Shared decision-making when deciding on lower extremity amputation level: perceived facilitators and barriers among surgeons

Background A major lower limb amputation profoundly affects patients´ lives. Shared decision-making (SDM) can play a crucial role when a sensitive decision such as determining the appropriate level of amputation has to be made. Despite clinicians aiming for SDM and patients wanting active participation, barriers persist for implementation. Aim To explore facilitators and barriers to SDM among orthopaedic and vascular surgeons when deciding amputation levels. Methods An electronic survey was distributed November 2023 at 21 hospitals in Denmark, yielding responses from 28 vascular and 24 orthopaedic surgeons. The questionnaire covered four domains known to influence SDM and assessed respondents’ viewpoints on the potential use and implementation of an SDM tool. Descriptive statistics and inter-specialty comparisons were performed. Results More vascular surgeons than orthopaedic surgeons believed an SDM support tool would enhance patients’ decision-making experience (77% vs 48%); benefit their praxis (62% vs 35%); and that they would use such a tool (65% vs 48%). While both groups agreed on patients´ desire to participate in SDM (75%), 35% thought patients would find it difficult to understand the advantages and disadvantages of amputation at different levels. Vascular surgeons described being left out of the decision of amputation level and 63% of the orthopaedic surgeons reported a lack of a genuine choice of amputation level. Conclusions The study identified facilitators and barriers to SDM in amputation level decisions, emphasising the need for enhanced interdisciplinary collaboration between vascular and orthopaedic surgeons. Implementing a decision support tool could facilitate collaboration between surgeons in favour of patient treatment satisfaction.