O. Choy1, S. Monaro3,4, S. Aitken1,2 1The University of Sydney,Concord Clinical School,Sydney, NSW, Australia 2Concord Repatriation General Hospital,Institute Of Academic Surgery,Sydney, NSW, Australia 3Concord Repatriation General Hospital,Department Of Vascular Surgery,Sydney, NSW, Australia 4The University of Sydney,Susan Wakil School Of Nursing,Sydney, NSW, Australia
Introduction:
Critical Limb Threatening Ischemia (CLTI) is a debilitating vascular condition, often with patients requiring multiple operations associated with a high risk of adverse events and poor outcomes. Few studies examine patient experiences of treatment for CLTI, with most published outcome measures determined by researching clinicians. This study aims to describe patients’ concerns and values related to CLTI treatment, informing patient-centered care for CLTI patients.
Methods:
An exploratory qualitative study design was piloted to describe the experiences of CLTI patients undergoing elective vascular surgery. In-depth, semi-structured patient interviews were recorded preoperatively and three months post discharge. Transcribed interviews were analyzed by two independent researchers, using content analysis, to derive patient-centered themes. Findings were mapped to the patient-centered care framework described by Doyle et al (2013) with themes of relational care: supportive, participative, educative and trustworthy, and functional care: effective, holistic, situated, and integrated. The Consolidated Criteria for Reporting Qualitative research checklist (2007) informed qualitative rigor.
Results:
Six patients were recruited, comprising 12 interviews. Procedures included angioplasty, minor amputation and open surgical bypass. For patients with CLTI, the negative experience of multiple procedures (5, 83%), impaired mobility (5, 83%), pain (4, 67%) and ulceration (4, 67%) were frequently expressed concerns. Mobility and ulceration improved after surgery but pain and sleep disturbance varied. Only two (33%) patients had concerns about amputation, with current symptoms of greater concern for patients than possible future outcomes. Patient-centered values closely reflected the analysis framework, with patients valuing strong relationships with their surgeon, and holistic, effective care. Failure to integrate care or address other health issues was seen as a negative outcome. Contrary to other surgical patients, CLTI patients did not strongly desire shared decision-making.
Conclusion:
If confirmed in larger studies, these preliminary findings suggest for patients with CLTI, strong relationships with their treating surgeon, involving trust and support are of equal importance as functional symptom relief. CLTI patients want to be informed; however, often feel without a choice in treatment options, limiting their participation in decision making. Immediate functional and symptom related outcomes were prioritized over hypothetical future outcomes like amputation. This exploratory pilot study is feasible to assess patient-centered values.
Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013;3:e001570.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ). International Journal for Quality in Health Care; 2007; 19(6): 349