title: A qualitative study of factors influencing the decision to have an elective amputation.
abstract: BACKGROUND
  Some patients with a functionally impaired lower limb choose to have an elective amputation, whereas others do not. Functional outcomes do not favor either type of treatment, making this a complex decision. The experiences of patients who have chosen elective amputation were analyzed to identify the key factors in this decision-making process.
  
  
  METHODS
  Patients from a tertiary care amputee clinic who had chosen to undergo elective amputation of a functionally impaired lower limb participated in the present study. A qualitative research design involved the use of one-on-one semi-structured interviews, which were audio recorded and transcribed. Narrative analysis was used by three researchers to provide triangulation. Recurrent key themes and patterns were described. Personal factors in the decision-making process were identified.
  
  
  RESULTS
  Factors that had the largest impact on the decision-making process were pain, function, and participation. Body image, self identity, and the opinions of others had little influence. Satisfaction with the surgical outcome was related to how closely the result matched the patient's expectations. Patients who were better informed prior to surgery had more realistic expectations about living with an amputation.
  
  
  CONCLUSIONS
  The severity of pain and the desire for improved function are strong drivers for patients deciding to undergo elective amputation of a functionally impaired lower extremity. While patients do not want others' opinions, information regarding life with an amputation helps to set realistic expectations regarding outcome.
authors.affiliation: The Ottawa Hospital Rehabilitation Centre, University of Ottawa, Ottawa, ON K1H 8M2, Canada. dquon@ottawahospital.on.ca
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Quon
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Dudek
authors.forename: Meridith
authors.initials: M
authors.lastname: Marks
authors.forename: Michael
authors.initials: M
authors.lastname: Boutet
authors.forename: Lara
authors.initials: L
authors.lastname: Varpio
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000671:Amputation, Surgical / Q000379:methods* / Q000706:statistics & numerical data; D001177:Arthropathy, Neurogenic / Q000175:diagnosis / Q000601:surgery; D002648:Child; D003657:Decision Making; D017558:Elective Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007407:Interviews as Topic; D007866:Leg / Q000601:surgery; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000523:psychology / Q000601:surgery; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D011051:Poliomyelitis / Q000175:diagnosis / Q000601:surgery; D036301:Qualitative Research; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult