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van Munster M, Pedrosa AJ, Künkler C, Pedrosa DJ. The Quality in Quality of Life in Parkinson's Disease: A Qualitative Meta-Synthesis. Mov Disord Clin Pract 2024; 11:761-769. [PMID: 38715240 PMCID: PMC11233873 DOI: 10.1002/mdc3.14063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/29/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Quality of life (QoL) is known to be impaired in people with Parkinson's disease (PwPD). Not surprisingly, a considerable effort of health interventions is aimed at maintaining or improving QoL. Yet, little is known about its determinants from a PwPD perspective to inform person-centered health care interventions. OBJECTIVES This systematic review aims to overcome this information gap by synthesizing existing evidence on factors associated with PwPD' self-perceived QoL. METHODS We searched six electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Cochrane Library) from inception to January 2022 for eligible qualitative studies of QoL in PwPD, supplemented by citation tracking and hand searching. Study quality was assessed using the QualSyst tool. In order to characterize the determinants of QoL in PwPD, we conducted a qualitative meta-synthesis. RESULTS Our analysis revealed a wide range of facilitators and barriers to QoL relating to seven overarching themes: Illness experience, health care, everyday life, social life, identity, spirituality/religion, and environment. CONCLUSIONS Our systematic review reinforces the impact of symptom experience on PwPD's QoL. However, it also highlights the need to consider the non-physical dimensions of PD when assessing patients' QoL. It is therefore essential that health care professionals acknowledge the psychological, social and spiritual repercussions of PD and endeavor to respond to these concerns through a comprehensive and patient-centered strategy. Further research is needed to gain a deeper understanding of these facets of PD and to formulate successful interventions aimed at improving the QoL of PwPD.
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Affiliation(s)
- Marlena van Munster
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
- Department of International Health, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Anna J Pedrosa
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Carolin Künkler
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - David J Pedrosa
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
- Centre for Mind, Brain and Behavior, Philipps-University Marburg, Marburg, Germany
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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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Shahmoon S, Limousin P, Jahanshahi M. Exploring the Caregiver Role after Deep Brain Stimulation Surgery for Parkinson’s Disease: A Qualitative Analysis. PARKINSON'S DISEASE 2023; 2023:5932865. [PMID: 37065969 PMCID: PMC10098415 DOI: 10.1155/2023/5932865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 12/22/2022] [Accepted: 03/18/2023] [Indexed: 04/07/2023]
Abstract
This pilot study aimed to explore how caregiver spouses make sense of themselves one and five years after their partner’s deep brain stimulation (DBS) surgery for Parkinson’s disease. 16 spouse (8 husbands and 8 wives) caregivers were recruited for the interview. Eight struggled to reflect on their own lived experience and primarily focused on the impact of PD on their partners, such that their transcripts were no longer viable for interpretative phenomenological analysis (IPA). A content analysis showed (1) how these 8 caregivers shared less than half as many self-reflections than the other caregivers, (2) that there was a bias to reflect on their partner’s experience answering the opening question, (3) the bias continued when answering subsequent questions, and (4) there was a lack of awareness of this bias. No other patterns of behaviour or themes were able to be extracted. The remaining 8 interviews were transcribed and analysed using IPA. This analysis discovered 3 inter-related themes: (1) DBS allows carers to question and shift the caregiver role, (2) Parkinson’s unites and DBS divides, and (3) seeing myself and my needs, DBS enhances visibility. How these caregivers interacted with these themes depended on when their partners were operated. The results suggested that spouses maintained the role of caregiver one year post DBS because they struggle to identify themselves in any other way but were more comfortable reassociating into the role of spouse 5 years post surgery. Further inquiry into caregiver and patient identity roles post DBS is recommended as a means of supporting their psychosocial adjustment after surgery.
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Affiliation(s)
- Suzette Shahmoon
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK
| | - Marjan Jahanshahi
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK
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Soilemezi D, Palmar‐Santos A, Navarta‐Sánchez MV, Roberts HC, Pedraz‐Marcos A, Haahr A, Sørensen D, Bragstad LK, Hjelle EG, Haavaag SB, Portillo MC. Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study. Health Expect 2023; 26:670-682. [PMID: 36573594 PMCID: PMC10010098 DOI: 10.1111/hex.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease. OBJECTIVE This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. METHODS A mixed-methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta-ethnography approach was used to analyse and synthesize cross-national findings. RESULTS A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. CONCLUSIONS Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. PATIENT OR PUBLIC CONTRIBUTION Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings.
