A Qualitative Study of Factors Influencing the Decision to Have an Elective Amputation
BACKGROUND:Some patients with a functionally impaired lower limb choose to have an elective amputation, whereas others do not. Functional outcomes do not favor either type of treatment, making this a complex decision. The experiences of patients who have chosen elective amputation were analyzed to i...
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| Veröffentlicht in: | Journal of bone and joint surgery. American volume 2011-11, Vol.93 (22), p.2087-2092 |
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| container_title | Journal of bone and joint surgery. American volume |
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| creator | Quon, Deanna L Dudek, Nancy L Marks, Meridith Boutet, Michael Varpio, Lara |
| description | BACKGROUND:Some patients with a functionally impaired lower limb choose to have an elective amputation, whereas others do not. Functional outcomes do not favor either type of treatment, making this a complex decision. The experiences of patients who have chosen elective amputation were analyzed to identify the key factors in this decision-making process.
METHODS:Patients from a tertiary care amputee clinic who had chosen to undergo elective amputation of a functionally impaired lower limb participated in the present study. A qualitative research design involved the use of one-on-one semi-structured interviews, which were audio recorded and transcribed. Narrative analysis was used by three researchers to provide triangulation. Recurrent key themes and patterns were described. Personal factors in the decision-making process were identified.
RESULTS:Factors that had the largest impact on the decision-making process were pain, function, and participation. Body image, self identity, and the opinions of others had little influence. Satisfaction with the surgical outcome was related to how closely the result matched the patientʼs expectations. Patients who were better informed prior to surgery had more realistic expectations about living with an amputation.
CONCLUSIONS:The severity of pain and the desire for improved function are strong drivers for patients deciding to undergo elective amputation of a functionally impaired lower extremity. While patients do not want others’ opinions, information regarding life with an amputation helps to set realistic expectations regarding outcome.
CLINICAL RELEVANCE:Health-care professionals can assist patients facing this decision by providing realistic information regarding life with an amputation. Connecting these patients to peers with amputations can supplement information provided by professionals. |
| doi_str_mv | 10.2106/JBJS.J.01998 |
| format | Article |
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METHODS:Patients from a tertiary care amputee clinic who had chosen to undergo elective amputation of a functionally impaired lower limb participated in the present study. A qualitative research design involved the use of one-on-one semi-structured interviews, which were audio recorded and transcribed. Narrative analysis was used by three researchers to provide triangulation. Recurrent key themes and patterns were described. Personal factors in the decision-making process were identified.
RESULTS:Factors that had the largest impact on the decision-making process were pain, function, and participation. Body image, self identity, and the opinions of others had little influence. Satisfaction with the surgical outcome was related to how closely the result matched the patientʼs expectations. Patients who were better informed prior to surgery had more realistic expectations about living with an amputation.
CONCLUSIONS:The severity of pain and the desire for improved function are strong drivers for patients deciding to undergo elective amputation of a functionally impaired lower extremity. While patients do not want others’ opinions, information regarding life with an amputation helps to set realistic expectations regarding outcome.
CLINICAL RELEVANCE:Health-care professionals can assist patients facing this decision by providing realistic information regarding life with an amputation. Connecting these patients to peers with amputations can supplement information provided by professionals.</description><identifier>ISSN: 0021-9355</identifier><identifier>EISSN: 1535-1386</identifier><identifier>DOI: 10.2106/JBJS.J.01998</identifier><identifier>PMID: 22262380</identifier><identifier>CODEN: JBJSA3</identifier><language>eng</language><publisher>Boston, MA: Copyright by The Journal of Bone and Joint Surgery, Incorporated</publisher><subject>Adolescent ; Adult ; Age Factors ; Amputation - methods ; Amputation - statistics & numerical data ; Arthropathy, Neurogenic - diagnosis ; Arthropathy, Neurogenic - surgery ; Biological and medical sciences ; Child ; Decision Making ; Diseases of the osteoarticular system ; Elective Surgical Procedures - methods ; Elective Surgical Procedures - statistics & numerical data ; Female ; Follow-Up Studies ; Humans ; Injury Severity Score ; Interviews as Topic ; Leg - surgery ; Leg Injuries - diagnosis ; Leg Injuries - surgery ; Male ; Medical sciences ; Middle Aged ; Orthopedic surgery ; Pain, Intractable - psychology ; Pain, Intractable - surgery ; Patient Preference - psychology ; Patient Preference - statistics & numerical data ; Poliomyelitis - diagnosis ; Poliomyelitis - surgery ; Qualitative Research ; Quality of Life ; Risk Assessment ; Severity of Illness Index ; Sex Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome ; Young Adult</subject><ispartof>Journal of bone and joint surgery. American volume, 2011-11, Vol.93 (22), p.2087-2092</ispartof><rights>Copyright 2011 by The Journal of Bone and Joint Surgery, Incorporated</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3656-8df3711485f22bd9945c4a2a8ce933fad2b1cbc3b01ad34f51c390d59ebf0cbb3</citedby><cites>FETCH-LOGICAL-c3656-8df3711485f22bd9945c4a2a8ce933fad2b1cbc3b01ad34f51c390d59ebf0cbb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27915,27916</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25331450$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22262380$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Quon, Deanna L</creatorcontrib><creatorcontrib>Dudek, Nancy L</creatorcontrib><creatorcontrib>Marks, Meridith</creatorcontrib><creatorcontrib>Boutet, Michael</creatorcontrib><creatorcontrib>Varpio, Lara</creatorcontrib><title>A Qualitative Study of Factors Influencing the Decision to Have an Elective Amputation</title><title>Journal of bone and joint surgery. American volume</title><addtitle>J Bone Joint Surg Am</addtitle><description>BACKGROUND:Some patients with a functionally impaired lower limb choose to have an elective amputation, whereas others do not. Functional outcomes do not favor either type of treatment, making this a complex decision. The experiences of patients who have chosen elective amputation were analyzed to identify the key factors in this decision-making process.
