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Salinas M, Yazdani U, Oblack A, McDaniels B, Ahmed N, Haque B, Pouratian N, Chitnis S. Know DBS: patient perceptions and knowledge of deep brain stimulation in Parkinson's disease. Ther Adv Neurol Disord 2024; 17:17562864241233038. [PMID: 38455848 PMCID: PMC10919129 DOI: 10.1177/17562864241233038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Deep brain stimulation (DBS) is an established therapy for Parkinson's disease (PD) that can significantly improve motor symptoms and quality of life. Despite its effectiveness, little is known about patient perceptions of DBS. Objectives To evaluate patient perceptions of DBS for PD, focusing on understanding, satisfaction, and factors influencing their outlook. This study aims to enhance patient education and counseling by identifying key determinants of patient perceptions. Design A patient survey. Methods We surveyed 77 PD patients who had undergone DBS at multiple centers using a comprehensive questionnaire. The questionnaire included questions on demographic information, disease history, and detailed understanding about the indications for DBS, side effects, outlook, and other common misconceptions. We summarize data using measures of central tendency and dispersion appropriate to the data type (categorical, continuous, proportional) and model relationships among variables using fractional and linear regression methods. Results Participants had a median age of 66 years, were predominantly male (66%), Caucasian (90%), well-educated (79% with at least college degrees), and had a disease duration of greater than 5 years (97%). They conveyed good understanding of the signs and symptoms addressed by DBS across the motor and non-motor domains and associated side effects. Regression analysis identified age, disease duration, and education level as key determinants of patient understanding and outlook of DBS. Conclusion Our study provides a detailed understanding of patient perceptions of DBS for PD, including the benefits, challenges, and misconceptions. Our findings underscore the importance of identifying the causes of disparities in patient knowledge and perceptions regarding DBS to tailor patient counseling and ensure optimal treatment outcomes.
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Affiliation(s)
- Meagen Salinas
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
- Neurology Section, VA North Texas Health Care System, Dallas, TX, USA
| | - Umar Yazdani
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Austin Oblack
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bradley McDaniels
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Nida Ahmed
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bilal Haque
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shilpa Chitnis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Stoycheva T, Jameel A, Bain P, Nandi D, Jones B, Honeyfield L, Gedroyc W, Moore J. 'Am I fixed, am I better now?': undergoing MR-guided focused ultrasound for essential tremor: an interpretative phenomenological analysis. Front Neurol 2024; 15:1352581. [PMID: 38390595 PMCID: PMC10882628 DOI: 10.3389/fneur.2024.1352581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Essential tremor (ET) is characterised by postural and intentional tremor typically affecting the upper limbs, which can negatively impact functionality and quality of life. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is a novel and promising non-invasive treatment for ET which offers instantaneous results. Methods Using interpretative phenomenological analysis we explored the experience of undergoing MRgFUS in six ET patients as well as their experiences pre- and post-procedure. Results One-time, retrospective semi-structured interviews were conducted and six themes emerged: Life pre-treatment: "It's everyday tasks that get you down" and "Most people who understand, they are okay. Some people aren't"; MRgFUS: Treatment day: "Going into the unknown" and "There's no way I was going to press that button"; and Life post-treatment: "One is good. Two is better" and "Am I fixed, am I better now?." Discussion The findings point to a significant period of adjustment associated with living with ET and the effects of undergoing ET MRgFUS treatment. As ET progressed, participants struggled to cope with increasing symptoms and had to develop coping strategies to manage life with ET. The procedure itself was perceived as strange and extraordinary and despite some immediate adverse effects participants were determined to go through with it. Post procedure, all participants reported tremor suppression which was life changing. While some participants still felt burdened by ET, others expressed it took them a while to psychologically adjust to what essentially was their new body. This study has highlighted the need for patients to be supported at all stages of their ET journey.
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Affiliation(s)
- Tsvetina Stoycheva
- Imperial College Healthcare NHS Trust, London, United Kingdom
- King's College London, London, England, United Kingdom
| | - Ayesha Jameel
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, England, United Kingdom
| | - Peter Bain
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, England, United Kingdom
| | - Dipankar Nandi
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, England, United Kingdom
| | - Brynmor Jones
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Wladyslaw Gedroyc
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, England, United Kingdom
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Elkaim LM, Niazi F, Levett JJ, Bokhari R, Gorodetsky C, Breitbart S, Alotaibi F, Alluhaybi AA, Weil AG, Fallah A, Alotaibi NM, Ibrahim GM. Deep brain stimulation in children and youth: perspectives of patients and caregivers gleaned through Twitter. Neurosurg Focus 2022; 53:E11. [DOI: 10.3171/2022.7.focus22276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/21/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE
This study aims to glean patient and caregiver perspectives surrounding deep brain stimulation (DBS) in children and youth through an analysis of patterns of social media usage.
METHODS
The authors performed a comprehensive search of the Twitter Application Programming Interface (API) database for all tweets about DBS use in children and youth, with no date restriction. Data pertaining to each tweet were extracted for analysis. Results were analyzed using qualitative and quantitative methodologies. These included thematic analysis of tweets, accounts, and descriptive statistics. Sentiment analysis of extracted tweets was also performed. A multivariable regression model was used to identify predictors of higher engagement metrics (likes, retweets, and quotes).
RESULTS
A comprehensive search of the Twitter database yielded 877 tweets from 816 unique accounts meeting study inclusion criteria. Most tweets were from patients or caregivers, researchers, or news media outlets. The most common themes among analyzed tweets were research discussing novel findings (45.2%) or personal experiences of patients or caregivers (27.4%). Sentiment analysis showed that 54.5% of tweets were positive, 35.1% were neutral, and 10.4% were negative. The presence of pictures or videos increased the tweet engagement count by an average of 10.5 (95% CI 7.3–13.6). Tweets about personal patient experiences (β = 6, 95% CI 0.95–12) and tweets tagging other accounts (β = 3.2, 95% CI 0.63–5.8) were also significantly associated with higher engagement metrics.
CONCLUSIONS
The current study is the first to assess patient and caregiver perspectives surrounding pediatric DBS through a comprehensive analysis of social media usage. Given the nascent field, social media presents an opportunity to share experiences and promote patient and healthcare professional education surrounding pediatric DBS.
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Affiliation(s)
- Lior M. Elkaim
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec
| | - Farbod Niazi
- Department of Medicine, Université de Montréal, Montréal, Québec
| | - Jordan J. Levett
- Department of Medicine, Université de Montréal, Montréal, Québec
| | - Rakan Bokhari
- Department of Surgery, Montréal General Hospital, McGill University, Montréal, Québec
| | - Carolina Gorodetsky
- Division of Neurology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Ontario
| | - Sara Breitbart
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Fahad Alotaibi
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdulelah A. Alluhaybi
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Alexander G. Weil
- Division of Neurosurgery, Sainte Justine Hospital, Montréal, Québec, Canada; and
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Naif M. Alotaibi
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
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Stoehr K, Pazira K, Bonnet K, Schlundt D, Charles D, Hacker M. Deep Brain Stimulation in Early-Stage Parkinson's Disease: Patient Experience after 11 Years. Brain Sci 2022; 12:brainsci12060766. [PMID: 35741651 PMCID: PMC9220916 DOI: 10.3390/brainsci12060766] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 01/25/2023] Open
Abstract
The deep brain stimulation (DBS) in early-stage Parkinson's disease (PD) pilot trial began more than a decade ago and remains the only investigation of DBS in mildly symptomatic patients. Patients completed therapeutic washouts biannually for two years, outpatient assessments through five years, and a longitudinal washout assessment after 11 years. Here, the patient experience of participating in the early DBS pilot trial is described. Semi-structured interviews were audio-recorded and transcribed. Transcripts were coded, analyzed using an iterative inductive-deductive approach, and used to develop a conceptual framework. Ten participants (n = 6 early optimal drug therapy (ODT), n = 4 early DBS + ODT) were interviewed. Motivations for participation included benefit to future PD patients and potential personal benefit, while hesitations included risk of surgical complications. While early ODT patients who received standard-of-care DBS described significant changes in their functional capacities after surgery, early DBS patients described a maintenance of quality of life that made PD less impactful over an extended period. Patients expressed high satisfaction with trial participation and early DBS. This study suggests that the PD experience with early DBS may notably differ from standard-of-care DBS. The FDA has approved the conduct of a pivotal clinical trial evaluating DBS in early-stage PD (IDEG050016).
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Affiliation(s)
- Kaitlyn Stoehr
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (K.S.); (K.P.); (D.C.)
| | - Kian Pazira
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (K.S.); (K.P.); (D.C.)
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN 37235, USA; (K.B.); (D.S.)
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN 37235, USA; (K.B.); (D.S.)
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (K.S.); (K.P.); (D.C.)
| | - Mallory Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (K.S.); (K.P.); (D.C.)
