Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.
Prog Transplant. 2023 Sep;33(3):216-222. doi: 10.1177/15269248231189863. Epub 2023 Aug 2.
Advancements in vascularized composite allotransplantation have made hand transplants possible for persons living with upper limb loss. Hand transplantation is not a life-saving procedure, but rather a quality-of-life enhancing procedure; hence the risk of morbidity and mortality must be weighed against improvements in function and appearance. This study explored the decision-making process of patients evaluated for hand transplantation.
METHODS/APPROACH: A qualitative case series study using retrospective chart data of evaluations was conducted between January 1, 2011 and February 28, 2020. Notes were extracted and read by three reviewers. Each case was summarized noting similarities and differences.
Nine patients underwent evaluation. Eight were no longer under evaluation and did not receive transplant; one was still undergoing evaluation. Patient motivations for evaluation were dissatisfaction with prostheses or self-image, chronic pain, performing activities of daily living, occupation, burden placed on caregivers, and concerns about overuse of non-affected limbs. Patients chose not to pursue transplantation due to rehabilitation time, immunosuppression, alternative treatments, and social and financial challenges. The clinical team discontinued evaluations due to unmet evaluation requirements, medical contraindications, or treatment alternatives. Different modes of shared decision-making were present depending on the party most heavily featured in the charts as driving decisions.
This was an examination of shared decision-making with hand transplant candidates who did not proceed to transplant. Reasons for choosing alternative strategies for management were multifactorial. Lessons learned regarding patient motivations and shared decision-making can inform future interventions to better support patients.
血管化复合组织同种异体移植的进步使得手部移植成为可能，为上肢缺失的患者提供了可能。手部移植不是救命手术，而是提高生活质量的手术；因此，发病率和死亡率的风险必须与功能和外观的改善相权衡。本研究探讨了接受手部移植评估的患者的决策过程。
方法/方法：这是一项定性病例系列研究，使用 2011 年 1 月 1 日至 2020 年 2 月 28 日的评估回顾性图表数据进行。摘录并由三位审阅者阅读笔记。总结每个案例，注意相似点和不同点。
9 名患者接受了评估。8 名患者不再接受评估，也未接受移植；1 名患者仍在接受评估。患者接受评估的动机包括对假肢或自我形象不满意、慢性疼痛、进行日常活动、职业、照顾者的负担以及对过度使用未受影响的肢体的担忧。患者选择不进行移植是因为康复时间、免疫抑制、替代治疗以及社会和财务挑战。临床团队因未满足评估要求、医学禁忌症或治疗替代方案而停止评估。根据图表中最主要的决策驱动方，存在不同的共同决策模式。
这是对手部移植候选者的共同决策的检查，这些候选者没有进行移植。选择替代管理策略的原因是多方面的。关于患者动机和共同决策的经验教训可以为未来的干预措施提供信息，以更好地支持患者。
