Medical treatment decision making after total XXXX @entity2685 : a qualitative study.

@entity1 @entity130 @entity155 @entity2685
UNASSIGNED: OBJECT Complete @entity155 traumatic @entity2685 ( @entity2685 ) can be treated using nerve and musculoskeletal reconstruction procedures. However, these interventions are most viable within certain timeframes, and even then they cannot restore all lost function. Little is known about how @entity1 make decisions regarding surgical treatment or what impediments they face during the decision-making process. Using qualitative methodology, the authors aimed to describe how and why @entity1 elect to pursue or forego surgical reconstruction, identify the barriers precluding adequate information transfer, and determine whether these @entity1 are satisfied with their treatment choices over time. METHODS Twelve @entity1 with total @entity155 @entity2685 were interviewed according to a semi-structured guide. The interview transcripts were qualitatively analyzed using the systematic inductive techniques of grounded theory to identify key themes related to the decision-making process and long-term satisfaction with decisions. RESULTS Four decision factors emerged from our analysis: desire to restore function, perceived value of functional gains, weighing the risks and costs of surgery, and having concomitant injuries. Lack of insurance coverage (4 @entity1 ), delayed diagnosis (3 @entity1 ), and insufficient information regarding treatment (4 @entity1 ) prevented @entity1 from making informed decisions and accessing care. Three individuals, all of whom had decided against reconstruction, had regrets about their treatment choices. CONCLUSIONS @entity1 with @entity130 are missing opportunities for reconstruction and often not considering the long-term outcomes of surgery. As more Americans gain health insurance coverage, it is very likely that the number of @entity1 able to pursue reconstruction will increase. The authors recommend implementing clinical pathways to help @entity1 meet critical points in care within the ideal timeframe and using a @entity1 - and family-centered care approach combined with @entity1 decision aids to foster shared decision making, increase access to information, and improve @entity1 satisfaction with decisions. These measures could greatly benefit @entity1 with BPI while reducing costs, improving efficiency, and generating better outcomes.