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Affiliation(s)
- Dia Soilemezi
- Department of Psychology, Faculty of Science and HealthUniversity of PortsmouthPortsmouthUK
| | - Ana Palmar‐Santos
- Nursing Department, Faculty of MedicineUniversidad Autónoma de MadridMadridSpain
| | | | - Helen C. Roberts
- National Institute for Health Research Applied Research Collaboration Wessex, Long Term Conditions, SouthamptonUK
- Academic Geriatric Medicine, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Azucena Pedraz‐Marcos
- Unidad de Investigación en Cuidados y Sistemas de SaludThe Carlos III Health Institute (ISCIII)MadridSpain
- Grupo de investigación ISCiiiResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | - Anita Haahr
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University CollegeAarhusDenmark
- Nursing and Healthcare, Department of Public HealthAarhus UniversityAarhusDenmark
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University CollegeAarhusDenmark
| | - Line K. Bragstad
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of OsloOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | - Ellen G. Hjelle
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of OsloOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | | | - Mari Carmen Portillo
- National Institute for Health Research Applied Research Collaboration Wessex, Long Term Conditions, SouthamptonUK
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
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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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Bluhm R, Castillo E, Achtyes ED, McCright AM, Cabrera LY. They Affect the Person, but for Better or Worse? Perceptions of Electroceutical Interventions for Depression Among Psychiatrists, Patients, and the Public. QUALITATIVE HEALTH RESEARCH 2021; 31:2542-2553. [PMID: 34672815 PMCID: PMC8579329 DOI: 10.1177/10497323211037642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Responding to reports of cases of personality change following deep brain stimulation, neuroethicists have debated the nature and ethical implications of these changes. Recently, this literature has been challenged as being overblown and therefore potentially an impediment to patients accessing needed treatment. We interviewed 16 psychiatrists, 16 patients with depression, and 16 members of the public without depression, all from the Midwestern United States, about their views on how three electroceutical interventions (deep brain stimulation, electroconvulsive therapy, and transcranial magnetic stimulation) used to treat depression might affect the self. Participants were also asked to compare the electroceuticals' effects on the self with the effects of commonly used depression treatments (psychotherapy and pharmaceuticals). Using qualitative content analysis, we found that participants' views on electroceuticals' potential effects on the self mainly focused on treatment effectiveness and side effects. Our results have implications for both theoretical discussions in neuroethics and clinical practice in psychiatry.
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Affiliation(s)
- Robyn Bluhm
- Michigan State University, East Lansing, Michigan, USA
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7
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Thomson CJ, Segrave RA, Fitzgerald PB, Richardson KE, Racine E, Carter A. "Nothing to Lose, Absolutely Everything to Gain": Patient and Caregiver Expectations and Subjective Outcomes of Deep Brain Stimulation for Treatment-Resistant Depression. Front Hum Neurosci 2021; 15:755276. [PMID: 34658822 PMCID: PMC8511461 DOI: 10.3389/fnhum.2021.755276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background: How "success" is defined in clinical trials of deep brain stimulation (DBS) for refractory psychiatric conditions has come into question. Standard quantitative psychopathology measures are unable to capture all changes experienced by patients and may not reflect subjective beliefs about the benefit derived. The decision to undergo DBS for treatment-resistant depression (TRD) is often made in the context of high desperation and hopelessness that can challenge the informed consent process. Partners and family can observe important changes in DBS patients and play a key role in the recovery process. Their perspectives, however, have not been investigated in research to-date. The aim of this study was to qualitatively examine patient and caregivers' understanding of DBS for TRD, their expectations of life with DBS, and how these compare with actual experiences and outcomes. Methods: A prospective qualitative design was adopted. Semi-structured interviews were conducted with participants (six patients, five caregivers) before DBS-implantation and 9-months after stimulation initiation. All patients were enrolled in a clinical trial of DBS of the bed nucleus of the stria terminalis. Interviews were thematically analyzed with data saturation achieved at both timepoints. Results: Two primary themes identified were: (1) anticipated vs. actual outcomes, and (2) trial decision-making and knowledge. The decision to undergo DBS was driven by the intolerability of life with severe depression coupled with the exhaustion of all available treatment options. Participants had greater awareness of surgical risks compared with stimulation-related risks. With DBS, patients described cognitive, emotional, behavioral and physical experiences associated with the stimulation, some of which were unexpected. Participants felt life with DBS was like "a roller coaster ride"-with positive, yet unsustained, mood states experienced. Many were surprised by the lengthy process of establishing optimum stimulation settings and felt the intervention was still a "work in progress." Conclusion: These findings support existing recommendations for iterative informed consent procedures in clinical trials involving long-term implantation of neurotechnology. These rich and descriptive findings hold value for researchers, clinicians, and individuals and families considering DBS. Narrative accounts capture patient and family needs and should routinely be collected to guide patient-centered approaches to DBS interventions.
