{
  "abstract": "Objectives Shared decision-making is widely advocated in policy and practice, but how it is to be applied in a high-stakes clinical decision such as major lower limb amputation due to chronic limb-threatening ischaemia or diabetic foot is unclear. The aim of this study was to explore the communication, consent, risk prediction and decision-making process in relation to major lower limb amputation.Design A qualitative study (done as part of a broader mixed-methods study) using semi-structured interviews. Interview transcriptions were analysed using thematic analysis.Setting Vascular centres in three large National Health Service hospitals in Wales and England, UK, between 1 October 2020 and 30 September 2022.Participants A purposive sample of 18 patients for whom major lower limb amputation was considered as a treatment option/carried out, with interviews conducted before or within 4 months of amputation and 4–6 months after amputation. A further purposive sample of 20 healthcare professionals (including eight surgeons) involved in supporting or conducting major lower limb amputation decision-making.Findings Five major categories were identified that highlighted the challenges of ensuring shared decision-making associated with major lower limb amputation: (i) patients’ limited understanding, (ii) variable patient attitudes to decision-making, (iii) healthcare professionals’ perceived challenges to sharing decision-making, (iv) surgeons’ paternalism and (v) patients’ and healthcare professionals’ decisional regret/possible consequences of challenges.Conclusion Amputation is a life-changing decision for both patients and healthcare professionals, with huge consequences. Despite being considered the gold standard, our findings highlight several challenges to effective shared decision-making for major lower limb amputation. Shared decision-making training for healthcare professionals is paramount if these limitations are to be addressed and patients are to feel confident in being adequately informed about the treatment decisions that they make.Trial registration number NCT04903756.",
  "authors": [
    {
      "affiliations": [
        "Centre for Trials Research, Cardiff University School of Medicine, Cardiff, Cardiff, UK"
      ],
      "name": "Hayley Prout"
    },
    {
      "affiliations": [
        "Centre for Trials Research, Cardiff University School of Medicine, Cardiff, Cardiff, UK"
      ],
      "name": "Cherry-Ann Waldron"
    },
    {
      "affiliations": [
        "Vascular Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, Wales, UK"
      ],
      "name": "Brenig Gwilym"
    },
    {
      "affiliations": [
        "Centre for Trials Research, Cardiff University School of Medicine, Cardiff, Cardiff, UK"
      ],
      "name": "Emma Thomas-Jones"
    },
    {
      "affiliations": [
        "Centre for Trials Research, Cardiff University School of Medicine, Cardiff, Cardiff, UK"
      ],
      "name": "Sarah Milosevic"
    },
    {
      "affiliations": [
        "Centre for Trials Research, Cardiff University School of Medicine, Cardiff, Cardiff, UK"
      ],
      "name": "Philip Pallmann"
    },
    {
      "affiliations": [
        "Centre for Trials Research, Cardiff University School of Medicine, Cardiff, Cardiff, UK"
      ],
      "name": "Debbie Harris"
    },
    {
      "affiliations": [
        "Cardiff University, Cardiff, UK"
      ],
      "name": "Adrian Edwards"
    },
    {
      "affiliations": [
        "Vascular Department, North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "Christopher P Twine"
    },
    {
      "affiliations": [
        "Cardiff and Vale University Health Board, Cardiff, UK"
      ],
      "name": "Ian Massey"
    },
    {
      "affiliations": [
        "ALAC, Rookwood Hospital, Cardiff, South Glamorgan, UK"
      ],
      "name": "Jo Burton"
    },
    {
      "affiliations": [
        "Vascular Department, Cardiff and Vale University Health Board, Cardiff, UK"
      ],
      "name": "Philippa Stewart"
    },
    {
      "affiliations": [
        "Involving People, Health and Care Research Wales, Cardiff, UK"
      ],
      "name": "Sian Jones"
    },
    {
      "affiliations": [
        "Health and Care Research Wales, Involve, Cardiff, South Glamorgan, UK"
      ],
      "name": "David Cox"
    },
    {
      "affiliations": [
        "South East Wales Vascular Network, Royal Gwent Hospital, Newport, Wales, UK",
        "Cardiff & Vale University Hospital, Cardiff, Wales, UK"
      ],
      "name": "David C Bosanquet"
    },
    {
      "affiliations": [
        "Centre for Trials Research, Cardiff University School of Medicine, Cardiff, Cardiff, UK"
      ],
      "name": "Lucy Brookes-Howell"
    },
    {
      "affiliations": [],
      "name": "PERCEIVE Study group"
    }
  ],
  "title": "Challenges in shared decision-making about major lower limb amputation: the PERCEIVE qualitative study",
  "uid": "76a495f0-63b1-5e1a-a47c-f55b4716b4c3"
}