A Qualitative Analysis of the Decision-Making Process for Patients with Severe Lower Leg Trauma

Background: Choosing the appropriate treatment for grade IIIB and IIIC open tibial fractures is a difficult decision for both the patient and the physician. Current research shows that the functional outcomes for reconstruction are similar to those for below-knee amputation, but little investigation of the qualitative outcomes of either treatment option has been performed from the patient perspective. This study was designed to perform a qualitative analysis of patient preferences for amputation or reconstruction. Methods: Twenty patients with type IIIB or IIIC open tibial fractures participated in the study. These patients had undergone either amputation or reconstruction between 1997 and 2007. Semistructured interviews were conducted and qualitative outcomes were assessed. Results: Interviews highlighted several issues involved with medical decision-making. Participants described not having a role in deciding which medical treatment to choose. Family and spouses played a greater role, often because of patients being medicated when needing to make a treatment choice. Both amputation and reconstruction patients described being satisfied with the outcomes of their surgical treatments, but also expressed second thoughts about their treatment choices. Conclusions: The findings of this study emphasize how difficult it is to assign preference to one medical treatment over another. The study reveals how the role of the patient is limited in making a decision about pursuing amputation or reconstruction. Instead, there is a continued need for physicians to discuss treatment options and risks with family members who act on the patient's behalf, and to incorporate the patient's preference in this complex decision. (Plast. Reconstr. Surg. 126: 2019, 2010.)