- Correspondence:
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Deep Brain Stimulation for Parkinson’s Disease: Why Earlier Use Makes Shared Decision Making Important. NEUROETHICS-NETH 2022. [DOI: 10.1007/s12152-022-09496-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Introduction
As deep brain stimulation (DBS) has shifted to being used earlier during Parkinson’s disease (PD), data is lacking regarding patient specific attitudes, preferences, and factors which may influence the timing of and decision to proceed with DBS in the United States. This study aims to identify and compare attitudes and preferences regarding the earlier use of DBS in Parkinson’s patients who have and have not undergone DBS.
Methods
We developed an online survey concerning attitudes about DBS and its timing in PD. The survey was distributed nationally in the United States via the Michael J. Fox Foundation Trial Finder, the American Parkinson Disease Association flyers, and as a link on the Parkinson Alliance website. Differences in responses between PD DBS and non-DBS patients were assessed.
Results
A total of 445 patients with PD met eligibility criteria for the survey of which 160 self-identified as having undergone DBS. Fifty-five percent (n = 124) of non-DBS patients believed that DBS for PD should only be considered after all medication options have been tried. Patients favoring early DBS had fewer concerns regarding the surgery than those favoring later DBS.
Conclusion
Our findings highlight a variety of important considerations and concerns patients have regarding DBS and its timing. These viewpoints are important aspects of shared decision-making, as they help to identify patients’ preferences, values, and goals, which should enable providers to better navigate, with their patients, the decision path for therapeutic options to consider.
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Alfonso D, Cabrera LY, Sidiropoulos C, Wang F, Sarva H. How Parkinson's patients in the USA perceive deep brain stimulation in the 21st century: Results of a nationwide survey. J Clin Neurosci 2021; 95:20-26. [PMID: 34929646 DOI: 10.1016/j.jocn.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/20/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
Research on attitudes regarding the use and timing of deep brain stimulation (DBS) has been mostly qualitative to this date. In this study, we aim to examine attitudes and perceptions about the use and timing of DBS in patients with Parkinson's disease (PD) who have not had DBS. We designed an online survey comprising Likert-type, multiple choice, and rank-order questions and distributed it to PD patients. We recruited participants via flyers, the Michael J. Fox Foundation Trial Finder, and the Parkinson Alliance website. We analyzed considerations for choosing or rejecting DBS and when participants would consider such a decision to be premature. Data were analyzed using descriptive and inferential statistics, including a multinomial logistic regression model. Among the 285 participants who reported not having undergone DBS, the most frequent concerns were related to the efficacy of DBS and not having exhausted medication alternatives. DBS was viewed as less convenient, effective, and safe when PD symptoms were still manageable by medication. Our regression model suggests that having fewer concerns over technical problems was a positive predictor of preferring early DBS, while concerns over DBS interfering with friendships and relationships was a negative predictor. Our results suggest that patients with PD who have not undergone DBS have a wide variety of attitudes regarding DBS and its timing. Given the increasing number of therapeutic options for PD, future work should compare perceptions and preferences regarding different PD treatment modalities to provide the best counseling for patients regarding their therapeutic options.
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Affiliation(s)
- Daniel Alfonso
- Weill Cornell Medical College, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA.
| | - Laura Y Cabrera
- Center for Neural Engineering, Department of Engineering Science and Mechanics, Pennsylvania State University, W-316 Millennium Science Complex, University Park, PA 16802, USA.
| | - Christos Sidiropoulos
- Department of Neurology and Ophthalmology, Michigan State University, 804 Service Road, East Lansing, MI 48824, USA.
| | - Fei Wang
- Population Health Sciences, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA.
| | - Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, 428 E 72(nd) St Suite 400, New York, NY 10021, USA.
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7
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Prasad S, Bhattacharya A, Sahoo LK, Batra D, Kamble N, Yadav R, Srinivas D, Pal PK. Knowledge, Attitude, and Perceptions about Deep Brain Stimulation for Parkinson's Disease: Observations from a Single Indian Center. J Mov Disord 2020; 14:60-64. [PMID: 32942838 PMCID: PMC7840234 DOI: 10.14802/jmd.20066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/21/2020] [Indexed: 12/05/2022] Open
Abstract
Objective Willingness to undergo deep brain stimulation (DBS) among patients with Parkinson’s disease (PD) and their overall satisfaction with the procedure is highly dependent upon expectations, which are based on the core concepts of knowledge, attitude and perceptions. The present study aims to evaluate these factors in patients and caregivers with PD from a single tertiary care hospital in India. Methods A structured questionnaire designed to assess the knowledge, attitude and perceptions about DBS in PD was administered to 400 patients with PD and their caregivers. Results A very small proportion of patients and caregivers were aware of DBS. Even those who claimed to be aware of DBS were inadequately informed and had incorrect knowledge, which led to wrong attitudes and perceptions. Conclusion There are very significant knowledge gaps and misconceptions regarding DBS among patients with PD and caregivers. Adequate and appropriate education is necessary to clarify these misconceptions to avoid the development of unrealistic expectations and poor satisfaction.