METHODS:Patients from a tertiary care amputee clinic who had chosen to undergo elective amputation of a functionally impaired lower limb participated in the present study. A qualitative research design involved the use of one-on-one semi-structured interviews, which were audio recorded and transcribed. Narrative analysis was used by three researchers to provide triangulation. Recurrent key themes and patterns were described. Personal factors in the decision-making process were identified.
RESULTS:Factors that had the largest impact on the decision-making process were pain, function, and participation. Body image, self identity, and the opinions of others had little influence. Satisfaction with the surgical outcome was related to how closely the result matched the patientʼs expectations. Patients who were better informed prior to surgery had more realistic expectations about living with an amputation.
CONCLUSIONS:The severity of pain and the desire for improved function are strong drivers for patients deciding to undergo elective amputation of a functionally impaired lower extremity. While patients do not want others’ opinions, information regarding life with an amputation helps to set realistic expectations regarding outcome.
CLINICAL RELEVANCE:Health-care professionals can assist patients facing this decision by providing realistic information regarding life with an amputation. Connecting these patients to peers with amputations can supplement information provided by professionals.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Amputation - methods</subject><subject>Amputation - statistics & numerical data</subject><subject>Arthropathy, Neurogenic - diagnosis</subject><subject>Arthropathy, Neurogenic - surgery</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Decision Making</subject><subject>Diseases of the osteoarticular system</subject><subject>Elective Surgical Procedures - methods</subject><subject>Elective Surgical Procedures - statistics & numerical data</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Interviews as Topic</subject><subject>Leg - surgery</subject><subject>Leg Injuries - diagnosis</subject><subject>Leg Injuries - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Orthopedic surgery</subject><subject>Pain, Intractable - psychology</subject><subject>Pain, Intractable - surgery</subject><subject>Patient Preference - psychology</subject><subject>Patient Preference - statistics & numerical data</subject><subject>Poliomyelitis - diagnosis</subject><subject>Poliomyelitis - surgery</subject><subject>Qualitative Research</subject><subject>Quality of Life</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Sex Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0021-9355</issn><issn>1535-1386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkU1v1DAQhq0K1G4Lt56RL4hLs8zYcTY-LqVfq0oIFbhajmN3A954sZ1W_fdNuluYy0ij530PzxByijBnCNXn1ZfV3Xw1B5SyPiAzFFwUyOvqDZkBMCwkF-KIHKf0GwDKEhaH5IgxVjFew4z8WtLvg_Zd1rl7sPQuD-0TDY5eapNDTPSmd36wven6e5rXln61pktd6GkO9FqPCd3TC2_NS3q52Q5TUejfkbdO-2Tf7_cJ-Xl58eP8urj9dnVzvrwtDK9EVdSt4wvEshaOsaaVshSm1EzXxkrOnW5Zg6YxvAHULS-dQMMltELaxoFpGn5CPu16tzH8HWzKatMlY73XvQ1DUhIXWCEDMZJnO9LEkFK0Tm1jt9HxSSGoSaSaRKqVehE54h_2xUOzse0_-NXcCHzcAzoZ7V3Uo6T0nxOcYykmrtxxj8FnG9MfPzzaqNZW-7xWMP1kLCwY4DQVFNOp4s95rYp1</recordid><startdate>20111116</startdate><enddate>20111116</enddate><creator>Quon, Deanna L</creator><creator>Dudek, Nancy L</creator><creator>Marks, Meridith</creator><creator>Boutet, Michael</creator><creator>Varpio, Lara</creator><general>Copyright by The Journal of Bone and Joint Surgery, Incorporated</general><general>Journal of Bone and Joint Surgery Incorporated</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111116</creationdate><title>A Qualitative Study of Factors Influencing the Decision to Have an Elective Amputation</title><author>Quon, Deanna L ; Dudek, Nancy L ; Marks, Meridith ; Boutet, Michael ; Varpio, Lara</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3656-8df3711485f22bd9945c4a2a8ce933fad2b1cbc3b01ad34f51c390d59ebf0cbb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Amputation - methods</topic><topic>Amputation - statistics & numerical data</topic><topic>Arthropathy, Neurogenic - diagnosis</topic><topic>Arthropathy, Neurogenic - surgery</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Decision Making</topic><topic>Diseases of the osteoarticular system</topic><topic>Elective Surgical Procedures - methods</topic><topic>Elective Surgical Procedures - statistics & numerical data</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Interviews as Topic</topic><topic>Leg - surgery</topic><topic>Leg Injuries - diagnosis</topic><topic>Leg Injuries - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Orthopedic surgery</topic><topic>Pain, Intractable - psychology</topic><topic>Pain, Intractable - surgery</topic><topic>Patient Preference - psychology</topic><topic>Patient Preference - statistics & numerical data</topic><topic>Poliomyelitis - diagnosis</topic><topic>Poliomyelitis - surgery</topic><topic>Qualitative Research</topic><topic>Quality of Life</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Sex Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Quon, Deanna L</creatorcontrib><creatorcontrib>Dudek, Nancy L</creatorcontrib><creatorcontrib>Marks, Meridith</creatorcontrib><creatorcontrib>Boutet, Michael</creatorcontrib><creatorcontrib>Varpio, Lara</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of bone and joint surgery. American volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Quon, Deanna L</au><au>Dudek, Nancy L</au><au>Marks, Meridith</au><au>Boutet, Michael</au><au>Varpio, Lara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Qualitative Study of Factors Influencing the Decision to Have an Elective Amputation</atitle><jtitle>Journal of bone and joint surgery. American volume</jtitle><addtitle>J Bone Joint Surg Am</addtitle><date>2011-11-16</date><risdate>2011</risdate><volume>93</volume><issue>22</issue><spage>2087</spage><epage>2092</epage><pages>2087-2092</pages><issn>0021-9355</issn><eissn>1535-1386</eissn><coden>JBJSA3</coden><abstract>BACKGROUND:Some patients with a functionally impaired lower limb choose to have an elective amputation, whereas others do not. Functional outcomes do not favor either type of treatment, making this a complex decision. The experiences of patients who have chosen elective amputation were analyzed to identify the key factors in this decision-making process.
METHODS:Patients from a tertiary care amputee clinic who had chosen to undergo elective amputation of a functionally impaired lower limb participated in the present study. A qualitative research design involved the use of one-on-one semi-structured interviews, which were audio recorded and transcribed. Narrative analysis was used by three researchers to provide triangulation. Recurrent key themes and patterns were described. Personal factors in the decision-making process were identified.
RESULTS:Factors that had the largest impact on the decision-making process were pain, function, and participation. Body image, self identity, and the opinions of others had little influence. Satisfaction with the surgical outcome was related to how closely the result matched the patientʼs expectations. Patients who were better informed prior to surgery had more realistic expectations about living with an amputation.
CONCLUSIONS:The severity of pain and the desire for improved function are strong drivers for patients deciding to undergo elective amputation of a functionally impaired lower extremity. While patients do not want others’ opinions, information regarding life with an amputation helps to set realistic expectations regarding outcome.
CLINICAL RELEVANCE:Health-care professionals can assist patients facing this decision by providing realistic information regarding life with an amputation. Connecting these patients to peers with amputations can supplement information provided by professionals.</abstract><cop>Boston, MA</cop><pub>Copyright by The Journal of Bone and Joint Surgery, Incorporated</pub><pmid>22262380</pmid><doi>10.2106/JBJS.J.01998</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Adult Age Factors Amputation - methods Amputation - statistics & numerical data Arthropathy, Neurogenic - diagnosis Arthropathy, Neurogenic - surgery Biological and medical sciences Child Decision Making Diseases of the osteoarticular system Elective Surgical Procedures - methods Elective Surgical Procedures - statistics & numerical data Female Follow-Up Studies Humans Injury Severity Score Interviews as Topic Leg - surgery Leg Injuries - diagnosis Leg Injuries - surgery Male Medical sciences Middle Aged Orthopedic surgery Pain, Intractable - psychology Pain, Intractable - surgery Patient Preference - psychology Patient Preference - statistics & numerical data Poliomyelitis - diagnosis Poliomyelitis - surgery Qualitative Research Quality of Life Risk Assessment Severity of Illness Index Sex Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Young Adult |
| title | A Qualitative Study of Factors Influencing the Decision to Have an Elective Amputation |
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