Objective: This study aims to compare the decision made by patients and physicians in selecting device-aided therapy (DAT) for advanced Parkinson’s disease (aPD) and to determine if discordance in patient choices affects treatment outcomes.

Background: Deep Brain Stimulation (DBS), Continuous Subcutaneous Apomorphine Infusion (CSAI) and Levodopa/Carbidopa Intestinal Gel (LCIG) are three available DAT in Thailand for managing aPD. Various factors related to the healthcare system, clinician, patient, and prognosis influence the selection of DAT. Despite numerous studies and guidelines, their applicability to individual patient cases may be questioned. Patient preference is crucial for treatment adherence, given the need for full patient cooperation in initiating and managing DAT.

Method: This retrospective cohort study examined aPD patients who underwent DAT from 2006 to January 2024. Data on demographics, patient and physician decisions, and outcome measures were collected. Subjects were categorized based on concordance and discordance between patient and physician decisions. Differences between patient and physician decisions were analyzed. Subsequently, DAT choices and outcomes were compared between the groups.

Results: Of the 122 patients who underwent DAT, 94 (77.0%) were in the concordant group, and 28 (23.0%) were in the discordant group [Table 1; Figure 1B]. Baseline characteristics were statistically similar between groups [Table 1]. Overall, both patients (65.6%) and physicians (64.8%) preferred DBS which was reflected in the final implemented modality (62.3%) [Table 2; Figure 1A], consistent with the concordant group [Figure 2A]. However, the discordant group showed increased use of CSAI (75.0%) due to concerns about age, side effects, neuropsychiatric, and balance symptoms [Figure 2B]. Inter-rater reliability analysis revealed moderate agreement between patient and physician decision but the highest is with DBS (κ=0.693) and least with LCIG (κ=0.228) [Table 2]. Comparison of outcomes showed that the discordant group has a significantly higher dropout rate (p=0.002) and greater motor impairment represented by Hoehn & Yahr Score (p=0.004) [Table 3].

Conclusion: There is discordance between patient and physician choices for DAT, but DBS remained the most preferred and implemented options. Such discordance in patient choice correlates with increased drop-out rates and motor impairment.

Table 1

Table 2

Figure 1

Figure 2

Table 3

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