Translating Outcomes That Matter Most to Individuals Living with Orthotics and Prosthetics to Shared Decisionmaking in the Practice Setting
Abstract
Objective and Rationale: Our overall objective is to better understand and measure the risk and benefit trade-off preferences of individuals with upper limb loss make when choosing a prosthesis (across a user-complexity spectrum) and to use their weighted preferences to create a decision aid that can be used at the point of care to advance shared decision-making and improve prostheses outcomes. We will test the feasibility of the patient preference-based decision aid use in Hanger prosthetic practices to advance the direct impact of this work. Our rationale is to address the problem that currently prosthetics are not meeting the needs of patients with upper limb loss. By 2020, 2.2 million people will be living with limb loss in the U.S., but up to 70% adopt but don’t use their prosthetic device. There is rapid innovation in advanced upper limb prosthetic devices, and their adoption and use are highly sensitive to the preferences of upper limb amputees. If patient preferences and available treatment regimens are misaligned, persons purchasing new innovative prosthetic devices may not use them, diminishing their quality of life. Prosthetic devices have the ability to significantly improve a person’s ability to function in the world, but their use has risks and takes user commitment. It is imperative to understand what those with upper limb loss want and how they weigh the risks and benefits of all levels of prosthetics currently available as well as a preference for no prosthetic. Currently, there is little research that focuses on patient preferences and how to use their voice to enhance patient/prosthetist communication in their clinic visits when making a prosthetic choice. We will provide a decision aid that defines patient’s preferences that can be shared with the prosthetist to advance their shared choices, and improve patient’s satisfaction, and outcomes and decrease their decisional conflict and regret and reduce prosthetic abandonment. Applicability and Research Impact: This project is directly applicable to the goals of the Orthotics and Prosthetics Outcomes Research Program (OPORP) to enhance the outcomes that matter most to individuals living with prosthetic devices. The results can have a direct impact into practice by demonstrating a mechanism for shared decision-making through our developed preference-based decision aid. Patient Group of Focus: We will focus on individuals with upper limb loss, as they have not received as much research attention as other types of limb loss. The major reasons for upper limb amputation are trauma (43%), congenital absence (18%), and cancer (14%). Exact figures on the incidence of upper limb amputations during conflict is not directly available, but both civilian and military populations are exposed with identical risk to crush injuries, road accidents, and other workplace trauma associated with upper limb loss. Our study will focus on understanding the prosthetic preferences of both civilian and Veterans seen nationally at Hanger clinics, University of California, San Francisco (UCSF) clinics, the Amputee Coalition members as well as expanding to the Palo Alto Department of Veterans Affairs (VA), if needed. Clinical Applications: This develop to new measures of patient preference that will be used to construct a decision aid for patients to use before their prosthetic appointment. The use of these tools can have direct clinical applications to put the patient voice more directly into prosthetic practice by promoting shared decision-making, which has been shown to improve patient satisfaction and improve outcomes. Time to Achieving Patient Outcomes: In the first year, we will define attributes important to those with upper limb loss in making a prosthetic choice create a tool to measure patient’s preferences. By the end of that year, we will design the PULLTY preference tool and begin our recruitment of those with upper limb loss to take this measure. By year 3, we
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310249
Entities
People
- Leslie Wilson
Organizations
- United States Army
- University of California, San Francisco