1
|
Hahn A, Lazar AA, Cernera S, Little S, Wang SS, Starr PA, Racine CA. Neuropsychological and social predictors of participation in a deep brain stimulation study of Parkinson's disease and dystonia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.29.24308133. [PMID: 38854092 PMCID: PMC11160823 DOI: 10.1101/2024.05.29.24308133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Objectives Participation is essential to DBS research, yet circumstances that affect diverse participation remain unclear. Here we evaluate factors impacting participation in an adaptive DBS study of Parkinson's disease (PD) and dystonia. Methods Twenty participants were implanted with a sensing-enabled DBS device (Medtronic Summit RC+S) that allows neural data streaming in naturalistic settings and encouraged to stream as much as possible for the first five months after surgery. Using standardized baseline data obtained through neuropsychological evaluation, we compared neuropsychological and social variables to streaming hours. Results Marital status and irritability significantly impacted streaming hours (estimate=136.7, bootstrapped ( b ) CI b =45.0 to 249.0, p b =0.016, and estimate=-95.1, CI b =-159.9 to -49.2, p b =0.027, respectively). These variables remained significant after multivariable analysis. Composite scores on verbal memory evaluations predicted the number of hours of data streamed (R 2 =0.284, estimate=67.7, CI b =20.1 to 119.9, p b =0.019). Discussion Verbal memory impairment, irritability, and lack of a caregiver may be associated with decreased participation. Further study of factors that impact research participation is critical to the sustained inclusion of diverse participants.
Collapse
Affiliation(s)
- Amelia Hahn
- University of California, San Francisco, Department of Neurological Surgery
| | - Ann A. Lazar
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Stephanie Cernera
- University of California, San Francisco, Department of Neurological Surgery
| | - Simon Little
- University of California, San Francisco, Department of Neurology
| | - Sarah S. Wang
- University of California, San Francisco, Department of Neurology
| | - Philip A. Starr
- University of California, San Francisco, Department of Neurological Surgery
| | - Caroline A. Racine
- University of California, San Francisco, Department of Neurological Surgery
| |
Collapse
|
2
|
Hurley ME, Sonig A, Herrington J, Storch EA, Lázaro-Muñoz G, Blumenthal-Barby J, Kostick-Quenet K. Ethical considerations for integrating multimodal computer perception and neurotechnology. Front Hum Neurosci 2024; 18:1332451. [PMID: 38435745 PMCID: PMC10904467 DOI: 10.3389/fnhum.2024.1332451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Background Artificial intelligence (AI)-based computer perception technologies (e.g., digital phenotyping and affective computing) promise to transform clinical approaches to personalized care in psychiatry and beyond by offering more objective measures of emotional states and behavior, enabling precision treatment, diagnosis, and symptom monitoring. At the same time, passive and continuous nature by which they often collect data from patients in non-clinical settings raises ethical issues related to privacy and self-determination. Little is known about how such concerns may be exacerbated by the integration of neural data, as parallel advances in computer perception, AI, and neurotechnology enable new insights into subjective states. Here, we present findings from a multi-site NCATS-funded study of ethical considerations for translating computer perception into clinical care and contextualize them within the neuroethics and neurorights literatures. Methods We conducted qualitative interviews with patients (n = 20), caregivers (n = 20), clinicians (n = 12), developers (n = 12), and clinician developers (n = 2) regarding their perspective toward using PC in clinical care. Transcripts were analyzed in MAXQDA using Thematic Content Analysis. Results Stakeholder groups voiced concerns related to (1) perceived invasiveness of passive and continuous data collection in private settings; (2) data protection and security and the potential for negative downstream/future impacts on patients of unintended disclosure; and (3) ethical issues related to patients' limited versus hyper awareness of passive and continuous data collection and monitoring. Clinicians and developers highlighted that these concerns may be exacerbated by the integration of neural data with other computer perception data. Discussion Our findings suggest that the integration of neurotechnologies with existing computer perception technologies raises novel concerns around dignity-related and other harms (e.g., stigma, discrimination) that stem from data security threats and the growing potential for reidentification of sensitive data. Further, our findings suggest that patients' awareness and preoccupation with feeling monitored via computer sensors ranges from hypo- to hyper-awareness, with either extreme accompanied by ethical concerns (consent vs. anxiety and preoccupation). These results highlight the need for systematic research into how best to implement these technologies into clinical care in ways that reduce disruption, maximize patient benefits, and mitigate long-term risks associated with the passive collection of sensitive emotional, behavioral and neural data.
Collapse
Affiliation(s)
- Meghan E. Hurley
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Anika Sonig
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - John Herrington
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry and Behavioral Sciences, Massachusetts General Hospital, Boston, MA, United States
| | | | - Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| |
Collapse
|
3
|
Balzekas I, Richardson JP, Lorence I, Lundstrom BN, Worrell GA, Sharp RR. Qualitative Analysis of Decision to Pursue Electrical Brain Stimulation by Patients With Drug-Resistant Epilepsy and Their Caregivers. Neurol Clin Pract 2024; 14:e200245. [PMID: 38585236 PMCID: PMC10996908 DOI: 10.1212/cpj.0000000000200245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/01/2023] [Indexed: 04/09/2024]
Abstract
Background and Objectives To understand why patients with drug-resistant epilepsy (DRE) pursue invasive electrical brain stimulation (EBS). Methods We interviewed patients with DRE (n = 20) and their caregivers about their experiences in pursuing EBS approximately 1 year post device implant. Inductive analysis was applied to identify key motivating factors. Results The cohort included participants aged from teens to 50s with deep brain stimulation, vagus nerve stimulation, responsive neurostimulation, and chronic subthreshold cortical stimulation. Patients' motivations included (1) improved quality of life (2) intolerability of antiseizure medications, (3) desperation, and (4) patient-family dynamics. Both patients and caregivers described a desire to alleviate burdens of the other. Patient apprehensions about EBS focused on invasiveness and the presence of electrodes in the brain. Previous experiences with invasive monitoring and the ability to see hardware in person during clinical visits influenced patients' comfort in proceeding with EBS. Despite realistic expectations for modest and delayed benefits, patients held out hope for an exceptionally positive outcome. Discussion Our findings describe the motivations and decision-making process for patients with DRE who pursue invasive EBS. Patients balance feelings of desperation, personal goals, frustration with medication side effects, fears about surgery, and potential pressure from concerned caregivers. These factors together with the sense that patients have exhausted therapeutic alternatives may explain the limited decisional ambivalence observed in this cohort. These themes highlight opportunities for epilepsy care teams to support patient decision-making processes.
