{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:30:28Z","timestamp":1793727028002,"version":"4.6.1"},"reference-count":39,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Health and Care Research Wales, Research for Patient and Public Benefit","award":["RfPPB-19-1642"],"award-info":[{"award-number":["RfPPB-19-1642"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,26]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Objectives<\/jats:title>\n Shared 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.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n \n A qualitative study (done as part of a broader mixed-methods study) using\n s<\/jats:bold>\n emi-structured interviews. Interview transcriptions were analysed using thematic analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Vascular centres in three large National Health Service hospitals in Wales and England, UK, between 1 October 2020 and 30 September 2022.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n A 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\u20136 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.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n Five major categories were identified that highlighted the challenges of ensuring shared decision-making associated with major lower limb amputation: (i) patients\u2019 limited understanding, (ii) variable patient attitudes to decision-making, (iii) healthcare professionals\u2019 perceived challenges to sharing decision-making, (iv) surgeons\u2019 paternalism and (v) patients\u2019 and healthcare professionals\u2019 decisional regret\/possible consequences of challenges.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Amputation 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.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT04903756<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104407","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T15:30:40Z","timestamp":1768231840000},"page":"e104407","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Challenges in shared decision-making about major lower limb amputation: the PERCEIVE qualitative 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