Patients and Physicians Differ on DBS Expectations and Outcomes for Parkinson's Disease

Patients’ postoperative self-assessments may correlate better with their own satisfaction than with neurologists’ impressions.



BOSTON—After undergoing deep brain stimulation (DBS), patients’ evaluations of improvement in their symptoms of Parkinson’s disease may not coincide with their neurologists’ assessments, according to research presented at the 2012 Annual Meeting of the American Neurological Association. Patients’ degree of satisfaction with the surgery may depend greatly on their preoperative expectations.

Study participants who underwent DBS were generally satisfied with the results. Patient satisfaction did not correlate with clinical improvement, as measured by neurologist-assigned clinical global impression (CGI) scores, however.

Following Patients Before and After DBS Implantation
Nasrin Esnaashari, CNP, CNS, nurse practitioner and Clinical Instructor at the University of Southern California in Los Angeles, and colleagues are enrolling patients with Parkinson’s disease in an ongoing study of patient satisfaction with DBS. All participants are patients at the university and have undergone preoperative screening to determine whether they are candidates for DBS implantation. The investigators have enrolled 19 patients to date.

Before surgery, patients complete a questionnaire about their goals for DBS, and neurologists calculate patients’ CGI-Severity scores. At six, 12, 18, and 24 months after surgery, patients rate how well DBS has met their goals, and neurologists determine patients’ CGI-Improvement scores.

The researchers analyzed data for 11 patients, including seven males, who had completed their six-month follow-up assessments. At the time of surgery, patients’ average age was 65. Seven patients had a Hoehn and Yahr stage of 2.0, and four patients had a Hoehn and Yahr stage of 2.5.

Patient Satisfaction Correlated With Fulfilled Expectations
After surgery, most of the patients’ goals had been achieved. All patients reported improvement in their neurologic symptoms, but their self-assessments did not match neurologists’ CGI-Improvement scores. In certain cases, “physicians thought that a patient got the best result, but the patient didn’t think that because his or her expectation was different,” Ms. Esnaashari told Neurology Reviews. On the other hand, some patients rated their improvement more highly than neurologists did.

“A lot depends on their expectations. If patients met their expectations and goals, they were happy, despite what the physician said. The physician evaluation is almost an independent value here,” said Ms. Esnaashari. “The degree of patient satisfaction correlated well with the extent to which their preoperative expectation was fulfilled. Sometimes what a patient sees as the best for [himself or herself] is not necessarily what the physician thinks is the best result for the patient.”

Some patients may have unrealistic preoperative expectations. “You need to spend time to explain that to them. They need to learn,” advised Ms. Esnaashari. “And then, at the end, they make their decision, fully informed. It’s empowering physicians and empowering patients.”

—Erik Greb

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