A Qualitative Study Exploring Patient Concerns and Values in Chronic Limb-Threatening Ischemia

Aitken, Sarah; Choy, Oh Sung; Monaro, Sue

doi:10.1016/j.jss.2019.05.055

Cited by 15 publications

(19 citation statements)

References 24 publications

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“…The high rates of reoperation, readmission and prolonged LOS in our study demonstrate the considerable illness burden patients with CLTI face. Adverse outcomes of CLTI, such as reduced AFS and increased perioperative complications contribute to decreased quality of life 4,5 . Patients with CLTI desire person‐centred care that is holistic, effective and integrated 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Adverse outcomes of CLTI, such as reduced AFS and increased perioperative complications contribute to decreased quality of life 4,5 . Patients with CLTI desire person‐centred care that is holistic, effective and integrated 4 . Early access to outpatient care like high‐risk foot clinics 20 may reduce late, complex presentations of CLTI and facilitate integrated care.…”

Section: Discussionmentioning

confidence: 99%

“…While amputation rates are important for benchmarking CLTI outcomes, amputation rates alone present a limited picture of the overall burden of illness related to CLTI. Patients with CLTI are also at risk of mortality, decreased quality of life and functional impairment 4,5 …”

Section: Introductionmentioning

confidence: 99%

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Variation in treatment and outcomes for patients with chronic limb‐threatening ischaemia in New South Wales, Australia

Choy

Manewell

Rajendran

et al. 2021

ANZ Journal of Surgery

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Background Chronic limb‐threatening ischaemia (CLTI) carries significant amputation and mortality risks. Australian population‐based outcomes for CLTI are inadequately known. This study aimed to distinguish factors associated with outcomes in the first 2 years after CLTI surgery. Methods By linking routinely collected health administrative and mortality data from New South Wales, this population‐based cohort study identified patients with ischaemic rest pain, gangrene or ulceration undergoing vascular surgery in public hospitals between 2010 and 2012. The primary outcome was 2‐year amputation‐free survival (AFS), and secondary outcomes included readmission and reoperation rates. Multivariable regression analysis identified prognostic factors adjusted for patient, hospital and geographic factors. Results Primary CLTI surgery was performed on 4898 patients. Almost half the cohort had minor amputations without concurrent revascularization (2398, 49%), and the remaining patients had open (652, 13%) or endovascular (1848, 38%) surgery. At 2‐years, the AFS rate was 72%. Significant disparity was seen between age groups, with the 2‐year AFS 71% in patients aged 75 years or older, compared to 95% in patients aged less than 75 years (P < 0.001). Place of residence or hospital training status did not significantly influence AFS or readmission, but non‐training hospitals had higher rates of reoperation. Conclusion This population‐based cohort study demonstrated variable outcomes for patients with CLTI, particularly with respect to older age, admission acuity and comorbidity. Results may guide service improvements however further research is needed into how population‐wide health initiatives can address age‐related disparities in CLTI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Variation in treatment and outcomes for patients with chronic limb‐threatening ischaemia in New South Wales, Australia

Choy

Manewell

Rajendran

et al. 2021

ANZ Journal of Surgery

Self Cite

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“…While these finding provides clinician-centred outcomes, the perspective of the patient in terms of what matters to them is lacking. Aitken, Oh, and Monaro (2019) recent work has, however, extended the capture of patient-centred care data to assess patient concerns and values in CLTI treatment. These concerns included social isolation and loneliness, intractable chronic ischaemia, rest pain, multiple but frequently delayed revascularisations, unmet information needs and a desire for holistic, integrated and participatory care.…”

Section: Backg Rou N Dmentioning

confidence: 99%

The body with chronic limb‐threatening ischaemia: A phenomenologically derived understanding

Monaro

West

Gullick

2020

Journal of Clinical Nursing

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Aims and Objectives To explore person and family lifeworld narratives of chronic limb‐threatening ischaemia (CLTI) after major amputation has been offered as a treatment option. Background Chronic limb‐threatening ischaemia manifests as ischaemic pain, ulceration and/or gangrene and is receiving heightened attention due to the increasing health system burden from associated complex wounds and hospitalisations for repeat procedures. The patient and family impact of these manifestations is not well‐reported: current studies largely seek to measure treatment outcomes. Patient‐reported outcome measurements need to be developed but should be underpinned by rigorous qualitative research. Design Prospective, longitudinal, qualitative design using interpretive phenomenology. Methods The journeys of 19 people with CLTI were explored via 42 semi‐structured interviews with 14 patient and 13 family participants. The initial interview was conducted soon after the advice of the need for major amputation, and where amputation followed, participants were invited for a second interview 6 months postprocedure. Hermeneutic phenomenological analysis was guided by Merleau‐Ponty's philosophy of embodiment. Results People with embodied CTLI faced an existential crisis due to the catastrophic impact of creeping decay of their flesh and vascular system, relentless pain and a sense of spreading poison from gangrene, infection and drugs, which disrupted the interleaving of the physical and existential body. Consequent to the creeping decay and surgery, participants also experienced shifting body boundaries and an unreliable body. Conclusions The lifeworld of the patient and family living with CTLI is irrevocably altered through the disruption of a spontaneous and reliable body. This shapes subsequent therapeutic relationships and discourse. Relevance to Clinical Practice People facing CLTI require early patient‐ and family‐centred discussions about the possibility for major amputation and its potential to arrest the further decline of the body and to support the body's existential expression.

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“…10 Patients with CLTI report pain and impairment in physical function, emotional wellbeing and social interactions, which is similar to the health status of very ill patients with cancer. 11 Disease progression is more likely in patients who are older, have an abnormal ABI, continue to smoke, and have diabetes or concurrent cardiovascular disease. 12 At five years, 7% of patients with asymptomatic PAD have clinical deterioration, while 21% of patients with intermittent claudication have a reduction in walking distance or progress to CLTI.…”

Section: Peripheral Artery Disease In the Lower Limbsmentioning

confidence: 99%

Peripheral artery disease in the lower limbs: The importance of secondary risk prevention for improved long-term prognosis

Aitken

2020

Aust J Gen Pract

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A Qualitative Study Exploring Patient Concerns and Values in Chronic Limb-Threatening Ischemia

Cited by 15 publications

References 24 publications

Variation in treatment and outcomes for patients with chronic limb‐threatening ischaemia in New South Wales, Australia

Variation in treatment and outcomes for patients with chronic limb‐threatening ischaemia in New South Wales, Australia

The body with chronic limb‐threatening ischaemia: A phenomenologically derived understanding

Peripheral artery disease in the lower limbs: The importance of secondary risk prevention for improved long-term prognosis

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