Amputation or Reconstruction? Development and Validation of a Patient Decision Aid for Treatment of Severe Lower-Extremity Trauma.

Abstract

Background: Our goal was to develop and validate the Severe Lower-Extremity Trauma decision aid (SLETRA) to help patients make treatment decisions aligned with their values regarding amputation versus reconstruction.

Methods: We recruited 62 adults (41 women) from a foot and ankle practice at a US academic hospital from June to August 2020. We excluded patients who could not read in English and who lacked internet service access. Patients completed an 8-question knowledge test regarding the risks, benefits, and outcomes of treatment options before and after reviewing SLETRA. The survey presented a hypothetical case of severe lower-extremity trauma. Respondents, imagining themselves as patients, indicated whether they would choose amputation or reconstruction. We evaluated knowledge scores (maximum, 8 points); decisional conflict scores (maximum, 400 points, with higher scores indicating greater respondent difficulty in decision making); ratings of factors influencing the decision; and SLETRA helpfulness (maximum, 7 points). Pre- and post-test knowledge scores were compared using paired Student's t-tests; Alpha = 0.05.

Results: Mean and standard deviation knowledge scores improved from 5.2 ± 1.6 (pre-test) to 6.7 ± 1.6 (post-test) (p < 0.001). Mean decisional conflict score was 223 ± 16, reflecting moderate difficulty. Factors affecting treatment choice were risk of complications (n = 29), recovery time (n = 27), and future prosthesis use (n = 27). No respondent had difficulty understanding SLETRA. Mean helpfulness score was 5.6 ± 0.16, reflecting considerable benefit.

Conclusion: The SLETRA decision aid is a helpful, understandable tool that significantly improves patient knowledge regarding treatment options for severe lower-extremity trauma.