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Affiliation(s)
- Cassandra J. Thomson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Rebecca A. Segrave
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Paul B. Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare, Camberwell, VIC, Australia
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Karyn E. Richardson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Montreal, QC, Canada
- Department of Medicine and Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
- Medicine and Biomedical Ethics Unit, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Adrian Carter
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
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Chacón Gámez YM, Brugger F, Biller-Andorno N. Parkinson's Disease and Deep Brain Stimulation Have an Impact on My Life: A Multimodal Study on the Experiences of Patients and Family Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189516. [PMID: 34574440 PMCID: PMC8467519 DOI: 10.3390/ijerph18189516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 12/21/2022]
Abstract
Parkinson’s disease (PD) has a large impact on patients’ physical and mental health, which also greatly affects their family caregivers. Deep brain stimulation (DBS) has emerged as an effective treatment for PD, but different authors have expressed their concerns about the potential impact of DBS on personality and identity. Our study aims at better understanding how patients and family caregivers experience life with PD and DBS, the impact of both on their personal and social lives, and their perception of the changes that have occurred as a result of the disease and the treatment. Our study applies a multimodal approach by means of narrative semi-structured interviews and drawings. Seven principal themes have been identified: “everyone’s Parkinson’s is different”, “changing as a person during the disease”, “going through Parkinson’s together”, “DBS improved my life”, “I am treated with DBS but I have Parkinson’s still”, “DBS is not perfect”, and “being different after DBS”. PD is perceived as an unpredictable and heterogeneous disease that changes from person to person, as does the effect of DBS. While DBS side-effects may have an impact on patients’ personality, behavior, and self-perception, PD symptoms and drug side-effects also have a great impact on these aspects.
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Affiliation(s)
- Yolanda María Chacón Gámez
- Institute of Medical Bioethics and History of Medicine, University of Zurich, Wintherthurerstrasse 30, 8006 Zurich, Switzerland;
- Correspondence:
| | - Florian Brugger
- Kantonsspital St. Gallen, Klinik für Neurologie, Haus 04 Rorsacher Strasse 95, 9007 St. Gallen, Switzerland;
| | - Nikola Biller-Andorno
- Institute of Medical Bioethics and History of Medicine, University of Zurich, Wintherthurerstrasse 30, 8006 Zurich, Switzerland;
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Tan QY, Cox NJ, Lim SER, Coutts L, Fraser SDS, Roberts HC, Ibrahim K. The Experiences of Treatment Burden in People with Parkinson's Disease and Their Caregivers: A Systematic Review of Qualitative Studies. JOURNAL OF PARKINSONS DISEASE 2021; 11:1597-1617. [PMID: 34334419 DOI: 10.3233/jpd-212612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BackgroundHigh treatment burden is associated with poor adherence, wasted resources, poor quality of life and poor health outcomes. Identifying factors that impact treatment burden in Parkinson's disease can offer insights into strategies to mitigate them.ObjectiveTo explore the experiences of treatment burden among people with Parkinson's disease (PwP) and their caregivers.MethodsA systematic review of studies published from year 2006 was conducted. Qualitative and mixed-method studies with a qualitative component that relate to usual care in Parkinson's disease were included. Quantitative studies and grey literature were excluded. Data synthesis was conducted using framework synthesis.Results1757 articles were screened, and 39 articles included. Understanding treatment burden in PwP and caregivers was not the primary aim in any of the included studies. The main issues of treatment burden in Parkinson's disease are: 1) work and challenges of taking medication; 2) healthcare provider obstacles including lack of patient-centered care, poor patient-provider relationships, lack of care coordination, inflexible organizational structures, lack of access to services and issues in care home or hospital settings; and 3) learning about health and challenges with information provision. The treatment burden led to physical and mental exhaustion of self-care and limitations on the role and social activities of PwP and caregivers.Conclusion:There are potential strategies to improve the treatment burden in Parkinson's disease at an individual level such as patient-centered approach to care, and at system level by improving access and care coordination between services. Future research is needed to determine the modifiable factors of treatment burden in Parkinson's disease.
