{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:34:52Z","timestamp":1790354092343,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T00:00:00Z","timestamp":1727308800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001787","name":"University of South Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001787","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Having a lower extremity amputation is a life\u2010changing decision for people living with a diabetes\u2010related foot ulcer. Although previous research has described both positive and negative lifestyle and function outcomes of diabetes\u2010related amputations, limited research has been conducted on the decision\u2010making processes leading up to the amputation. This study aimed to explore the perspectives of persons, healthcare practitioners and experts (including academics and specialists) on decision\u2010making for people with a diabetes\u2010related foot ulcer who may require a non\u2010emergency amputation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A qualitative descriptive study using semi\u2010structured interviews enabled people to share their thought processes when making decisions for amputation. Twenty\u2010six participants were interviewed, including nine people with a diabetes\u2010related foot ulcer or amputation, nine health practitioners and eight experts located across five countries. There were 13 female and 13 male participants. Thematic analysis was used for data analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four themes described the decision\u2010making considerations for amputation: \u2018Balancing the evidence in decision\u2010making\u2019, \u2018Trust, respect and timing of conversations inform decision\u2010making\u2019, \u2018Tailoring decisions for individual circumstance\u2019 and \u2018Reaching the tipping point in decisions for the future\u2019. Work commitments, functional and lifestyle impacts of amputation, the presence of support networks and clinical wound features formed the evidence for a decision for amputation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Understanding quality of life needs ensured that decisions for amputation addressed expectations and lifestyle needs. Living with a diabetes\u2010related foot ulcer presented daily challenges that pushed people to a tipping point, at which amputation was considered to overcome these hardships and enable them to move on to the next chapter of their life. Further research is required to understand how person\u2010centred factors can be better incorporated alongside objective clinical assessments in decisions for amputation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patient or Public Contribution<\/jats:title><jats:p>People with diabetes\u2010related foot ulcers, health practitioners and experts shared their perspectives on the decision\u2010making process for amputation through one\u2010to\u2010one interviews. Consideration of the person in the context of their life, environment and personal needs alongside the pathological factors is warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hex.70043","type":"journal-article","created":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T07:25:56Z","timestamp":1727335556000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["\u2018Leaving the Door Open\u2019: Perspectives on Decision\u2010Making for Non\u2010Emergency Diabetes\u2010Related Amputation"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7691-1263","authenticated-orcid":false,"given":"Emilee Kim Ming","family":"Ong","sequence":"first","affiliation":[{"name":"Allied Health and Human Performance Unit University of South Australia Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4471-0509","authenticated-orcid":false,"given":"Carolyn","family":"Murray","sequence":"additional","affiliation":[{"name":"Allied Health and Human Performance Unit University of South Australia Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Hillier","sequence":"additional","affiliation":[{"name":"Allied Health and Human Performance Unit University of South Australia Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Causby","sequence":"additional","affiliation":[{"name":"Allied Health and Human Performance Unit University of South Australia Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,26]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"\u201cKey Global Findings 2021 \u201d International Diabetes Federation 2021 https:\/\/diabetesatlas.org\/#:~:text=Diabetes%20around%20the%20world%20in%202021%3A %2D%20and%20middle%2Dincome%20countries."},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12404"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2021.107960"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12474"},{"issue":"11","key":"e_1_2_13_6_1","first-page":"16","article-title":"When a Diabetic Foot Ulcer Results in Amputation: A Qualitative Study of the Lived Experience of 15 Patients","volume":"60","author":"Foster D.","year":"2014","journal-title":"Ostomy Wound Management"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/00332747.2019.1672438"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3657"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2023.111015"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2019.06.998"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2019.28.1.30"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S309366"},{"issue":"1","key":"e_1_2_13_13_1","first-page":"47","article-title":"Emotional Aspects Present in the Lives of Amputees: A Literature Review","volume":"20","author":"Bergo M. F. C.","year":"2018","journal-title":"Psicologia \u2010 Teoria e Pr\u00e1tica"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2012.677936"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2018.12.038"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/2333393617742282"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-9-52"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-10-5251-4_103"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_13_21_1","unstructured":"\u201cInternational Classification of Functioning Disability and Health (ICF) \u201d World Health Organisation 2001 https:\/\/www.who.int\/standards\/classifications\/international-classification-of-functioning-disability-and-health#:~:text=ICF%20is%20the%20WHO%20framework and%20measure%20health%20and%20disability."},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/10497323211022312"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315588501"},{"key":"e_1_2_13_25_1","first-page":"23","volume-title":"Qualitative Research Methods","author":"Liamputtong P.","year":"2013"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-012-9829-2"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-006-0431-0"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7023.71"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2788.2012.01550.x"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13822"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1369-7625.2006.00359.x"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2004.00269.x"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/ihj-2019-000032"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1369-7625.2004.00296.x"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2020.08.031"},{"issue":"1","key":"e_1_2_13_36_1","first-page":"1","article-title":"A Qualitative Exploration of the Experiences of Aboriginal and Torres Strait Islander People Using a Real\u2010Time Video\u2010Based Telehealth Service for Diabetes\u2010Related Foot Disease","volume":"24","author":"Graham K.","year":"2024","journal-title":"Rural and Remote Health"}],"container-title":["Health Expectations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70043","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T18:36:45Z","timestamp":1730140605000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hex.70043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,26]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/hex.70043"],"URL":"https:\/\/doi.org\/10.1111\/hex.70043","archive":["Portico"],"relation":{},"ISSN":["1369-6513","1369-7625"],"issn-type":[{"value":"1369-6513","type":"print"},{"value":"1369-7625","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,26]]},"assertion":[{"value":"2024-06-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70043"}}