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Henegan P, Koczara J, Bluhm R, Cabrera LY. Public Perceptions of Treating Opioid Use Disorder With Deep Brain Stimulation: Comment Analysis Study. Online J Public Health Inform 2024; 16:e49924. [PMID: 39151160 DOI: 10.2196/49924] [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: 06/13/2023] [Revised: 03/19/2024] [Accepted: 07/10/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND The number of opioid-related deaths in the United States has more than tripled over the past 7 years, with a steep increase beginning at the same time as the COVID-19 pandemic. There is an urgent need for novel treatment options that can help alleviate the individual and social effects of refractory opioid use disorder (OUD). Deep brain stimulation (DBS), an intervention that involves implanting electrodes in the brain to deliver electrical impulses, is one potential treatment. Currently in clinical trials for many psychiatric conditions, including OUD, DBS's use for psychiatric indications is not without controversy. Several studies have examined ethical issues raised by using DBS to counter treatment-resistant depression, obsessive-compulsive disorder, and eating disorders. In contrast, there has been limited literature regarding the use of DBS for OUD. OBJECTIVE This study aims to gain empirical neuroethical insights into public perceptions regarding the use of DBS for OUD, specifically via the analysis of web-based comments on news media stories about the topic. METHODS Qualitative thematic content analysis was performed on 2 Washington Post newspaper stories that described a case of DBS being used to treat OUD. A total of 292 comments were included in the analysis, 146 comments from each story, to identify predominant themes raised by commenters. RESULTS Predominant themes raised by commenters across the 2 samples included the hopes and expectations with treatment outcomes, whether addiction is a mental health disorder, and issues related to resource allocation. Controversial comments regarding DBS as a treatment method for OUD seemingly decreased when comparing the first printed newspaper story to the second. In comparison, the number of comments relating to therapeutic need increased over time. CONCLUSIONS The general public's perspectives on DBS as a treatment method for OUD elucidated themes via this qualitative thematic content analysis that include overarching sociopolitical issues, positions on the use of technology, and technological and scientific issues. A better understanding of the public perceptions around the use of DBS for OUD can help address misinformation and misperceptions about the use of DBS for OUD, and identify similarities and differences regarding ethical concerns when DBS is used specifically for OUD compared to other psychiatric disorders.
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Affiliation(s)
- Patricia Henegan
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA, United States
| | - Jack Koczara
- College of Natural Sciences, Michigan State University, East Lansing, MI, United States
| | - Robyn Bluhm
- Department of Philosophy, Michigan State University, East Lansing, MI, United States
- Lyman Briggs College, Michigan State University, East Lansing, MI, United States
| | - Laura Y Cabrera
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA, United States
- Rock Ethics Institute, Pennsylvania State University, University Park, PA, United States
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2
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Starke G, Akmazoglu TB, Colucci A, Vermehren M, van Beinum A, Buthut M, Soekadar SR, Bublitz C, Chandler JA, Ienca M. Qualitative studies involving users of clinical neurotechnology: a scoping review. BMC Med Ethics 2024; 25:89. [PMID: 39138452 PMCID: PMC11323440 DOI: 10.1186/s12910-024-01087-z] [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: 01/23/2023] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The rise of a new generation of intelligent neuroprostheses, brain-computer interfaces (BCI) and adaptive closed-loop brain stimulation devices hastens the clinical deployment of neurotechnologies to treat neurological and neuropsychiatric disorders. However, it remains unclear how these nascent technologies may impact the subjective experience of their users. To inform this debate, it is crucial to have a solid understanding how more established current technologies already affect their users. In recent years, researchers have used qualitative research methods to explore the subjective experience of individuals who become users of clinical neurotechnology. Yet, a synthesis of these more recent findings focusing on qualitative methods is still lacking. METHODS To address this gap in the literature, we systematically searched five databases for original research articles that investigated subjective experiences of persons using or receiving neuroprosthetics, BCIs or neuromodulation with qualitative interviews and raised normative questions. RESULTS 36 research articles were included and analysed using qualitative content analysis. Our findings synthesise the current scientific literature and reveal a pronounced focus on usability and other technical aspects of user experience. In parallel, they highlight a relative neglect of considerations regarding agency, self-perception, personal identity and subjective experience. CONCLUSIONS Our synthesis of the existing qualitative literature on clinical neurotechnology highlights the need to expand the current methodological focus as to investigate also non-technical aspects of user experience. Given the critical role considerations of agency, self-perception and personal identity play in assessing the ethical and legal significance of these technologies, our findings reveal a critical gap in the existing literature. This review provides a comprehensive synthesis of the current qualitative research landscape on neurotechnology and the limitations thereof. These findings can inform researchers on how to study the subjective experience of neurotechnology users more holistically and build patient-centred neurotechnology.