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Affiliation(s)
- Qian Yue Tan
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton, UK
| | - Stephen E R Lim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Laura Coutts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon D S Fraser
- National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK.,School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
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10
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van Hienen MM, Contarino MF, Middelkoop HAM, van Hilten JJ, Geraedts VJ. Effect of deep brain stimulation on caregivers of patients with Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2020; 81:20-27. [PMID: 33038702 DOI: 10.1016/j.parkreldis.2020.09.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Caregivers of patients with Parkinson's Disease (PD) often provide important support in the pre- and postoperative phase of Deep Brain Stimulation (DBS). DBS-associated changes of patient-functioning may affect caregiver wellbeing and impact the support system. Factors influencing caregiver-wellbeing under these circumstances are incompletely known. OBJECTIVE to systematically review studies of sufficient methodological quality on the impact of DBS on caregivers of PD patients. METHODS using PRISMA guidelines, major databases were searched up to May 2020. Five subcategories were identified: Caregiver burden, Caregiver cognitive and psychiatric functioning, Caregiver Quality of Life (QoL), Marital Satisfaction/Conflicts, and Caregiver Satisfaction. Quality was assessed using an in-house checklist. RESULTS 293 studies were identified; 12 were ultimately included. Caregiver burden, psychiatric and cognitive functioning and QoL remained relatively unchanged. Results on marital satisfaction/conflicts were contrasting: an increase in marital conflicts despite improved relationship quality scores DBS. Caregiver satisfaction with surgery was low with 50-58% of caregivers being disappointed with DBS outcomes. Concerning caregiver related factors: a higher preoperative caregiver QoL, younger age, lower scores on psychiatric rating scales, and more favourable preoperative relationship quality scores, were associated with better caregiver wellbeing. A favourable patient-profile includes younger age and age-at-onset, shorter disease duration, lower medication requirements, and lower scores on psychiatric rating scales. CONCLUSION Although most patient- and caregiver-related subdomains remained unchanged after DBS, dissatisfaction among caregivers and marital problems may constitute a large risk for a well-functioning patient-caregiver dyad. Early recognition of potential problem situations may improve post-DBS care for both patients and caregivers.
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Affiliation(s)
- Marle M van Hienen
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Department of Neurology, Haga Teaching Hospital, the Hague, the Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor J Geraedts
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
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11
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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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12
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Baertschi M, Favez N, Flores Alves Dos Santos J, Radomska M, Herrmann F, Burkhard PR, Canuto A, Weber K, Ghisletta P. Illness Representations and Coping Strategies in Patients Treated with Deep Brain Stimulation for Parkinson's Disease. J Clin Med 2020; 9:E1186. [PMID: 32326245 PMCID: PMC7230846 DOI: 10.3390/jcm9041186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/26/2022] Open
Abstract
There is a debate on possible alterations of self-identity following deep brain stimulation for neurological disorders including Parkinson's disease. Among the psychological variables likely to undergo changes throughout such a medical procedure, illness representations and coping strategies have not been the target of much research to this day. In order to remedy this, we investigated the dynamics of illness representations and coping strategies in an 18-month longitudinal study involving 45 patients undergoing deep brain stimulation for idiopathic Parkinson's disease. Two research hypotheses were formulated and investigated through repeated measures of ANOVAs and structural equation modelling with full information maximum likelihood and Bayesian estimations. Representations of Parkinson's disease as a cyclical condition and perception of control over the disease diminished after surgery. Use of instrumental coping strategies was not modified after deep brain stimulation. These changes were identified by SEM but not ANOVAs; their magnitude was nevertheless relatively small, implying general stability in representations. These findings suggest that psychological variables do not undergo major changes after deep brain stimulation for Parkinson's disease.
