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253 The use of a shared decision support tool when deciding amputation level – perceived facilitators and barriers among clinicians – a national cross-sectional study
  1. Ane Simony1,
  2. Charlotte Abrahamsen2,
  3. Ulla R Madsen3,
  4. Katrine R Stoevring4
  1. 1Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding, Denmark and Department of Public Health, University of Southern Denmark, Denmark
  2. 2Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding, Denmark and Department of Public Health, University of Southern Denmark, Denmark
  3. 3Ortopedic Department, Holbaek Hospital, REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  4. 4Ortopedic Department, Holbaek Hospital

Abstract

Introduction Despite clinicians aiming for shared decision-making (SDM),1 barriers persist for implementation.2,3,4Patients desire active participation,1 even in unavoidable amputations.5 The aim of this study was to explore facilitators and barriers towards SDM among orthopedic and vascular surgeons, when deciding amputation level.

Method An electronic survey was distributed among 22 hospitals in Denmark, November 2023, and answered by vascular (n= 28) & orthopedic (n=24) surgeons working within this specific field. The questionnaire covered four domains, known to influence implementation of SDM4: 1) Environmental Context and Resources, 2) Social/Professional Role and Identity, 3) Knowledge and Skills, and 4) Beliefs about Capabilities. Furthermore, respondents’ viewpoints on the potential use and implementation of a tool to facilitate SDM in the determination of amputation levels, was explored.

Preliminary Results Both groups agreed on patients wanting to participate in SDM (75%), however, 35% thought patients would find it difficult to understand the advantages and disadvantages of amputation at different levels. Less vascular than orthopedic surgeons believed they had the needed competency´s to involve in SDM (54 vs 88%), and the needed time available (46 vs 71%). More vascular than orthopedic surgeons believed; a SDM support tool would improve patients‘ experience of the decision-making process (77 vs 48%); would benefit their praxis (62 vs 35%); would use such a tool (65 vs 48%).

Discussion The clinicians’ didn´t experience the environmental context and resources as a barrier for SDM, and believed they had the capabilities to engage in SDM. Opposite, beliefs about the patients´ capabilities may act as a barrier for involving the patients actively in SDM.

Conclusion Different barriers and facilitators for implementing a SDM support tool exist among vascular and orthopedic surgeons. This should be taken into account in the implementation process.

References

  1. Leonard C, Sayre G, Williams S, et al. Perceived shared decision-making among patients undergoing lower- limb amputation and their care teams: A qualitative study. Prosthetics and Orthotics International. 2023;47(4):379–386.

  2. Coulter A. Shared decision making: everyone wants it, so why isn’t it happening? World Psychiatry. 2017;16(2):117–8.

  3. Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns. 2014;94(3):291–309.

  4. Waddell A, Lennox A, Spassova G, Bragge P. Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review. Implementation Science. 2021;16(1):74.

  5. Columbo JA, Davies L, Kang R, Barnes JA, Leinweber KA, Suckow BD, et al. Patient Experience of Recovery After Major Leg Amputation for Arterial Disease. Vasc Endovascular Surg. 2018;52(4):262–8.

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