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Affiliation(s)
- Shweta Prasad
- Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Karnataka, India.,Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Lulup Kumar Sahoo
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Dhruv Batra
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
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Haahr A, Norlyk A, Hall EOC, Hansen KE, Østergaard K, Kirkevold M. Sharing our story individualized and triadic nurse meetings support couples adjustment to living with deep brain stimulation for Parkinson's disease. Int J Qual Stud Health Well-being 2020; 15:1748361. [PMID: 32268846 PMCID: PMC7178889 DOI: 10.1080/17482631.2020.1748361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Treatment with deep brain stimulation for Parkinson’s disease, leads to a rapid improvement in mobility, which may challenge patients and spouses when adjusting to everyday life. An intervention, developed to support the adjustment to everyday life with DBS, demonstrated that individualized meetings with a specialized nurse was experienced as important and fruitful by both patient and spouses. Purpose: The aim was to gain a deeper understanding of how the meetings contributed to the adjustment process. Method: 38 audio-recorded meetings and six written summaries from eight couples participating in the intervention, were analyzed in a hermeneutic process. Results: The analysis revealed four themes: A relational triad of co-creating personal knowing. Sharing and listening in an atmosphere of trust and openness. Unveiling the couple’s everyday life, coping strategies and expectations. Supporting adjustment through knowing their personal story. Conclusion: The triadic dynamics in the meetings were quite particular. The main focus was the patients’ and spouses’ stories, individually and as a couple. The DBS nurse pursues solutions based on professional and specialized knowledge of Parkinson’s disease and the couple’s everyday life. Thus, the intervention meetings offered tailored, individualized and specialized care in supporting adjustment to DBS for PD both individually and as couples.
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Affiliation(s)
- Anita Haahr
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark
| | | | - Elisabeth O C Hall
- Public Health, Nursing, Aarhus University, Aarhus, Denmark.,Faculty of Health Sciences and Nursing, University of the Faroe Islands, Tórshavn, Faroe Islands
| | | | - Karen Østergaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Marit Kirkevold
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway.,Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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9
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Cabrera LY, Kelly-Blake K, Sidiropoulos C. Perspectives on Deep Brain Stimulation and Its Earlier Use for Parkinson's Disease: A Qualitative Study of US Patients. Brain Sci 2020; 10:brainsci10010034. [PMID: 31936218 PMCID: PMC7016580 DOI: 10.3390/brainsci10010034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Deep brain stimulation (DBS) is being used earlier than was previously the case in the disease progression in people with Parkinson’s disease (PD). To explore preferences about the timing of DBS, we asked PD patients with DBS whether they would have preferred the implantation procedure to have occurred earlier after diagnosis. Methods: Twenty Michigan-based patients were interviewed about both their experiences with DBS as well as their attitudes regarding the possible earlier use of DBS. We used a structured interview, with both closed and open-ended questions. Interviews were transcribed verbatim and analyzed using a mixed-methods approach. Results: We found that the majority of our participants (72%) had high overall satisfaction with DBS in addressing motor symptoms (mean of 7.5/10) and quality of life (mean of 8.25/10). Participants were mixed about whether they would have undergone DBS earlier than they did, with five participants being unsure and the remaining nearly equally divided between yes and no. Conclusion: Patient attitudes on the early use of DBS were mixed. Our results suggest that while patients were grateful for improvements experienced with DBS, they would not necessarily have endorsed its implementation earlier in their disease progression. Larger studies are needed to further examine our findings.