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Grants
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- NGBMI (759370) European Research Council (ERC)
- NGBMI (759370) European Research Council (ERC)
- NGBMI (759370) European Research Council (ERC)
- NGBMI (759370) European Research Council (ERC)
- SSMART (01DR21025A), NEO (13GW0483C), QHMI (03ZU1110DD), QSHIFT (01UX2211) and NeuroQ (13N16486) Federal Ministry of Research and Education (BMBF)
- SSMART (01DR21025A), NEO (13GW0483C), QHMI (03ZU1110DD), QSHIFT (01UX2211) and NeuroQ (13N16486) Federal Ministry of Research and Education (BMBF)
- SSMART (01DR21025A), NEO (13GW0483C), QHMI (03ZU1110DD), QSHIFT (01UX2211) and NeuroQ (13N16486) Federal Ministry of Research and Education (BMBF)
- SSMART (01DR21025A), NEO (13GW0483C), QHMI (03ZU1110DD), QSHIFT (01UX2211) and NeuroQ (13N16486) Federal Ministry of Research and Education (BMBF)
- A-2019-558 Einstein Foundation Berlin
- A-2019-558 Einstein Foundation Berlin
- A-2019-558 Einstein Foundation Berlin
- A-2019-558 Einstein Foundation Berlin
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Affiliation(s)
- Georg Starke
- Faculty of Medicine, Institute for History and Ethics of Medicine, Technical University of Munich, Munich, Germany.
- College of Humanities, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | | | - Annalisa Colucci
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mareike Vermehren
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Amanda van Beinum
- Centre for Health Law Policy and Ethics, University of Ottawa, Ottawa, ON, Canada
| | - Maria Buthut
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jennifer A Chandler
- Bertram Loeb Research Chair, Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Marcello Ienca
- Faculty of Medicine, Institute for History and Ethics of Medicine, Technical University of Munich, Munich, Germany
- College of Humanities, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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3
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Raffin Bouchal DS, Ferguson AL, Green T, McAusland L, Kiss Z, Ramasubbu R. Personal recovery associated with deep brain stimulation for treatment-resistant depression: A constructivist grounded theory study. J Psychiatr Ment Health Nurs 2023; 30:1005-1018. [PMID: 37002931 DOI: 10.1111/jpm.12923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 02/07/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Major depressive disorder is the most prevalent of all mental illnesses. 10%-20% of patients with depression and 1% of the population overall have treatment-resistant depression (TRD). DBS is an emerging investigational treatment for TRD with documented clinical efficacy and safety. The framework of the recovery model includes both clinical and personal recovery. Personal recovery is a self-process in which hope, empowerment and optimism are embraced to overcome the impact of mental illness on one's sense of self. Although clinical and functional outcomes of DBS for TRD have been well documented in the previous studies, personal recovery as an outcome has been explored only in a handful of studies. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first qualitative study exploring personal recovery from DBS treatment specific to the target of subcallosal cingulate cortex in patients with TRD. Since the existing literature on personal recovery in DBS studies is limited, the contribution of this paper is crucial to this field. For individuals who responded to deep brain stimulation clinically, neither participants nor family believed it cured their depression, but rather there was a significant decrease in the severity of symptoms of depression. A holistic-oriented framework (that includes personal recovery) is significant for those individuals with TRD undergoing DBS. Personal and clinical recovery are two different constructs, and individuals may