Collapse
Affiliation(s)
- Irena Balzekas
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Jordan P Richardson
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Isabella Lorence
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Brian Nils Lundstrom
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Gregory A Worrell
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Richard R Sharp
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| |
Collapse
|
4
|
Smith AP, Taiclet L, Ebadi H, Levy L, Weber M, Caruso EM, Pouratian N, Feinsinger A. "They were already inside my head to begin with": Trust, Translational Misconception, and Intraoperative Brain Research. AJOB Empir Bioeth 2023; 14:111-124. [PMID: 36137012 PMCID: PMC10030379 DOI: 10.1080/23294515.2022.2123869] [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] [Indexed: 10/14/2022]
Abstract
Background: Patients undergoing invasive neurosurgical procedures offer researchers unique opportunities to study the brain. Deep brain stimulation patients, for example, may participate in research during the surgical implantation of the stimulator device. Although this research raises many ethical concerns, little attention has been paid to basic studies, which offer no therapeutic benefits, and the value of patient-participant perspectives.Methods: Semi-structured interviews were conducted with fourteen individuals across two studies who participated in basic intraoperative research during their deep brain stimulator surgery. Interviews explored interpretations of risks and benefits, enrollment motivations, and experiences of participating in awake brain research. Reflexive thematic analysis was conducted.Results: Seven themes were identified from participant narratives, including robust attitudes of trust, high valuations of basic science research, impacts of the surgical context, and mixed experiences of participation.Conclusion: We argue that these narratives raise the potential for a translational misconception and motivate intraoperative re-consent procedures.
Collapse
Affiliation(s)
- Ally Peabody Smith
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Lauren Taiclet
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Hamasa Ebadi
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, United States
| | - Liliana Levy
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Megan Weber
- Anderson School of Management, University of California, Los Angeles, United States
| | - Eugene M. Caruso
- Anderson School of Management, University of California, Los Angeles, United States
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, United States
| | - Ashley Feinsinger
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| |
Collapse
|
5
|
Lázaro-Muñoz G, Pham MT, Muñoz KA, Kostick-Quenet K, Sanchez CE, Torgerson L, Robinson J, Pereira S, Outram S, Koenig BA, Starr PA, Gunduz A, Foote KD, Okun MS, Goodman W, McGuire AL, Zuk P. Post-trial access in implanted neural device research: Device maintenance, abandonment, and cost. Brain Stimul 2022; 15:1029-1036. [PMID: 35926784 PMCID: PMC9588741 DOI: 10.1016/j.brs.2022.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/16/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Clinical trial participants who benefit from experimental neural devices for the treatment of debilitating and otherwise treatment-resistant conditions are generally not ensured continued access to effective therapy or maintenance of devices at the conclusion of trials. OBJECTIVE/HYPOTHESIS Post-trial obligations have been extensively examined in the context of drug trials, but there has been little empirical examination of stakeholder perspectives regarding these obligations in the rapidly growing field of neural device research. METHODS This study examined the perspectives of 44 stakeholders (i.e., 23 researchers and 21 patient-participants) involved in implantable neural device trials. RESULTS Researchers were concerned about current post-trial management, identified barriers like cost, and suggested ways to improve the system. Many patient-participants were unaware of whether they would have post-trial access, but most thought they should keep devices if beneficial, and agreed with researchers that more should be done to help them keep and maintain these neural devices. CONCLUSION To our knowledge, this is the first in-depth examination of researcher perspectives regarding continued access to experimental neural devices and only the second such examination of patient-participant perspectives. These data can help inform future ethical and policy decisions about post-trial access to implantable neurotechnology.
Collapse
Affiliation(s)
- Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, United States; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States.
| | - Michelle T Pham
- Center for Bioethcis and Social Justice, College of Human Medicine, Michigan State University, East Fee Hall 965 Wilson Road Rm A-126, East Lansing, MI, 48824, United States
| | - Katrina A Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Clarissa E Sanchez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Jill Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Simon Outram
- Program in Bioethics, University of California, 490 Illinois Street, San Francisco, CA, 94143, United States
| | - Barbara A Koenig
- Program in Bioethics, University of California, 490 Illinois Street, San Francisco, CA, 94143, United States
| | - Philip A Starr
- Department of Neurological Surgery, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, United States
| | - Aysegul Gunduz
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, United States; Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Biomedical Science Building, JG56, Gainesville, FL, 32611, United States
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, United States
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, United States
| | - Wayne Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd Suite E4.100, Houston, TX, 77030, United States
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Peter Zuk
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, United States
| |
Collapse
|