LOWER EXTREMITY AMPUTATION AND SHARED DECISION MAKING: Perceived Facilitators and Barriers among Surgeons

Aim: To explore facilitators and barriers towards shared decision making (SDM) among orthopedic and vascular surgeons when deciding amputation level.
Method: An electronic survey was distributed November 2023 at 22 hospitals in Denmark, and answered by vascular (n= 28) & orthopedic (n=24) surgeons . The questionnaire covered four domains, known to influence implementation of SDM: 1) Environmental Context and Resources, 2) Social/Professional Role and Identity, 3) Knowledge and Skills, and 4) Beliefs about Capabilities. Furthermore, respondents' viewpoints on the potential use and implementation of a tool to facilitate SDM in the determination of amputation levels was explored.
Preliminary results: Both groups agreed on patients wanting to participate in SDM (75%). One-third (35%) thought patients would find it difficult to understand the advantages and disadvantages of amputation at different levels, and most (88%) found it advantageous to involve the patient's relatives in the decision process. Less vascular than orthopedic surgeons explain to patients the advantages and disadvantages of amputating at the different levels (68 vs 98%); believed they had the needed competency´s to involve in SDM (54 vs 88%), and the needed time available (46 vs 71%). More vascular than orthopedic surgeons believed; a SDM support tool would improve patients' experience of the decision-making process (77 vs 48%); would benefit their praxis (62 vs 35%); would use such a tool (65 vs 48%).
Conclusion:
Different barriers and facilitators for implementing a SDM support tool exist among vascular and orthopedic surgeons. This should be taken into account in the implementation process.