An initial qualitative study exploring decision-making experiences and needs of diabetic foot patients undergoing lower extremity amputation via the patient journey mapping method

Yiyuan Chen^1,2Yuxia Wu²Yan Kong³Hui Wang⁴Bo Zhang⁵Haiou Yan^1*Xiaohui Wu^1*

• ¹Affiliated Hospital of Nantong University, Nantong, China
• ²Nantong University, Nantong, China
• ³The PRC Ministry of Education Engineering Research Center of Intelligent Technology for Healthcare,, Wuxi, China
• ⁴Nantong Stomatological Hospital Affiliated to Nantong University, Nantong, China
• ⁵U link high school of Suzhou industrial park, Suzhou, China

Background: Diabetic foot is a chronic complication of diabetes with high disability and mortality rates, with persistently high incidence and amputation rates. Patients face multidimensional health decision-making dilemmas throughout the disease course. Existing nursing decision support lacks specificity and systematic structure. Identifying the multidimensional decision-management needs of patients based on patient journey mapping provides a basis for optimizing decision support and formulating targeted nursing strategies. Methods: A descriptive qualitative research method was employed. From December 2024 to August 2025, 15 patients who had undergone diabetic foot amputation were selected as interview participants, and semi-structured focus group interviews were conducted. Interview data were analyzed using content analysis, and a patient journey map was constructed. Results: Using the screening and diagnosis phase, perioperative phase, and treatment phase of diabetic foot patients as the timeline, and from four dimensions—tasks, emotions, pain points, and solutions—the amputation decision-making experience of elderly diabetic foot patients was subdivided into 28 themes, including seeking medical care due to perceived symptoms, intelligent and humanized medical services, difficulty understanding treatment options, difficulty in accessing and evaluating information, contradictions between self-care knowledge and needs, and functional reconstruction and quality of life. Conclusion: The decision-making needs of diabetic foot patients undergoing amputation are protracted and complex, with their psychological, physical, and social needs dynamically evolving across different disease stages. This study serves as an initial exploration in this research domain, aiming to identify the core decision-making needs of patients during distinct stages of the amputation decision-making process. Subsequently, based on the identified needs, targeted development and implementation of intervention strategies will be carried out to refine the amputation decision support system for such patients, thereby providing scientific evidence for precise clinical nursing care.