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Affiliation(s)
- Laura Y. Cabrera
- Center of Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI 48824, USA;
- Department of Translational Neuroscience, Michigan State University, Grand Rapids, MI 49503, USA
- Correspondence: ; Tel.: +1-517-355-755
| | - Karen Kelly-Blake
- Center of Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI 48824, USA;
- Department of Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Christos Sidiropoulos
- Department of Neurology & Ophthalmology, Michigan State University, East Lansing, MI 48824, USA;
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Desmoulin-Canselier S. Patient's lived experience with DBS between medical research and care: some legal implications. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:375-386. [PMID: 30074133 DOI: 10.1007/s11019-018-9859-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In the past 50 years, an ethical-legal boundary has been drawn between treatment and research. It is based on the reasoning that the two activities pursue different purposes. Treatment is aimed at achieving optimal therapeutic benefits for the individual patient, whereas the goal of scientific research is to increase knowledge, in the public interest. From this viewpoint, the patient's experience should be clearly distinguished from that of a participant in a clinical trial. On this premise, two parallel and mutually exclusive regimes have been established. Yet in the case of deep brain stimulation (DBS), this presentation is a poor fit, for both the patient's lived experience and medical practice and research. The frictions may be explained by the specificities of the treatment (including surgery and medical devices) and of the pathologies concerned (chronic and evolutive), and by the characteristics of the medical team implementing the treatment. These particularities challenge the dominant frame of reference in medical bioethics and cause difficulties for the current legal framework in fulfilling its dual role: to protect patients while supporting the development of innovative treatments. The dominant model is still the clinical trial for medication safety and legal requirements of drug market regulation. However, DBS forces us to reflect on a medical device that is permanently implanted in the brain by highly specialized multi-disciplinary neurosurgical teams, for the treatment of chronic evolutive diseases. These devices demand fine-tuning on a case-by-case basis and there is still a lot to discover about why DBS is effective (or not). As a result, the wall between treatment and research is osmotic: many discoveries are made incidentally, in the course of treatment. The following study begins with these observations, and suggests that we review legal provisions (especially in French and United States law) so that they are better adapted to the first-person needs and experience of the patient undergoing brain stimulation.
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Affiliation(s)
- Sonia Desmoulin-Canselier
- CNRS/Université de Nantes UMR 6297 Droit et Changement Social, Faculté de Droit et de sciences politiques, Université de Nantes, Chemin de la Censive du Tertre, Nantes, France.
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11
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Troisoeufs A. Deep Brain Stimulation (DBS) experiences: an ethnographic approach to their expression on the Internet forums. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:343-352. [PMID: 30377912 DOI: 10.1007/s11019-018-9874-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This contribution aims at describing the experiences of Deep Brain Stimulation (DBS) as discussed on Internet forums. Since the 2000s, increasing attention has been paid to health practices associated with the use of the Internet, whether by medical professionals, public authorities or researchers in the social sciences. We know that Internet is used by patients with Parkinson's disease, in order to discuss about their lived experiences. This contribution will present how these Internet users address the specific theme of DBS. We will examine how their use and the information sharing associated to it participate in the "shaping" of the lived experience of deep cerebral stimulation. This contribution will be introduced by an analysis of the state-of-the-art in sociological and anthropological international research on the topic of "Internet health". On the basis of this analysis, it will propose a framework to describe and understand the various uses of the web that are made to give an account of the experience of stimulation. The existence of collective mobilizations in Parkinson's disease, an old Internet experience and media oppositions concerning certain antiparkinsonian drugs, are conditions which push us to question these themes concerning DBS. This paper is a description, for the first time, of roles played by the users of these Internet forums and the different online activities produced about DBS subject. In an ethnographic perspective, we had to imagine that we were an Internet user seeking patient experiences with this surgical procedure to understand these interactions about DBS. The main goal of this contribution is to describe the attention paid by users for medical information about DBS in the identity and self-help process. The interest of such an approach is to open an anthropological reflection on the place and the role of the medical representations in the testimonies of experience of the disease or the treatments.
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Affiliation(s)
- Aurélien Troisoeufs
- Normastim UMR 8103; Cermes3 - UMR CNRS 8211 - Unité Inserm 988 - EHESS - Université Paris Descartes, Paris, France.
