Finnie Dawn, Griffin Joan M, Kennedy Cassie C, Schaepe Karen, Boehmer Kasey, Hargraves Ian, Amer Hatem, Jowsey-Gregoire Sheila
Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
Transplant Center, Mayo Clinic, Rochester, MN, United States.
Front Psychol. 2022 Sep 27;13:953113. doi: 10.3389/fpsyg.2022.953113. eCollection 2022.
The goals of vascular composite allotransplantation (VCA) for hand are to maximize functional status and psychosocial wellbeing and to improve quality of life. Candidates are carefully vetted by transplant programs through an extensive evaluation process to exclude those patients with contraindications and to select those that are most likely to attain functional or quality of life benefit from transplant. Patient choice for any treatment, however, requires that candidates be able to understand the risks, benefits, and alternatives before choosing to proceed. This study aimed to understand patients' knowledge and perceptions about treatment options for hand loss, including hand transplant. This study will be used to inform a standardized education approach and develop conversation aids for use by clinicians and patients throughout the treatment decision process. Ten individuals who had experienced hand amputation or had congenital limb loss were interviewed to better understand previous and current decisions about treatment, experiences in adjusting to their treatment, and perceptions about hand VCA. From this qualitative interview data, four findings emerged: (1) knowledge and education around VCA as a treatment option; (2) adaptation of individuals with limb loss; (3) fear of risk associated with transplantation; (4) issues of aging and overuse injuries to existing limbs. Results suggests that there is opportunity for expanding education about all treatment options for patients with new loss, long-term loss, and congenital limb loss. Establishing a baseline of knowledge about all options-prosthetics, rehabilitative strategies, and VCA-can help patients evaluate their values and goals of treatment. Issues associated with aging, including overuse and injury, and adaptability over the life course should be included in considerations about treatment choices. Data indicate the need for routinely assessing patient preferences about treatment choice so patients can plan for their future as they adapt and age and as technology for treatments change. To assure that thorough information is provided for current and future decision-making, education about treatment choices and selection procedures for VCA should be standardized.
手部血管化复合组织异体移植（VCA）的目标是使功能状态和心理社会幸福感最大化，并提高生活质量。移植项目会通过广泛的评估过程对候选者进行仔细审查，以排除有禁忌症的患者，并挑选出最有可能从移植中获得功能改善或生活质量提升的患者。然而，对于任何治疗，患者的选择都要求候选者在决定继续治疗之前能够了解风险、益处和替代方案。本研究旨在了解患者对手部缺失治疗方案的知识和看法，包括手部移植。本研究将用于为标准化教育方法提供信息，并开发谈话辅助工具，供临床医生和患者在整个治疗决策过程中使用。对10名经历过手部截肢或先天性肢体缺失的个体进行了访谈，以更好地了解他们之前和当前关于治疗的决定、适应治疗的经历以及对手部VCA的看法。从这些定性访谈数据中得出了四个发现：（1）作为一种治疗选择的VCA相关知识和教育；（2）肢体缺失个体的适应情况；（3）对移植相关风险的恐惧；（4）现有肢体的老化和过度使用损伤问题。结果表明，对于新缺失、长期缺失和先天性肢体缺失的患者，有机会扩大对所有治疗选择的教育。建立关于所有选择——假肢、康复策略和VCA的知识基线，有助于患者评估他们的治疗价值观和目标。与老化相关的问题，包括过度使用和损伤，以及一生中的适应能力，应纳入治疗选择的考虑范围。数据表明需要定期评估患者对治疗选择的偏好，以便患者能够随着自身适应、变老以及治疗技术的变化规划未来。为确保为当前和未来的决策提供全面信息，应标准化关于治疗选择和VCA选择程序的教育。
