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Patients' shifting goals for deep brain stimulation and informed consent
Cynthia S Kubu1, Thomas Frazier2, Scott E Cooper2
1From the Center for Neurological Restoration (C.S.K.), Neuroethics Program (P.J.F.), Center for Pediatric Behavioral Health (T.F.), and Center for Neurological Restoration (A.M.), Cleveland Clinic, OH; and Department of Neurology (S.E.C., J.V.), University of Minnesota, Minneapolis. kubuc@ccf.org.
Neurology
|July 1, 2018
Summary
Deep brain stimulation (DBS) significantly alters patient priorities for Parkinson disease (PD) symptom goals, but not behavioral goals, early after surgery. These findings highlight the need for improved informed consent regarding DBS expectations.
Area of Science:
- Neuroscience
- Neurosurgery
- Movement Disorders
Background:
- Parkinson disease (PD) significantly impacts patients' quality of life, necessitating effective treatment strategies.
- Deep brain stimulation (DBS) is an established therapy for managing advanced PD symptoms.
- Understanding patient-reported outcomes and goal prioritization is crucial for evaluating treatment efficacy.
Purpose of the Study:
- To prospectively assess changes in the importance of pre-defined symptom and behavioral goals for Parkinson disease patients following DBS surgery.
- To investigate the relationship between symptom severity and behavioral goal attainment changes and the shifts in goal prioritization after DBS.
Main Methods:
- A prospective, repeated-measures design was employed with 52 Parkinson disease patients undergoing DBS.
- Patients' symptom and behavioral goals were rank-ordered pre- and post-surgery using semistructured interviews and visual analog scales.
- Statistical analyses, including chi-squared tests and mixed-effects linear regression, examined changes in goal importance and their relationship with symptom severity and goal attainment.
Main Results:
- A significant majority of patients (81% symptom goals, 77% behavioral goals) altered their goal priorities within 3 months of DBS.
- Improvements in self-reported symptom severity correlated with a decreased rank of symptom goals.
- No significant relationship was observed between improvements in behavioral goal attainment and changes in the rank of behavioral goals.
Conclusions:
- Deep brain stimulation leads to early shifts in patient priorities, particularly for symptom-related goals, which align with objective improvements.
- Behavioral goals, potentially reflecting core personal values, showed less change and were not directly linked to post-DBS improvements.
- These findings underscore the differential impact of DBS on symptom versus behavioral aspects of Parkinson disease and can inform patient expectations and the informed consent process.