Challenges in shared decision-making about major lower limb amputation: the PERCEIVE qualitative study

Prout, Hayley ORCID: https://orcid.org/0000-0003-0170-7027, Waldron, Cherry-Ann ORCID: https://orcid.org/0000-0001-8465-2492, Gwilym, Brenig, Thomas-Jones, Emma ORCID: https://orcid.org/0000-0001-7716-2786, Milosevic, Sarah ORCID: https://orcid.org/0000-0003-1973-8286, Pallmann, Philip ORCID: https://orcid.org/0000-0001-8274-9696, Harris, Debbie ORCID: https://orcid.org/0000-0002-7073-7724, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446, Twine, Christopher P ORCID: https://orcid.org/0000-0003-0385-5760, Massey, Ian, Burton, Jo, Stewart, Philippa, Jones, Sian, Cox, David, Bosanquet, David C ORCID: https://orcid.org/0000-0003-2304-0489 and Brookes-Howell, Lucy ORCID: https://orcid.org/0000-0002-8263-7130 2026. Challenges in shared decision-making about major lower limb amputation: the PERCEIVE qualitative study. BMJ Open 16 , e104407. 10.1136/bmjopen-2025-104407

Preview

PDF - Published Version Available under License Creative Commons Attribution Non-commercial. Download (986kB) | Preview

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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine Research Institutes & Centres > Centre for Trials Research (CNTRR)
Date of First Compliant Deposit:	14 January 2026
Date of Acceptance:	26 November 2025
Last Modified:	15 Jan 2026 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/183819

Actions (repository staff only)

Edit Item