VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA.
VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Ann Vasc Surg. 2023 May;92:313-322. doi: 10.1016/j.avsg.2023.01.042. Epub 2023 Feb 4.
Among patients facing lower extremity amputation due to dysvascular disease, the mortality risk is very high. Given this, as well as the importance of a patient-centered approach to medical care, informing patients about their possible risk of dying may be important during preoperative shared decision-making. The goal of this investigation was to gain an understanding of patient and provider experiences discussing mortality within the context of amputation within the Veterans Health Administration.
Semistructured interviews were performed with Veterans with peripheral arterial disease and/or diabetes, vascular and podiatric surgeons, and physical medicine and rehabilitation physicians. Interviews were analyzed using team-based content analysis to identify themes related to amputation-level decisions.
We interviewed 22 patients and 21 surgeons and physicians and identified 3 themes related to conversations around mortality: (1) both patients and providers report that mortality conversations are not common prior to amputation; (2) while most providers find value in mortality conversations, some express concerns around engaging in these discussions with patients; and (3) some patients perceive mortality conversations as unnecessary, but many are open to engaging in the conversation.
Providers may benefit from introducing the topic with patients, including providing the context for why mortality conversations may be valuable, with the understanding that patients can always decline to participate should they not be interested or comfortable discussing this issue.
在因血管疾病而面临下肢截肢的患者中，死亡率非常高。考虑到这一点，以及以患者为中心的医疗方法的重要性，在术前共同决策时告知患者他们可能面临的死亡风险可能很重要。本研究的目的是了解退伍军人事务部患者和医务人员在截肢背景下讨论死亡率的经验。
对患有外周动脉疾病和/或糖尿病的退伍军人、血管和足病外科医生以及物理医学和康复医生进行半结构化访谈。使用基于团队的内容分析对访谈进行分析，以确定与截肢决策相关的主题。
我们采访了 22 名患者和 21 名外科医生和医生，并确定了与死亡相关的 3 个主题：（1）患者和医务人员都报告说，在截肢之前，关于死亡的对话并不常见；（2）尽管大多数医务人员认为死亡对话有价值，但有些医务人员对与患者进行这些讨论表示担忧；（3）一些患者认为死亡对话没有必要，但许多患者愿意参与对话。
医务人员可能会受益于与患者一起提出这个话题，包括为为什么讨论死亡率可能有价值提供背景，同时也要理解，如果患者对此不感兴趣或感到不舒服，他们可以随时拒绝参与讨论。
