UPCC 25524 Examining Decision Regret Around Pursuing Lower Extremity Amputation in Patients with Neoplasm, Trauma, and Infection

The primary objective of this study is to determine the level of regret patients experience following the decision to pursue amputation and how the extent of patient-reported regret varies with respect to indication (neoplasm versus trauma versus infection). Our secondary objective is to examine how patient- and surgeon-specific factors (including the number of surgeries leading up to the index amputation decision, number of related hospital admissions, length of stay, and prior limb salvage) contribute to decision regret and post-operative dissatisfaction among patients undergoing amputation.

Specific Aims
Aim 1: Examine the decision-making process of patients who have sustained limb-threatening lower extremity injury associated with an oncologic versus trauma diagnosis through 1) patient-reported outcome measures and 2) follow-up prospective, semi-structured interviews. Notable measures explored in our study include the degree of regret pre- and post-surgery, extent of patient involvement in decision-making, and subsequent satisfaction with respect to functional outcomes and overall patient quality of life.

Aim 2: Identify and characterize factors that influence sunk cost fallacy, levels of decision regret, and post-operative satisfaction for patients in the context of lower extremity amputation. In particular, we aim to elucidate patient priorities that shape decision-making, including perceptions around the severity and nature of their diagnosis.

Aim 3: Identify and characterize factors that contribute to sunk cost fallacy, denial of limb salvage failure, and avoidance of lower extremity amputation for surgeons. We will examine how surgeon perceptions around the indications for and necessity of amputation influence the decision to pursue amputation, and how these factors may align or conflict with those of patients.

Hypothesis
1. Patients with an oncologic diagnosis will demonstrate higher tolerance for loss and corresponding lower levels of regret following the decision to proceed with amputation in comparison to those who made a similar decision in response to trauma. Specifically, we believe patients with a malignant diagnosis will ascribe greater emphasis on life preservation, which in turn will be reflected in lower levels of regret following amputation, particularly when compared to patients with trauma who made a similar decision. We also hypothesize that patients who underwent amputation due to infection as a complication of elective surgery (i.e., joint replacement) will experience higher levels of decision regret compared to those within the neoplastic cohort. 2. Patients who invest greater time, money, and emotional energy (as well as other surrogate measures of investment related to their treatment trajectory) will exhibit increased post-operative decision regret and stress due to the sunk cost fallacy phenomenon. 3. We hypothesize that the extent to which amputation is indicated for the purposes of life preservation (as seen in the context of an oncologic diagnosis) is the primary driver of decision-making from the perspective of surgeons.

You may be eligible for this study if you meet the following criteria:

• Conditions: Medical Research
• Age: 99 years or below
• Gender: All