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Affiliation(s)
- Marc Baertschi
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
- Nant Foundation, Service of General Psychiatry and Psychotherapy, Avenue des Alpes 66, 1820 Montreux, Switzerland
| | - Nicolas Favez
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
| | - João Flores Alves Dos Santos
- Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland;
| | - Michalina Radomska
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
| | - François Herrmann
- Division of Geriatrics, Geneva University Hospitals, Chemin du Pont-Bochet 3, 1226 Thônex, Switzerland;
| | - Pierre R. Burkhard
- Service of Neurology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland;
| | - Alessandra Canuto
- Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland; (A.C.); (K.W.)
| | - Kerstin Weber
- Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland; (A.C.); (K.W.)
| | - Paolo Ghisletta
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
- Swiss Distance Learning University, Überlandstrasse 12, 3900 Brig, Switzerland
- Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, Universities of Lausanne and of Geneva, CH-1015 Lausanne, Switzerland
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13
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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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14
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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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15
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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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16
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What we (Should) Talk about when we Talk about Deep Brain Stimulation and Personal Identity. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09396-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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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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18
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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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19
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Baertschi M, Favez N, Flores Alves Dos Santos J, Radomska M, Herrmann F, Burkhard P, Canuto A, Weber K. The Impact of Deep Brain Stimulation for Parkinson's Disease on Couple Satisfaction: An 18-Month Longitudinal Study. J Clin Psychol Med Settings 2019; 26:461-469. [PMID: 30706305 DOI: 10.1007/s10880-019-09601-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patients with Parkinson's disease (PD) may benefit from deep brain stimulation (DBS) to improve motor and medication-induced symptoms. Yet mixed evidence regarding the outcome of successful DBS on couple satisfaction has been highlighted in the literature. Thirty patients diagnosed with PD were included in a study investigating couple satisfaction (MSS-14), depression (HAD-D) and anxiety (HAD-A) at four measurement times: before DBS and 6, 12, and 18 months post-surgically. Sixteen spouses/partners were included as well. Couple satisfaction from the patient perspective was never associated with depression or anxiety. However, poor marital adjustment (i.e., difference and absolute difference between patients and spouses/partners MSS-14 scores) predicted patients' pre-operative depressive mood. Longitudinal analyses showed that couple satisfaction (n = 9) worsened at 12 months and 18 months compared to pre-DBS scores, F(2.047, 16.378) = 8.723, p = .003, and despite concomitant motor improvement. Growth curve analyses showed that couple satisfaction worsening occurred between 6 and 12 months post-operatively (b = 2.938, p < .001). Thus, couple satisfaction did not increase along with motor improvement and deteriorated after the adjustment period following DBS.
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Affiliation(s)
- Marc Baertschi
- Faculty of Psychology, University of Geneva, Boulevard du Pont-d'Arve 40, 1205, Geneva, Switzerland. .,Service of General Psychiatry and Psychotherapy, Nant Foundation, Avenue des Alpes 66, 1820, Montreux, Switzerland.
| | - Nicolas Favez
- Faculty of Psychology, University of Geneva, Boulevard du Pont-d'Arve 40, 1205, Geneva, Switzerland
| | - João Flores Alves Dos Santos
- Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.,Liaison Psychiatry and Emergency Psychiatric Center, Neuchatel Psychiatric Center, Maladière 45, 2000, Neuchâtel, Switzerland
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva, Boulevard du Pont-d'Arve 40, 1205, Geneva, Switzerland
| | - François Herrmann
- Division of Geriatrics, Geneva University Hospitals, Chemin du Pont-Bochet 3, 1226, Thônex, Switzerland
| | - Pierre Burkhard
- Service of Neurology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Alessandra Canuto
- Executive and General Management Service, Hôpital de Nant, Nant Foundation, 1804, Corsier-sur-Vevey, Switzerland
| | - Kerstin Weber
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Les Voirons - Chemin du Petit-Bel-Air 2, 1225, Chêne-Bourg, Switzerland
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20
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21
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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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22
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Liddle J, Phillips J, Gustafsson L, Silburn P. Understanding the lived experiences of Parkinson's disease and deep brain stimulation (DBS) through occupational changes. Aust Occup Ther J 2017; 65:45-53. [PMID: 29165825 DOI: 10.1111/1440-1630.12437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS), a surgically based treatment for people living with Parkinson's disease (PD), can result in a significant improvement of motor symptoms. However, the broader impact of DBS and the changes it creates are not well understood. Greater understanding of the experiences and needs related to DBS would enable development of relevant outcome measures and supports. OBJECTIVES To explore the lived experiences of people undergoing DBS for Parkinson's disease. METHODS A descriptive phenomenological study was undertaken exploring experiences, perspectives and outcomes with key stakeholders. Semi-structured, audiotaped interviews were undertaken with people with PD who have had DBS, their family members and health professionals across four states and territories in Australia. RESULTS Perspectives and experiences of 14 people with PD undergoing DBS, 10 family members and 11 health professionals were analysed. Occupations emerged as a key aspect throughout the DBS experience. Two major themes captured the role of occupation in relation to DBS: Occupations as a barometer, where occupational experiences and performances shaped people's understanding of their condition, the impact of treatments and their overall adjustment; and Shifting occupational identity where the life transition of DBS altered the occupational experiences of relationships, volition, roles and responsibilities of people with PD and their family members. CONCLUSION Occupational experiences and changes served as an important way for people with PD and their families to understand and communicate their experiences of PD and related treatments. There is an identified need for outcome measures and clinical education and interventions to reflect this.
