# Improving Dysvascular Amputee Outcomes by Enhancing Shared Decision Making Through the Development and Implementation of a Patient Decision Aid and a Decision Support Tool

> **NIH VA I01** · VA PUGET SOUND HEALTHCARE SYSTEM · 2020 · —

## Abstract

The choice of amputation level in patients with peripheral arterial disease and diabetes can have profound
effects on many functional outcomes. There are no clinical guidelines or evidence that clearly define a
recommended amputation level in any individual patient. There has been an increased emphasis on preserving
a portion of the foot (transmetatarsal [TM] amputation) in an effort to minimize the anatomic loss of the
extremity with the hope of preserving mobility. This fundamental assumption has been questioned due to the
high rate of delayed or failure of healing, which results in the need for prolonged wound care, repeated surgery
and in the end, the need for a transtibial (TT) level amputation. The transtibial amputation is associated with a
much-reduced risk of failure of healing, a similar mobility outcome, but somewhat higher mortality. However,
transtibial amputation may have adverse effects on other outcomes, such as body image, quality of life,
prosthetic fitting demands, and/or rehabilitation treatment intensity. Each patient will likely prioritize these
outcomes in different ways based upon their values and preferences. The Veterans Health Administration
(VHA) has emphasized the importance of patient-centric care, which is defined as “health care that establishes
a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions
respect patients' wants, needs and preferences and solicit patients' input on the education and support they
need to make decisions and participate in their own care.” The use of Patient Decision Aids (PtDA) and
physician decision support tools (DST) have been advocated as critical components that can be used to
enhance patient participation in important decisions, and to ensure that the choice they make is aligned with
the outcomes that are most important to them. The purpose of this research, therefore, is to improve the
rehabilitation outcome of Veterans who require a dysvascular lower extremity amputation, where either a
dysvascular TM or TT amputation is being considered. We propose to develop two point of care “tools” to
enhance shared decision making at the time of amputation level selection that will be integrated into a web-
based portal called AMPDECIDE: 1) the DST will utilize our validated AMPREDICT prediction models to
inform providers of patient specific risks/probabilities for functional mobility, mortality, and failure of healing at
each major amputation level, and 2) the PtDA will educate patients about amputation surgery, prosthetic use,
inform them about the outcome differences, and help them determine and rank their outcome priorities. We will
then perform a pilot trial using the tools in the AMPDECIDE portal in a shared decision making process that will
inform a future large scale clinical trial to determine if their use results in reduced numbers of reamputations,
preservation of functional life years, and enhanced patient satisfaction. To accomp...

## Key facts

- **NIH application ID:** 9995391
- **Project number:** 5I01RX002960-03
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Daniel C Norvell
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-10-01 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9995391

## Citation

> US National Institutes of Health, RePORTER application 9995391, Improving Dysvascular Amputee Outcomes by Enhancing Shared Decision Making Through the Development and Implementation of a Patient Decision Aid and a Decision Support Tool (5I01RX002960-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9995391. Licensed CC0.

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