Observational studyBMJ open2026
Challenges in shared decision-making about major lower limb amputation: the PERCEIVE qualitative study.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04903756 (Prediction of Risk and Communication of Outcome Following Major Lower Limb Amputation - a Collaborative Study), which is not on this map. Not yet cited in PubMed.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Prediction of Risk and Communication of Outcome Following Major Lower Limb Amputation - a Collaborative Study (PERCEIVE). A Multi-methods Study of Risk Perception, Communication and the Extent and Experiences of Shared Decision Making Around the Time of Major Lower Limb Amputation.
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesShared decision-making is widely advocated in policy and practice, but how it is to be applied in a high-stakes clinical decision such as major lower limb amputation due to chronic limb-threatening ischaemia or diabetic foot is unclear. The aim of this study was to explore the communication, consent, risk prediction and decision-making process in relation to major lower limb amputation.
designA qualitative study (done as part of a broader mixed-methods study) using
settingVascular centres in three large National Health Service hospitals in Wales and England, UK, between 1 October 2020 and 30 September 2022.
participantsA purposive sample of 18 patients for whom major lower limb amputation was considered as a treatment option/carried out, with interviews conducted before or within 4 months of amputation and 4-6 months after amputation. A further purposive sample of 20 healthcare professionals (including eight surgeons) involved in supporting or conducting major lower limb amputation decision-making.
findingsFive major categories were identified that highlighted the challenges of ensuring shared decision-making associated with major lower limb amputation: (i) patients' limited understanding, (ii) variable patient attitudes to decision-making, (iii) healthcare professionals' perceived challenges to sharing decision-making, (iv) surgeons' paternalism and (v) patients' and healthcare professionals' decisional regret/possible consequences of challenges.
conclusionAmputation is a life-changing decision for both patients and healthcare professionals, with huge consequences. Despite being considered the gold standard, our findings highlight several challenges to effective shared decision-making for major lower limb amputation. Shared decision-making training for healthcare professionals is paramount if these limitations are to be addressed and patients are to feel confident in being adequately informed about the treatment decisions that they make. TRIAL REGISTRATION NUMBER: NCT04903756.
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