Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.
Disabil Rehabil. 2013 Jul;35(15):1293-301. doi: 10.3109/09638288.2012.727945. Epub 2012 Oct 19.
To explore, from the perspective of the person with tetraplegia, the issues that influenced decision making about upper limb surgery and develop a conceptual framework describing the decision making process.
Purposive and theoretical sampling of 22 people with tetraplegia, followed by interviews. Ten people had upper limb surgery and 12 had not. Verbatim transcripts were analyzed with constructivist grounded theory.
Participants responded to the offer of surgery in one of three ways: yes, let me have it; no thanks; or possibly. Many influences on the decision about surgery had a temporal element, such as hope for the cure or recovery from SCI, inadequate physical or social supports while rehabilitating, life roles and goals, and the avoidance of re-hospitalization. The conceptual framework illustrated that many participants entered a liminal state within which they required a stimulus to review their decision about upper limb surgery.
Decision making is a temporal process, and for some the process was a prolonged and liminal one. Therefore, multiple offers for surgery are required to allow for changing thoughts and circumstances throughout an individual's lifetime. Flexibility with regard to timing for surgery and type of rehabilitation may increase the uptake, especially for women.
• Multiple offers for upper limb surgery are required throughout an individual's lifetime to account for changing thoughts and priorities. • Identification of the type of support required (informational, emotional) may assist in decreasing the time taken to make the decision about surgery. • Flexibility in surgical and rehabilitation options, especially for women, may increase the uptake of surgery.
从四肢瘫痪者的角度探讨影响上肢手术决策的因素，并构建一个描述决策过程的概念框架。
对 22 名四肢瘫痪者进行目的性和理论性抽样，然后进行访谈。其中 10 人接受了上肢手术，12 人未接受。对逐字记录的转录进行建构主义扎根理论分析。
参与者对手术的回应有三种方式：是，我要做；不，谢谢；或者可能。许多影响手术决策的因素都具有时间因素，例如对 SCI 治愈或恢复的希望、康复期间身体或社会支持不足、生活角色和目标，以及避免再次住院。该概念框架表明，许多参与者进入了一个阈限状态，在这种状态下，他们需要一个刺激来重新审视他们对上肢手术的决定。
决策是一个时间过程，对于一些人来说，这个过程是一个漫长而阈限的过程。因此，需要多次提供手术机会，以允许个人在其一生中不断改变想法和环境。手术时间和康复类型的灵活性可能会增加手术的接受度，尤其是对女性而言。
• 需要在个人的一生中多次提供上肢手术机会，以考虑到不断变化的想法和优先事项。
• 确定所需的支持类型（信息、情感）可能有助于缩短手术决策时间。
• 手术和康复选择的灵活性，特别是对女性而言，可能会增加手术的接受度。
