title: How to improve patient education on deep brain stimulation in Parkinson's disease: the CARE Monitor study.
abstract: BACKGROUND
  The introduction of deep brain stimulation (DBS) about 25 years ago provided one of the major breakthroughs in the treatment of Parkinson's disease (PD). However, a high percentage of patients are reluctant to undergo DBS. Previous research revealed that the critical step on the patient's path to DBS is the decision whether to undergo further diagnostic assessment for surgery at a specialized DBS-center. The aims of the current study were to evaluate how effective the combination of an outpatient DBS screening tool, STIMULUS, with specially developed educational material was to enhance patient education on DBS and to identify motivational aspects which influenced the patients' willingness to undergo further assessment.
  
  
  METHODS
  In total, 264 patients were identified as appropriate candidates for DBS by general neurologists using the electronic preselection tool STIMULUS. Patient-centered information material was designed and handed out to support education on DBS. Further, several clinical characteristics and details of the patient counseling were documented. Refusal or consent to show up at a DBS center was registered over the following 16 months.
  
  
  RESULTS
  114 (43.2%) patients preselected as eligible for DBS (STIMULUS Score ≥ 6) agreed to show up at a specialized DBS center to undergo further diagnostic assessment. The patients' ages, PD classification as an akinetic-rigid type and the talks' topics side-effects of dopaminergic medication and the optimal time frame had a significant influence on the patients' decisions.
  
  
  CONCLUSIONS
  The combination of preselection tools as STIMULUS with comprehensive information material is effective to increase DBS-acceptance rate in PD patients. Important topics of the information about DBS cover the optimal time frame for DBS surgery, the side-effects of dopaminergic medication as well as side-effects and complications of DBS surgery.
authors.affiliation: Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Dinkelbach
authors.affiliation: Department of Neurology, University of Kiel, Kiel, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Möller
authors.affiliation: Department of Neurology, University of Kiel, Kiel, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Witt
authors.affiliation: Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Alfons
authors.initials: A
authors.lastname: Schnitzler
authors.affiliation: Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Düsseldorf, Germany. msuedmeyer@klinikumevb.de.|Department of Neurology, Ernst von Bergmann Klinikum, Charlottenstrasse 72, Potsdam, D-14467, Germany. msuedmeyer@klinikumevb.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Südmeyer
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010300:Parkinson Disease / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods*; D018579:Patient Selection
keywords: Deep brain stimulation; Parkinson’s disease; Patient education; Referral; Treatment acceptance