ADOPTED PROJECT: Development of a decision aid for offloading device selection for people with diabetic foot ulceration

Principal Investigator: Dr Lindsey Cherry, Associate Professor University of Southampton  

Research team: Dr Michael Backhouse, Associate Professor, University of Warwick; Dr Kate Lippiet, University of Southampton & Wessex Cancer Alliance, Dr Surussawadi Bennett – Research Fellow, Ms Joanne Casey – Senior Research Administrator

Partners: Great Foundations Charity (Funder) University of Southampton & Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Diabetes UK, University of Warwick, University of Plymouth & Wessex Cancer Alliance

So far, we found that people have different priorities when needing to choose between treatment options. There are pros and cons for each treatment.

Treatment choice can be summarised into removable (‘ROD’ e.g., a specialist boot) and non-removable (‘NROD’ e.g., a plaster cast) offloading devices.

Choosing between ROD and NROD is important to people.

Evidence to support one treatment over another differs depending upon the treatment goal. For example, NROD is likely to heal the wound quickly. ROD is likely to be more comfortable and people can still drive.

People (staff and patients) are often unclear about what a decision aid is and how it could be used to support discussion about treatment choice – so we made a helpful animation: OFFLOAD: what is shared decision making?

We talked with patients about their experience of using ROD/NROD and making a treatment choice. We found out what people need that is currently missing in their care.

We talked with clinicians about their experience of prescribing ROD/NROD and supporting people to make treatment choices. We found out what the barriers or enablers are to supporting choice in routine practice.

We worked with patient and professional advisors and our PPIE partner Debs to create an animation that explains what a decision aid is and how to use it. The animation will be made publicly available on completion of the study.

We completed an in-depth review of the literature to identify evidence supporting each treatment option.

We used the learning from patient & clinician experience and the literature review to create a decision aid (a written summary of the choice to be made and comparative evidence for each treatment option based upon factors identified as important to people e.g., speed of wound healing, risk of infection or amputation, mobility, ability to drive, comfort etc.).

We tested and refined the decision aid in clinical settings. Our next step is to evaluate the difference in health and wellbeing that use of the aid makes.

We worked with a design company, our study advisory board and our PPIE partner to create a user-friendly version of the decision aid. This ensures people with differing health literacy have access to decision support.

We plan to:

 Publish our research findings (interviews with patients and clinicians, literature review, development of the DA)

Apply for NIHR RfPB funding to evaluate the clinical and cost-effectiveness of using the decision aid in clinical practice

Continue working with PPIE and Charity partners to understand the challenges and opportunities to access OFFLOAD devices and enable choice

 Work with industry partners to explore routes to supporting knowledge mobilisation about offloading decision support and use of the DA in the UK and internationally

Work with international partners to share the animation in Canada; to explore French translation and cultural adaptation