Thoughts and experiences on leg amputation among patients with diabetic foot ulcers

Figures & data

Figure 1. Analysis by IPA

Table I. Characteristics of participants. Names are psuedonyms

Participant	Sex	Age	Civil status	Wound history	Diabetes
Morten	male	46	living alone	Current wound < 1 year. Had a wound for > 4 years in the past	type 2 > 10 years
Gert	male	53	living alone	>2 years	type 2 > 5 years
Steen	male	72	living alone	>1 year	type 2 < 1 year
Niels	male	73	married	< ½ year	type 2 > 10 years
Bente	female	70	living alone	< ½ year	type 2 > 10 years

Table II. Three examples of work with empirics in step two, three, four and six of IPA. Names are pseudonyms

Notes	Transcription	Emergent theme	Super-ordinate theme	Themes based on patterns across the interviews
Morten compares death and leg amputation. Where do such comparison come from? Taboo—for whom and why? What is it about leg amputation that is so terrible?	Niels: “[…] Well, it´s like you´re not talking about death … it´s like … a little taboo-like”	Comparison between death and leg amputation	Leg amputation—a taboo	Considered—not spoken
Gert has tried to talk to his friends about his foot ulcer and his own thoughts on potential leg amputation, but his friends dont´t want to talk about it. Reluctance? Why is it so difficult to talk about? Why don´t his friends want to talk about it, even though he brings up the topic himself?	Gert: “[…] here after I got my foot ulcer, I´ve mentioned it sometimes, but it´s not something people [his friends] want to talk about.”	Leg amputation—difficult to talk to others about.	Other people´s view on legamputation
Morten considers leg amputation as punishment because he has not taken care of his diabetes. Punishment. But who is punishing and why? Who decides if you have looked after your diabetes well enough? Whose responsibility is it? The health services, individual or in combination?	Morten: “Well, I could see it as some kind of punishment because I didn´t take good care of myself.”	Responsibility for health and illness.	View on own situation

Table

Interview guide
I am writing a thesis about what thoughts, reflections and considerations people with a diabetic foot ulcer may have in relation to leg amputation. I have not worked with either people who have had diabetic foot ulcers or amputations and with my thesis I would like to gain insight into some of the thoughts, considerations and reflections that you as a person with diabetic foot ulcers might have about leg amputation. Today it is your thoughts, reflections and considerations that I ask for, so there are no right or wrong answers. I will record our conversation so that I can remember what we have talked about and then write down our conversation verbatim. Parts of the interview I will then use in my thesis and perhaps in a public article but of course your name will not be used. If there is something you would like to say without it being recorded, just say so. The interview will probably last approximately 60 minutes. If you are in doubt about something along the way, need a break or something else then of course just say so. In the interview, I will use the term “leg amputation” and to be sure that we are speaking from the same notion of what that covers. It will be an amputation of the lower leg (I show them my leg). Is there anything you want to ask before we start?
	Interview questions	Additional questions
Background questions	I just want to start by hearing how old you are?
	What is your marital status?
	Do you have any kids?	Possibly grandchildren?
	What is your employment status?
	How long have you had diabetes?	Type 1 or Type 2?
	How long have you had your ulcer on your foot?	Do you know how your ulcer came about?
		Have you ever had ulcers on your feet that required treatment before?
	Can you tell me what you know about leg amputation?	Why do you think leg amputation is sometimes done?
		How do you know? (Doctor, media, etc.)
	Do you remember if you have ever known or met someone who had a leg amputation?	It could also be someone you had just heard of/seen a random who had a leg amputation?
		Do you remember what thoughts you had when you were told/heard/saw that they had had a leg amputation?
	How do you think you will do after a leg amputation?
	What are your thoughts about whether you could find yourself in a situation where leg amputation could be a treatment option for your foot ulcer?
Possible thoughts, considerations and reflections in relation to physical conditions related to a leg amputation	What thoughts do you think you would have about your physical state if you were to have a leg amputation?	Are there thoughts that would be more dominant than others?
		Would there be anything that scared you?
		Something that would be good?
		What do you think your everyday life would look like if you had leg amputation?
	Do you think there would be some things that would be especially important to you that would help you gain knowledge regarding your physical state after a leg amputation?	Where do you think this knowledge should come from?
		Could there be something the health care professionals could do to prepare you for the physical challenges? (… e.g., pain, activity, etc.)
Possible thoughts, considerations and reflections in relation to mental conditions in a leg amputation.	Can you put how you think you would feel psychologically if you had to have a leg amputation into words?	What thoughts would those be?
		Are there thoughts that would be more dominant than others?
		What do you think those thoughts would do to you?
	Do you think as that there would be any psychological concerns that would be particularly important for you as you gained knowledge about a leg amputation?	Where do you think this knowledge should come from?
		Would there be something you would like your health care professional to do to help you in this regard?
		Who do you think should take the initiative to talk about it?
Possible thoughts, considerations and reflections in relation to social conditions in a leg amputation.	Is leg amputation something you talk about?	With whom? Where? Why/Why not?
	What do you think you would feel if people knew you had/would have a leg amputation?	Would you be open about it?
		Why/why not?
		What do you think you would talk about?
		Is there something you wouldn’t talk about?
		Do you think it would make a difference depending on whether it was family who knew about it versus, for example, people on the street who saw it?
	How do you think your family and friends would react if you had a leg amputation?
De-briefing How has it been to talk about leg amputation today? I don’t have any more questions. First of all, I want to thank you for talking to me. I want to hear if you have any questions or if you think there is anything else about leg amputation we haven’t discussed? All conversations can sometimes trigger thoughts—even afterwards. It is important that you know that you are always welcome to contact the ambulatory unit if you need to talk about anything.