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12
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Liddle J, Sundraraj A, Ireland D, Bennett S, Stillerova T, Silburn P. Impact of deep brain stimulation on people with Parkinson's disease: A mixed methods feasibility study exploring lifespace and community outcomes. Hong Kong J Occup Ther 2019; 32:97-107. [PMID: 32009861 PMCID: PMC6967222 DOI: 10.1177/1569186119865736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/25/2019] [Indexed: 01/07/2023] Open
Abstract
Background Deep brain stimulation is a surgical treatment for Parkinson’s
disease. Its impacts on motor symptoms are widely reported;
however, little is known about the broader impact of deep brain
stimulation on the community lives of people with Parkinson’s
disease. Lifespace is a measure of lived community mobility,
providing an indication of community access and
participation. Aims This pilot study explored the feasibility of remotely monitoring
the qualitative and quantitative community outcomes related to
deep brain stimulation. Methods A longitudinal mixed methods study with a convergent design was
undertaken exploring the lifespace, quality of life, life
satisfaction and lived experiences of people with Parkinson’s
disease before and after deep brain stimulation. Data were
collected through questionnaires, semi-structured interviews and
a smartphone-based application which collected geolocation
data. Results Quantitative and qualitative data from eight participants living
with Parkinson’s disease were analysed and integrated. At
baseline, participants had a median age of 68 years and a median
Hoehn and Yahr score of 2. Measuring a range of community-based
outcomes indicated different change trajectories for individuals
across outcomes. Key content areas were developed from the
qualitative data: participation in occupations and travel and
home. This study indicates the potential value of including
geolocation data-based lifespace collection in metropolitan and
regional areas. Conclusions Monitoring lifespace in conjunction with subjective measures
provides insights into the complex and individually varied
experiences. Further research could explore the impacts of deep
brain stimulation on occupations and community participation to
gain a deeper understanding of the related needs and support
clinical approaches.
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Affiliation(s)
- Jacki Liddle
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Australia.,School of Information Technology and Electrical Engineering, The University of Queensland, Australia
| | - Amreetaa Sundraraj
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - David Ireland
- CSIRO, Australian ehealth Research Centre, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Tereza Stillerova
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Australia
| | - Peter Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Australia
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13
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Livingood WC, Bilello L, Lukens-Bull K. Seeing the quality improvement forest through the quality improvement trees: A meta-synthesis of case studies in Florida and Georgia. SAGE Open Med 2019; 7:2050312119845703. [PMID: 31041099 PMCID: PMC6477764 DOI: 10.1177/2050312119845703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/02/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives To identify important characteristics of quality improvement applications for population health and healthcare settings and to explore the use of quality improvement as a model for implementing and disseminating evidence-based or best practices. Methods A meta-synthesis was used to examine published quality improvement case studies. A total of 10 published studies that were conducted in Florida and Georgia were examined and synthesized using meta-synthesis (a qualitative research methodology) for meaningful insights and lessons learned using defined meta-synthesis inclusion criteria. The primary focus of the analysis and synthesis were the reported processes and findings that included responses to structured questioning in addition to emergent results from direct observation and semi-structured open-ended interviewing. Results The key insights for the use of quality improvement in public health and healthcare settings included (1) the essential importance of data monitoring, analysis, and data-based decision making; (2) the need to focus on internal mutable factors within organizations; (3) the critical role of quality improvement team group dynamics; (4) the value of using a quality improvement collaborative or multi-clinic quality council/committee for sharing and comparing performance on key metrics; and (5) the need to identify a quality improvement approach and methods for clarification as a structured quality improvement intervention. Conclusion In addition to the advantages of using quality improvement to enhance or improve healthcare and public health services, there is also potential for quality improvement to serve as a model for enhancing the adoption of evidence-based practices within the context of dissemination and implementation research.
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Affiliation(s)
- William C Livingood
- Center for Health Equity and Quality Research, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Lori Bilello
- Center for Health Equity and Quality Research, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Katryne Lukens-Bull
- Center for Health Equity and Quality Research, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
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14
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Mapping the experiences and needs of deep brain stimulation for people with Parkinson’s disease and their family members. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundDeep brain stimulation (DBS) is an effective treatment for the motor symptoms of Parkinson’s disease (PD). The lived experience of people with PD suggests a process of adjustment follows. This study aimed to explore the adjustment and associated education and support needs of people with PD undergoing DBS and their family members across the continuum of the DBS experience.MethodA structured qualitative description study including semi-structured interviews with people with PD (n = 14), family members (n = 10) and clinicians (n = 11) was conducted to explore lived experiences, needs, perspectives and clinical considerations. Inductive analysis indicated common temporal stages related to undergoing DBS, and the related experiences and needs were mapped.FindingsFour stages, each with unique needs, emerged: Considering DBS involved needs for peer-based education and realistic, meaningful goal setting; Surgery and Support shifted to clinical support related to the surgery and support for the person and their family around immediate changes experienced; Seeking Stability focused on timely clinical and practical support for the person and family around new changes and challenges to symptoms, behaviours and roles; and Next Steps involved direction and support for reengagement in the self-management of the condition, and current and future changes related to PD.All participants with PD and their family members in this study indicated that overall their experiences with DBS had led to positive changes in their symptoms and lives. Consideration of different needs at different times in the process may be applied within clinical practice to support adjustment.