experience one or the other or both. The experience of participants who responded to deep brain stimulation recognized that the recovery from depression is a process of reconstructing self. This process involved a period of adjustment that evoked a deeper self-awareness, re-engagement with daily living and newfound gratitude in living. Individuals transitioned from an emotionally driven life to one where future goals were considered. Supportive relationships were instrumental in this process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A deep brain stimulation intervention for treatment-resistant depression offered individuals an opportunity for personal recovery where a reconstruction of self occurred. Personal recovery can be considered as an outcome in conjunction with clinical and functional outcomes in future DBS trials for TRD. The relevance of personal recovery in the prevention of relapses needs further investigation. To advocate for care and services that facilitate the process of recovery from depression, it is important to understand the personal dimensions and experience of recovery that may influence the process. To develop recovery-oriented interventions to help patients and families in recovery post-deep brain stimulation, further understanding of support and negotiating relationships during this life-altering experience is needed. ABSTRACT: Introduction Multiple trials of antidepressant treatments in patients with depression pose a major challenge to the mental health system. Deep brain stimulation (DBS) is an emerging and promising investigational treatment to reduce depressive symptoms in individuals with treatment-resistant depression (TRD). The clinical and functional outcomes of DBS for TRD have been well documented in previous studies; however, studies of personal recovery as an outcome of DBS specific to the target of subcallosal cingulate cortex in patients with TRD are limited. Aim To explore the processes of personal recovery in patients with treatment-resistant depression following subcallosal cingulate-deep brain stimulation. Method Participants were 18 patients with TRD who participated in the subcallosal cingulate (SCC)-DBS trial and 11 family members. They also participated in add-on individual cognitive behavioural therapy during the trial. A qualitative constructivist grounded theory approach was used to conceptualize the personal recovery process of patients and families. Results While every participant and their families' journey were unique following the deep brain stimulation intervention, a theoretical model of Balancing to Establish a Reconstructed Self emerged from the data. The themes underlying the model were (1) Balancing to Establish a Reconstructed Self: A Whole-Body Experience, (2) The Liminal Space in-between: Balancing with Cautious Optimism, (3) Hope: Transitioning from Emotion-Focussed Living to Goal-Oriented Planning and (4) Support: Negotiating Relationships. Discussion This is the first study examining recovery from patients' perspectives as an outcome of SCC-DBS intervention for TRD. The study shows that personal recovery is a gradual and continual process of reconstruction of the self, developing through supportive relationships. Clinical and personal recovery are two distinct constructs, and individuals may experience one or the other or both. Most patients who do respond clinically experience improvement in terms of having optimism and hope. Some patients, however, respond with significant symptom reduction but are not able to achieve personal recovery to experience joy or hope for improved quality of living. Implications for Practice Strategies for personal recovery for both patients and family need to be considered during and post deep brain stimulation intervention. Nurses working with these patients and families may benefit from education, training and support to assess and engage in conversations about their recovery process.
