Objective: To explore patients’ perceptions of treatment options for aPD and treatment decision considerations.

Background: As PD advances, some people with Parkinson’s (PwP) on oral therapies develop motor fluctuations and need to consider device-aided therapies (DAT), including continuous subcutaneous infusion (CSI) of apomorphine or future levodopa formulations, levodopa intestinal gel (LIG) formulations, and deep brain stimulation (DBS). Personalized treatment considerations include patients’ clinical characteristics, lifestyle, costs, and awareness and perception of available treatment options.

Method: Sixteen one-on-one qualitative phone interviews were conducted (14 PwP, 2 caregivers) across the US, UK, and Germany.

Results: All but two PwP were DAT-naïve, with an average of 9 years since PD diagnosis. PwP’s main concerns about oral treatments were pill burden and the fear of long-lasting side effects, while they valued the non-invasive nature, ease of use and treatment reversibility [table1]. PwP’s main concerns about LIG were the need for abdominal surgery and the risk of infection. The wearable delivery system was perceived to be complex to handle and inconvenient with physical activity. For DBS, most PwP were hesitant to undergo brain surgery. They perceived DBS as a more dangerous and painful procedure compared to other options. They expressed concern over invasiveness, reversibility difficulties, risk of follow-up infection and recovery time. However, the lack of treatment visibility as compared to a portable pump was a reason to consider DBS. CSI was perceived as preferable to LIG and DBS as surgery is not required. Concerns were related to fear of needles and associated pain. PwP’s main drivers for treatment switching were side effect avoidance, less frequent administration and greater efficacy [table2]. Aspects of treatment modality considered in decision making included how invasive, painful or complex a procedure is and treatment reversibility.

Conclusion: Treatment efficacy, modality, convenience and safety were considered by PwP when discussing aPD treatments. This can inform shared decision-making with PwP in evaluating treatment options for aPD. Tailoring information to the individual patient’s concerns and needs can help address their treatment preferences and reservations, especially when familiarity with available options is limited.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/understanding-patient-perceptions-of-advanced-parkinsons-disease-apd-treatments/