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Affiliation(s)
- Jacki Liddle
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland
| | - Jessie Phillips
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Silburn
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland
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23
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Kudlicka A, Hindle JV, Spencer LE, Clare L. Everyday functioning of people with Parkinson’s disease and impairments in executive function: a qualitative investigation. Disabil Rehabil 2017; 40:2351-2363. [DOI: 10.1080/09638288.2017.1334240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Aleksandra Kudlicka
- School of Psychology, University of Exeter, Exeter, UK
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | - John V. Hindle
- School of Psychology, Bangor University, Bangor, United Kingdom
- Department of Care of the Elderly, Llandudno Hospital, Betsi Cadwaladr University Health Board, Llandudno, United Kingdom
| | | | - Linda Clare
- School of Psychology, University of Exeter, Exeter, UK
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
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24
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Navarta-Sánchez MV, Caparrós N, Riverol Fernández M, Díaz De Cerio Ayesa S, Ursúa Sesma ME, Portillo MC. Core elements to understand and improve coping with Parkinson's disease in patients and family carers: A focus group study. J Adv Nurs 2017; 73:2609-2621. [PMID: 28494098 DOI: 10.1111/jan.13335] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study were: (1) To explore the meaning that coping with Parkinson's disease has for patients and family carers; (2) To suggest the components of an intervention focused on enhancing their coping with the disease. BACKGROUND Adapting to Parkinson's disease involves going through many difficult changes; however, it may improve quality of life in patients and family carers. One of the key aspects for facilitating the psychosocial adjustment to Parkinson's disease is the strengthening of coping skills. DESIGN A sequential explanatory mixed methods study was carried out. Findings from the qualitative phase are presented. METHODS Data were collected in May 2014 through three focus groups: one of people with Parkinson's disease (n = 9), one of family carers (n = 7) and one of healthcare professionals (n = 5). All focus groups were digitally recorded and transcribed verbatim and content analysis was independently carried out by two researchers. FINDINGS The participants coincided in highlighting that coping with Parkinson's disease helped the patient and the family carer in their search for balance; and it implied a transformation in their lives. To aid the process of coping with Parkinson's disease, a multifaceted intervention is proposed. CONCLUSION Coping with Parkinson's disease is a complex process for both patients and family carers and it should therefore be considered a standard service in healthcare policies aimed at this group. The proposed intervention constitutes a nursing tool which has great potential to improve the quality of life in Parkinson's disease and in other long-term conditions.
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Affiliation(s)
| | - Neus Caparrós
- Faculty of Law and Social Sciences, University of La Rioja, Logroño, La Rioja, Spain
| | | | | | - M Eugenia Ursúa Sesma
- San Juan Primary Health Centre, Navarre Service of Health-Osasunbidea, Pamplona, Navarre, Spain
| | - Mari Carmen Portillo
- NIHR CLAHRC WESSEX, Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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25
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Shahmoon S, Jahanshahi M. Optimizing psychosocial adjustment after deep brain stimulation of the subthalamic nucleus in Parkinson's disease. Mov Disord 2017; 32:1155-1158. [PMID: 28504352 DOI: 10.1002/mds.27032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Suzette Shahmoon
- Cognitive Motor Neuroscience Group & Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
| | - Marjan Jahanshahi
- Cognitive Motor Neuroscience Group & Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
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26
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de Haan S, Rietveld E, Stokhof M, Denys D. Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations. PLoS One 2017; 12:e0175748. [PMID: 28426824 PMCID: PMC5398533 DOI: 10.1371/journal.pone.0175748] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/30/2017] [Indexed: 11/19/2022] Open
Abstract
Does DBS change a patient's personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson's disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality.