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Affiliation(s)
- Donna S Raffin Bouchal
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, T2N 1N4, Alberta, Canada
| | - Angela L Ferguson
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, T2N 1N4, Alberta, Canada
| | - Theresa Green
- Faculty of Health & Behavioural Sciences, School of Nursing, Midwifery & Social Work, University of Queensland, St Lucia, 4072, Queensland, Australia
| | - Laina McAusland
- Department of Psychiatry and Clinical Neurosciences and Hotchkiss Brain Institute, Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, TRW 4D64, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Alberta, Canada
| | - Zelma Kiss
- Department of Psychiatry and Clinical Neurosciences and Hotchkiss Brain Institute, Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, TRW 4D64, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Alberta, Canada
| | - Rajamannar Ramasubbu
- Department of Psychiatry and Clinical Neurosciences and Hotchkiss Brain Institute, Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, TRW 4D64, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Alberta, Canada
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4
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Boulicault M, Goering S, Klein E, Dougherty D, Widge AS. The Role of Family Members in Psychiatric Deep Brain Stimulation Trials: More Than Psychosocial Support. NEUROETHICS-NETH 2023; 16:14. [PMID: 37250273 PMCID: PMC10212803 DOI: 10.1007/s12152-023-09520-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/08/2023] [Indexed: 05/31/2023]
Abstract
Family members can provide crucial support to individuals participating in clinical trials. In research on the "newest frontier" of Deep Brain Stimulation (DBS)-the use of DBS for psychiatric conditions-family member support is frequently listed as a criterion for trial enrollment. Despite the significance of family members, qualitative ethics research on DBS for psychiatric conditions has focused almost exclusively on the perspectives and experiences of DBS recipients. This qualitative study is one of the first to include both DBS recipients and their family members as interview participants. Using dyadic thematic analysis-an approach that takes both the individuals and the relationship as units of analyses-this study analyzes the complex ways in which family relationships can affect DBS trial participation, and how DBS trial participation in turn influences family relationships. Based on these findings, we propose ways to improve study designs to better take family relationships into account, and better support family members in taking on the complex, essential roles that they play in DBS trials for psychiatric conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s12152-023-09520-7.
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Affiliation(s)
- Marion Boulicault
- Department of Philosophy, University of Edinburgh, Edinburgh, UK
- Center for Neurotechnology, University of Washington, Seattle, WA USA
| | - Sara Goering
- Center for Neurotechnology, University of Washington, Seattle, WA USA
- Department of Philosophy, University of Washington, Seattle, WA USA
| | - Eran Klein
- Center for Neurotechnology, University of Washington, Seattle, WA USA
- Department of Neurology, Oregon Health & Science University School of Medicine, Portland, OR USA
| | - Darin Dougherty
- Neurotherapeutics Division, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Alik S. Widge
- Medical Discovery Team on Addiction, University of Minnesota, Minneapolis, MN USA
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN USA
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5
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Acevedo N, Castle D, Groves C, Bosanac P, Mosley PE, Rossell S. Clinical recommendations for the care of people with treatment-refractory obsessive-compulsive disorder when undergoing deep brain stimulation. Aust N Z J Psychiatry 2022; 56:1219-1225. [PMID: 35603702 DOI: 10.1177/00048674221100947] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Deep brain stimulation is an emerging therapy for treatment-refractory obsessive-compulsive disorder patients. Yet, accessibility is limited, treatment protocols are heterogeneous and there is no guideline or consensus on the best practices. Here, we combine evidence from scientific investigations, expert opinions and our clinical expertise to propose several clinical recommendations from the pre-operative, surgical and post-operative phases of deep brain stimulation care for treatment-refractory obsessive-compulsive disorder patients. A person-centered and biopsychosocial approach is adopted. Briefly, we discuss clinical characteristics associated with response, the use of improved educational materials, an evaluative consent process, comprehensive programming by an expert clinician, a more global assessment of treatment efficacy, multi-disciplinary adjunct psychotherapy and the importance of peer support programs. Furthermore, where gaps are identified, future research suggestions are made, including connectome surgical targeting, scientific evaluation of hardware models and health economic data. In addition, we encourage collaborative groups of data and knowledge sharing by way of a clinical registry and a peer group of programming clinicians. We aim to commence a discussion on the determinants of deep brain stimulation efficacy for treatment-refractory obsessive-compulsive disorder patients, a rare and severe patient group, and contribute to more standardized and evidence-based practices.
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - David Castle
- Department of Psychiatry, The University of Melbourne, VIC, Australia.,Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Clare Groves
- Clinical service, Clarity Health Care, Melbourne, VIC, Australia
| | - Peter Bosanac
- Department of Psychiatry, The University of Melbourne, VIC, Australia.,St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Philip E Mosley
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia.,Biomedical Informatics Group, CSIRO, Herston, QLD, Australia
| | - Susan Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.,St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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