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15
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The Lived Experiences of Deep Brain Stimulation in Parkinson's Disease: An Interpretative Phenomenological Analysis. PARKINSONS DISEASE 2019; 2019:1937235. [PMID: 30854185 PMCID: PMC6377998 DOI: 10.1155/2019/1937235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022]
Abstract
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD). In this study, we used an interpretative phenomenological analysis to explore how 10 male people with PD experienced life after STN-DBS surgery. Two themes emerged. The first, "Healed and relieved: all that glitters is not gold," highlights the benefits and the personal "costs" of surgery. The second, "The change within: new interpretations of the present and future unfold," explores how patients reinterpreted their lives as individuals and members of society in the present and as they face their future. Relief, gratitude, disappointment, and the need for social support are expressed as well as a new appraisal of values and the future. STN-DBS alters the life course of people with PD, and this study provides new insight into psychological and social issues that surgery raises for the patient and their family system. These psychosocial issues should be taken into account when preparing the patient and their family for surgery or supporting them postoperatively.
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16
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Tsui C, Koss K, Churchward MA, Todd KG. Biomaterials and glia: Progress on designs to modulate neuroinflammation. Acta Biomater 2019; 83:13-28. [PMID: 30414483 DOI: 10.1016/j.actbio.2018.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/05/2018] [Accepted: 11/06/2018] [Indexed: 02/06/2023]
Abstract
Microglia are multi-functional cells that play a vital role in establishing and maintaining the function of the nervous system and determining the fate of neurons following injury or neuropathology. The roles of microglia are diverse and essential to the capacity of the nervous system to recover from injury, however sustained inflammation can limit recovery and drive chronic disease processes such as neurodegenerative disorders. When assessing implantable therapeutic devices in the central nervous system, an improved lifetime of the implant is considered achievable through the attenuation of microglial inflammation. Consequently, there is a tremendous underexplored potential in biomaterial and engineered design to modulate neuroinflammation for therapeutic benefit. Several strategies for improving device compatibility reviewed here include: biocompatible coatings, improved designs in finer and flexible shapes to reduce tissue shear-related scarring, and loading of anti-inflammatory drugs. Studies about microglial cell cultures in 3D hydrogels and nanoscaffolds to assess various injuries and disorders are also discussed. A variety of other microglia-targeting treatments are also reviewed, including nanoparticulate systems, cellular backpacks, and gold plinths, with the intention of delivering anti-inflammatory drugs by targeting the phagocytic nature of microglia. Overall, this review highlights recent advances in biomaterials targeting microglia and inflammatory function with the potential for improving implant rejection and biocompatibility studies. STATEMENT OF SIGNIFICANCE: Microglia are the resident immune cells of the central nervous system, and thus play a central role in the neuroinflammatory response against conditions than span acute injuries, neuropsychiatric disorders, and neurodegenerative disorders. This review article presents a summary of biomaterials research that target microglia and other glial cells in order to attenuate neuroinflammation, including but not limited to: design of mechanically compliant and biocompatible stimulation electrodes, hydrogels for high-throughput 3D modelling of nervous tissue, and uptake of nanoparticle drug delivery systems. The goal of this paper is to identify strengths and gaps in the relevant literature, and to promote further consideration of microglia behaviour and neuroinflammation in biomaterial design.
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Affiliation(s)
- C Tsui
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - K Koss
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - M A Churchward
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - K G Todd
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 2R3, Canada.
