LAS VEGAS — Shared decision-making between patients and clinicians can help patients make more informed decisions regarding partial foot amputations, according to presenters at the American Orthotic & Prosthetic Association 2017 World Congress.
P. Dillon, PhD, of La Trobe University in Melbourne, Australia, and Stefania Fatone, PhD, BPO, of Northwestern University in Chicago, presented the study, which aimed to analyze outcomes after partial foot amputation, interview patients who had undergone the procedure and determine how shared decision-making could help them through the process.
“For most of these people, they described the decision to proceed to amputation as one that was made on their behalf, and one that was made without discussion or about what the different treat options will be,” Dillon said. “Also, people seemed to accept that decision without question. Of all the people we interviewed, none expressed challenging the medical decision or asking for any additional information.”
According to Dillon and Fatone, patients were grossly uninformed regarding partial foot amputation, its expected outcomes and the likelihood of complications.
“When you consider that 41% of patients who have partial foot amputation will go on to have some sort of serious complication, such as infection or complete wound failure, it is almost criminal to think that that could happen,” Dillon added.
To address this lack of informed decision-making on the part of the patient, clinicians should engage in shared decision-making, the presenters said. This can include encouraging patients to be more active in the decision-making process, providing accurate data about treatment options and supporting deliberation, Fatone said.
According to the presenters, studies have shown that these steps can improve patients’ knowledge of their options and their perception of the risks involved. It can also reduce a patient’s sense of feeling uninformed and unsupported, they said.
“We want to encourage meaningful and informed conversations between clinicians, families and loved ones,” Fatone said. “We want the family and the patient to know the likely outcomes and risks they face, and we want them to make an informed decision about what is going to happen to them next.”
Dillon M and Fatone S. Experience of sequential partial foot and transtibial amputation: Implications for shared decision making. Presented at: American Orthotic & Prosthetic Association World Congress; Sept. 6-9, 2017; Las Vegas.
Disclosures: The presenters report that the study was partially funded by the American Orthotic & Prosthetic Association.