Objective: To characterize the contribution of a social worker (SW) in selecting and managing patients for deep brain stimulation (DBS) surgery.

Background: It is common for pre-DBS surgical evaluations to include meetings with members of a multidisciplinary team to assess surgical candidacy. At our institution, all patients meet with a SW; however, the role of a SW in the DBS evaluation process has not been reported or clearly defined in the literature. Prior work in the fields of transplant and oncologic surgery, which also require prolonged follow-up and post-operative management, has revealed that SWs can assist in identifying barriers, setting expectations, and assessing a person’s understanding of the procedure and commitment to follow-up.

Method: We conducted a retrospective chart review of 100 consecutive patients who were evaluated by our DBS multidisciplinary team. We reviewed notes from the SW and the summary from the DBS multidisciplinary meeting, and we extracted data using a standardized form. We interviewed the SW to identify items to be included in the clinical assessment based on her experience.

Results: Of the 100 charts reviewed, 97 patients met with SW at least once. The indications for multidisciplinary DBS evaluation were Parkinson’s disease (n = 54), essential tremor (n = 29), dystonia (n = 14), Tourette syndrome (n = 2), and obsessive-compulsive disorder (n = 1). Sixteen percent of subjects lived alone, and 38.5% did not have advance directives before the SW meeting. The median distance from the subject’s home to the closest movement disorders specialist was 24.5 miles (range 1 – 88.6 mi). The SW identified follow-up items for two subjects regarding insurance questions and transportation options. Both of these subjects contacted the SW subsequently to follow up. During the interview, the SW highlighted the importance of a suicide risk assessment.

Conclusion: The SW fills many unmet needs in the DBS multidisciplinary team. Items discussed by the SW that were not addressed by other members of the multidisciplinary team included identifying caregivers for the postoperative period, discussing advance care planning, assisting in the execution of a living will, and addressing transportation barriers. The SW also completed a presurgical biopsychosocial assessment and a suicide risk assessment and was available for follow-up with both patients and families.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-role-of-a-social-worker-in-a-deep-brain-stimulation-multidisciplinary-team/