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Affiliation(s)
- Sanneke de Haan
- The Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Erik Rietveld
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
- Institute for Logic, Language and Computation, Department of Philosophy, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin Stokhof
- Institute for Logic, Language and Computation, Department of Philosophy, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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Abstract
The aim of this study is to discuss the meaning of walking impairment among people who have previously been able to walk on their own. The study is based on findings from three different life situations: older people recovering after admission in intermediate care, people who have lost a leg, and people who live with Parkinson's disease. The analysis of the data is inspired by Paul Ricoeur's philosophy of interpretation. Four themes were identified: (a) I feel high in two ways; (b) Walking has to be automatic; (c) Every Monday, I walk with the girls in the park; and (d) I dream of walking along the street without sticks and things like that. The findings demonstrate that inability to walk profoundly affected the participants' lives. Other problems seemed small by comparison because walking impairment was at the same time experienced as a concrete physical limit and an existential deficit.
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Affiliation(s)
| | | | | | - Annelise Norlyk
- 1 Aarhus University, Denmark.,2 VIA University College, Aarhus, Denmark
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28
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Abstract
Most people with Parkinson’s disease (PD) reside in their homes with their family members. Nurses are in a good position to partner with people with PD and their family members for better self-management of the disease and improved quality of life. The purpose of this systematic review was to assess the state of the science of nursing research related to PD during the 10-year period, 2006 to 2015. A total of 27 studies were included in this review. Family caregiving was the most studied topic, followed by symptom management/medication adherence, quality of life, end-of-life/palliative care, and functional status/improving function. Recommendations for future studies in PD include (a) developing and testing interventions based on theoretical models in the areas of self-management, symptom management, and function improvement in people with PD and for caregivers caring for people with advanced stage PD, and (b) building programs of research with interprofessional teams.
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29
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Mathers J, Rick C, Jenkinson C, Garside R, Pall H, Mitchell R, Bayliss S, Jones LL. Patients' experiences of deep brain stimulation for Parkinson's disease: a qualitative systematic review and synthesis. BMJ Open 2016; 6:e011525. [PMID: 27338883 PMCID: PMC4932278 DOI: 10.1136/bmjopen-2016-011525] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To review and synthesise qualitative research studies that have explored patients' experience of deep brain stimulation (DBS) in advanced Parkinson's disease (PD). DESIGN Systematic review and meta-synthesis of 7 original papers, using metaethnography. SETTING Studies conducted in Denmark, France and Sweden. PARTICIPANTS 116 patients who had undergone DBS and 9 spouses of patients. RESULTS Prior to surgery, the experience of advancing PD is one of considerable loss and a feeling of loss of control. There are significant hopes for what DBS can bring. Following surgery, a sense of euphoria is described by many, although this does not persist and there is a need for significant transitions following this. We suggest that normality as a concept is core to the experience of DBS and that a sense of control may be a key condition for normality. Experience of DBS for patients and spouses, and of the transitions that they must undertake, is influenced by their hopes of what surgery will enable them to achieve, or regain (ie, a new normality). CONCLUSIONS There is a need for further qualitative research to understand the nature of these transitions to inform how best patients and their spouses can be supported by healthcare professionals before, during and after DBS. In assessing the outcomes of DBS and other treatments in advanced PD, we should consider how to capture holistic concepts such as normality and control. Studies that examine the outcomes of DBS require longer term follow-up.
