title: Reluctance to start medication for Parkinson's disease: a mutual misunderstanding by patients and physicians.
abstract: Reluctance to start medication has never been investigated before in PD. We studied reluctance to start medication for PD motor symptoms, namely its prevalence, underlying reasons, drug-specificity, and associated delay in the start of PD medication. A cross-sectional observational international study was conducted. Patients with a clinical diagnosis of PD advised to start antiparkinsonian medication in the previous 5 years were invited to complete a questionnaire in three centers located in North America and Europe. An electronic online survey was sent to physicians through the mailing list of the Movement Disorder Society. 469 participants (201 PD patients, 268 physicians). 40.2% (n = 82) of the patients reported reluctance to start medication, but 88.6% (n = 234/264) of the physicians estimated that ≤20% of their patients with PD had been reluctant to start medication. The most common reasons reported by patients were the fear of side effects (n = 35, 55.6%), followed by non-acceptance of diagnosis (n = 23, 36.5%); fear of a temporally limited benefit was more commonly selected by physicians (n = 92/267, 34.5%). Patients indicated reluctance to start DAs more frequently compared with L-DOPA (OR: 2.22, 95% CI: 1.30, 9.03; p = 0.013) while physicians perceived L-DOPA to be associated with more reluctance (OR: 4.7, 95% CI: 3.41; 6.59; p < 0.0001). Patients with PD and physicians have a different perspective on the issue of reluctance to start medication. There is a need to bring physicians and patients with PD closer to a shared vision of the problem reluctance to start medication.
authors.affiliation: Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada. Electronic address: tmestre@toh.on.ca.
authors.forename: Tiago A
authors.initials: TA
authors.lastname: Mestre
authors.affiliation: Clinical Pharmacology Unit, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisboa, Portugal.
authors.forename: Tiago
authors.initials: T
authors.lastname: Teodoro
authors.affiliation: Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Reginold
authors.affiliation: Institute of Neurogenetics, University of Luebeck, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Graf
authors.affiliation: Institute of Neurogenetics, University of Luebeck, Germany; Department of Psychiatry and Psychotherapy, University of Luebeck, Germany.
authors.forename: Maike
authors.initials: M
authors.lastname: Kasten
authors.affiliation: Mobility Program Clinical Research Unit, Toronto, Canada.
authors.forename: Joanna
authors.initials: J
authors.lastname: Sale
authors.affiliation: Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada; Department of Psychiatry, Toronto Western Hospital, Toronto, Canada.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Zurowski
authors.affiliation: Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada.
authors.forename: Janis
authors.initials: J
authors.lastname: Miyasaki
authors.affiliation: Clinical Pharmacology Unit, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisboa, Portugal.
authors.forename: Joaquim J
authors.initials: JJ
authors.lastname: Ferreira
authors.affiliation: Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada.
authors.forename: Connie
authors.initials: C
authors.lastname: Marras
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D000978:Antiparkinson Agents
keywords: Parkinson's disease; Reluctance; Treatment initiation