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17
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Hermanowicz N, Castillo-Shell M, McMean A, Fishman J, D'Souza J. Patient and physician perceptions of disease management in Parkinson's disease: results from a US-based multicenter survey. Neuropsychiatr Dis Treat 2019; 15:1487-1495. [PMID: 31239684 PMCID: PMC6551617 DOI: 10.2147/ndt.s196930] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/04/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Clinical care for patients with Parkinson's disease (PD) is complex, and disconnect may exist between patient and physician perceptions of treatment, disease awareness, and impact on quality of life (QoL). Relatively few studies have analyzed patient and physician perspectives of disease management concurrently, and even fewer have compared responses between corresponding patients and their physicians. This study aimed to characterize these aspects and identify opportunities to improve alignment. Methods: This cross-sectional study used an online survey and chart review. Participating physicians completed a profiling survey, followed by patient record forms (PRFs) for their next five patients with PD. Patients completed paper questionnaires. PRFs were matched with patient questionnaires, and patient and physician responses compared. Results: Of 107 participating physicians, 70 completed 350 PRFs. Patients completed 71 questionnaires; 66 were matched to PRFs. From a physician perspective, there was alignment between the motor symptoms that were most bothersome for patients and those that were most discussed (physicians felt tremor was most bothersome for most patients [71%]; 77% of physicians included tremor among top three most discussed), but disconnect between the most bothersome and most discussed nonmotor symptoms (physicians felt fatigue was most bothersome for most patients [35%]; cognitive impairment was the most discussed nonmotor symptom, with 52% of physicians including it in top three most discussed). Patients and physicians reported moderate satisfaction with current PD medication. Patients considered form of delivery more important than did physicians. Physicians showed a strong level of awareness of PD's impact on patient QoL, although validated QoL instruments were not widely used. Physicians were more confident than patients about patients' awareness of support resources for patients with PD. Conclusion: Nonmotor symptoms, form of medication delivery, and awareness of support services are areas where PD physician and patient alignment could be increased to improve outcomes.
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Affiliation(s)
- Neal Hermanowicz
- Movement Disorders Program and Department of Neurology, University of California-Irvine, Irvine, CA, USA
| | | | - Angela McMean
- Ashfield Insight & Performance, part of Ashfield Healthcare Communications Group Ltd, Macclesfield, Cheshire, UK
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18
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"It Is Hard Work, But It Is Worth It": Patients and Spouses' Experiences of a Nursing Intervention to Promote Adjustment to Deep Brain Stimulation for Parkinson's Disease-A Feasibility Study. ANS Adv Nurs Sci 2018; 41:174-187. [PMID: 29727341 DOI: 10.1097/ans.0000000000000208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article evaluates the feasibility of a nursing intervention when adjusting to deep brain stimulation for Parkinson disease. Eight couples were included in the study. Main activities of the intervention were a diary and individualized meetings between nurses, patients, and spouses with a focus on everyday life and expectations to deep brain stimulation. All meetings were audio recorded and analyzed together with the content of the diary. The intervention was evaluated as feasible and experienced as meaningful. It supports the need for individualized care involving both patients and spouses and contributes to the development of an evidence-based nursing practice.
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19
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Jones LL, Calvert M, Moiemen N, Deeks JJ, Bishop J, Kinghorn P, Mathers J. Outcomes important to burns patients during scar management and how they compare to the concepts captured in burn-specific patient reported outcome measures. Burns 2017; 43:1682-1692. [PMID: 29031889 DOI: 10.1016/j.burns.2017.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/21/2017] [Accepted: 09/15/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pressure garment therapy (PGT) is an established treatment for the prevention and treatment of hypertrophic scarring; however, there is limited evidence for its effectiveness. Burn survivors often experience multiple issues many of which are not adequately captured in current PGT trial measures. To assess the effectiveness of PGT it is important to understand what outcomes matter to patients and to consider whether patient-reported outcome measures (PROMs) can be used to ascertain the effect of treatments on patients' health-related quality of life. This study aimed to (a) understand the priorities and perspectives of adult burns patients and the parents of burns patients who have experienced PGT via in-depth qualitative data, and (b) compare these with the concepts captured within burn-specific PROMs. METHODS We undertook 40 semi-structured interviews with adults and parents of paediatric and adolescent burns patients who had experienced PGT to explore their priorities and perspectives on scar management. Interviews were audio-recorded, transcribed and thematically analysed. The outcomes interpreted within the interview data were then mapped against the concepts captured within burn-specific PROMs currently in the literature. RESULTS Eight core outcome domains were identified as important to adult patients and parents: (1) scar characteristics and appearance, (2) movement and function, (3) scar sensation, (4) psychological distress, adjustments and a sense of normality, (5) body image and confidence, (6) engagement in activities, (7) impact on relationships, and (8) treatment burden. CONCLUSIONS The outcome domains presented reflect a complex holistic patient experience of scar management and treatments such as PGT. Some currently available PROMs do capture the concepts described here, although none assess psychological adjustments and attainment of a sense of normality following burn injury. The routine use of PROMs that represent patient experience and their relative contribution to trial outcome assessment versus clinical measures is now a matter for further research and debate.
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Affiliation(s)
- Laura L Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Naiem Moiemen
- The Scar Free Foundation Centre for Burns Research, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Jonathan Bishop
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Philip Kinghorn
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
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- Membership of the Pegasus Study Group is provided in the Acknowledgements
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