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Affiliation(s)
- J Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - C Rick
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - C Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Garside
- European Centre for Environment and Human Health, University of Exeter, Exeter, UK
| | - H Pall
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - R Mitchell
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - L L Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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30
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Gibson G. 'Signposts on the journey'; medication adherence and the lived body in men with Parkinson's disease. Soc Sci Med 2016; 152:27-34. [PMID: 26826806 DOI: 10.1016/j.socscimed.2016.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
Adherence to medication has been identified as a key issue in the treatment of many chronic illnesses, however such a perspective fails to account for the lived experience of medication usage and its effects on the body as lived. Parkinson's Disease, a neurological disease predominantly affecting movement and mobility, and which is treated via a wide range of medications provides a useful opportunity to explore experiences of medication usage in chronic illness. Reporting on findings of a study exploring men's experience of living with Parkinson's Disease, this paper adopts a lived body perspective to explore lived experiences of medication usage and adherence in PD. Findings are reported from 30 narrative in depth interviews with 15 men of various ages living with Parkinson's disease of mild to severe intensity. Findings first discuss PD's effects on men's sense of the lived body, in which a fluctuating embodiment is linked to medication regimes and their bodily effects. Second, as PD disrupts the body's place with the everyday and habitual experience of lived time, medication regimens come to place new structures upon the men's everyday experience of time. Finally, the paper explores the role medications play in men's attempts to create and sustain narratives for the individual progression of their illness, and how these narratives differ from clinical narratives associated with PD's treatment. This paper concludes by discussing debates around adherence to medication within the treatment of PD and the need to consider lived experience of medication usage and their effects at the level of the lived body.
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Affiliation(s)
- Grant Gibson
- School of Applied Social Science Colin Bell Building, University of Stirling, Stirling, FK9 4LA, United Kingdom.
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31
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Winge K. Lower urinary tract dysfunction in patients with parkinsonism and other neurodegenerative disorders. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:335-56. [DOI: 10.1016/b978-0-444-63247-0.00019-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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32
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Hariz GM, Hamberg K. Perceptions of living with a device-based treatment: an account of patients treated with deep brain stimulation for Parkinson's disease. Neuromodulation 2013; 17:272-7; discussion 277-8. [PMID: 24033886 DOI: 10.1111/ner.12073] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/30/2013] [Accepted: 04/02/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS) is an established treatment for Parkinson's disease. Little is known about patients' own perceptions of living with the implanted hardware. We aimed to explore patients' own perceptions of living with an implanted device. MATERIALS AND METHODS Semistructured interviews with open-ended questions were conducted with 42 patients (11 women) who had been on DBS for a mean of three years. The questions focused on patients' experiences of living with and managing the DBS device. The interviews were transcribed verbatim and analyzed according to the difference and similarity technique in grounded theory. RESULTS From the patients' narratives concerning living with and managing the DBS device, the following four categories emerged: 1) The device-not a big issue: although the hardware was felt inside the body and also visible from outside, the device as such was not a big issue. 2) Necessary carefulness: Patients expressed the need to be careful when performing certain daily activities in order not to dislocate or harm the device. 3) Continuous need for professional support: Most patients relied solely on professionals for fine-tuning the stimulation rather than using their handheld controller, even if this entailed numerous visits to a remote hospital. 4) Balancing symptom relief and side-effects: Patients expressed difficulties in finding the optimal match between decrease of symptoms and stimulation-induced side-effects. CONCLUSIONS The in-depth interviews of patients on chronic DBS about their perceptions of living with an implanted device provided useful insights that would be difficult to capture by quantitative evaluations.
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Affiliation(s)
- Gun-Marie Hariz
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden; Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
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33
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Haahr A, Norlyk A, Hall EO. Ethical challenges embedded in qualitative research interviews with close relatives. Nurs Ethics 2013; 21:6-15. [PMID: 23774032 DOI: 10.1177/0969733013486370] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforeseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence, respect for human rights and respect for autonomy through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative research interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological interview studies. We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers' premises to react to unexpected situations and act in a sound ethical manner must be enhanced, and there is a need for an increased focus on the researchers' ethical preparation and to continually address and discuss cases from their own interviews.
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Affiliation(s)
- Anita Haahr
- VIA University College, Bachelor Programme in Nursing, Denmark
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34
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Bell E, Racine E. Ethics guidance for neurological and psychiatric deep brain stimulation. HANDBOOK OF CLINICAL NEUROLOGY 2013; 116:313-25. [DOI: 10.1016/b978-0-444-53497-2.00026-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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35
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Haahr A, Kirkevold M, Hall EO, Østergaard K. ‘Being in it together’: living with a partner receiving deep brain stimulation for advanced Parkinson’s disease - a hermeneutic phenomenological study. J Adv Nurs 2012; 69:338-47. [DOI: 10.1111/j.1365-2648.2012.06012.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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