients stated goals were never discussed, healthcare professionals stated they were. The most important goal for patients was to live independently after lower limb amputation. Patients and caregivers feel healthcare professionals should be upfront about the possible necessity of lower limb amputation. Reasons to undergo lower limb amputation were absence of treatment options, pain and wanting to enjoy life again. Participants indicated accelerating lower limb amputation was not a viable option.

CONCLUSION: All stakeholders reported overlapping values and preferences regarding main reasons for lower limb amputation, the primary goals after lower limb amputation, and the absence of a desire to accelerate lower limb amputation. The main difference in values and preferences is the preferred timing of discussing lower limb amputation.

© 2021 Nieuwstraten et al.

Keywords: SDM; communication; shared decision-making; vascular surgery

Conflict of interest statement

The authors report no conflicts of interest in this work. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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