Deep Brain Stimulation and Ethics: Perspectives from a Multisite Qualitative Study of Canadian Neurosurgical Centers
Identifieur interne : 001958 ( Main/Exploration ); précédent : 001957; suivant : 001959Deep Brain Stimulation and Ethics: Perspectives from a Multisite Qualitative Study of Canadian Neurosurgical Centers
Auteurs : Emily Bell [Canada] ; Bruce Maxwell [Canada] ; Mary Pat Mcandrews [Canada] ; Abbas Sadikot [Canada] ; Eric Racine [Canada]Source :
- World neurosurgery : (Print) [ 1878-8750 ] ; 2011.
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- Pascal (Inist)
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Abstract
OBJECTIVE: Deep brain stimulation (DBS) is an approved neurosurgical intervention for motor disorders such as Parkinson disease. The emergence of psychiatric uses for DBS combined with the fact that it is an invasive and expensive procedure creates important ethical and social challenges in the delivery of care that need further examination. We endeavored to examine health care provider perspectives on ethical and social challenges encountered in DBS. METHODS: Health care providers working in Canadian DBS surgery programs participated in a semistructured interview to identify and characterize ethical and social challenges of DBS. A content analysis of the interviews was conducted. RESULTS: Several key ethical issues, such as patient screening and resource allocation, were identified by members of neurosurgical teams. Providers described challenges in selecting patients for DBS on the basis of unclear evidence-based guidance regarding behavioral issues or cognitive criteria. Varied contexts of resource allocation, including some very challenging schemas, were also reported. In addition, the management of patients in the community was highlighted as a source of ethical and clinical complexity, given the need for coordinated long-term care. CONCLUSIONS: This study provides insights into the complexity of ethical challenges that providers face in the use of DBS across different neurosurgical centers. We propose actions for health care providers for the long-term care and postoperative monitoring of patients with DBS. More data on patient perspectives in DBS would complement the understanding of key challenges, as well as contribute to best practices, for patient selection, management, and resource allocation.
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aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Montréal, Québec</wicri:noRegion></affiliation></author><author><name sortKey="Pat Mcandrews, Mary" sort="Pat Mcandrews, Mary" uniqKey="Pat Mcandrews M" first="Mary" last="Pat Mcandrews">Mary Pat Mcandrews</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Division of Brain Imaging & Behaviour Systems-Neuroscience, Toronto Western Research Institute</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Sadikot, Abbas" sort="Sadikot, Abbas" uniqKey="Sadikot A" first="Abbas" last="Sadikot">Abbas Sadikot</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Montreal Neurological Institute and Hospital, McGill University</s1><s2>Montreal, Québec</s2><s3>CAN</s3><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName><orgName type="university">Université McGill</orgName></affiliation></author><author><name sortKey="Racine, Eric" sort="Racine, Eric" uniqKey="Racine E" first="Eric" last="Racine">Eric Racine</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Neuroethics Research Unit, Institut de recherches cliniques de Montréal</s1><s2>Montréal, Québec</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Montréal, Québec</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Medicine and Department of Social and Preventive Medicine, Université de Montreal</s1><s2>Montreal, Québec</s2><s3>CAN</s3><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Montreal, Québec</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Department of Neurology and Neurosurgery, Medicine, and Biomedical Ethics Unit, McGill University</s1><s2>Montreal, Québec</s2><s3>CAN</s3><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName><orgName type="university">Université McGill</orgName></affiliation></author></analytic><series><title level="j" type="main">World neurosurgery : (Print)</title><idno type="ISSN">1878-8750</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">World neurosurgery : (Print)</title><idno type="ISSN">1878-8750</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Encephalon</term><term>Ethics</term><term>Human</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Surgery</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Encéphale</term><term>Ethique</term><term>Chirurgie</term><term>Homme</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVE: Deep brain stimulation (DBS) is an approved neurosurgical intervention for motor disorders such as Parkinson disease. The emergence of psychiatric uses for DBS combined with the fact that it is an invasive and expensive procedure creates important ethical and social challenges in the delivery of care that need further examination. We endeavored to examine health care provider perspectives on ethical and social challenges encountered in DBS. METHODS: Health care providers working in Canadian DBS surgery programs participated in a semistructured interview to identify and characterize ethical and social challenges of DBS. A content analysis of the interviews was conducted. RESULTS: Several key ethical issues, such as patient screening and resource allocation, were identified by members of neurosurgical teams. Providers described challenges in selecting patients for DBS on the basis of unclear evidence-based guidance regarding behavioral issues or cognitive criteria. Varied contexts of resource allocation, including some very challenging schemas, were also reported. In addition, the management of patients in the community was highlighted as a source of ethical and clinical complexity, given the need for coordinated long-term care. CONCLUSIONS: This study provides insights into the complexity of ethical challenges that providers face in the use of DBS across different neurosurgical centers. We propose actions for health care providers for the long-term care and postoperative monitoring of patients with DBS. More data on patient perspectives in DBS would complement the understanding of key challenges, as well as contribute to best practices, for patient selection, management, and resource allocation.</div></front></TEI><affiliations><list><country><li>Canada</li></country><region><li>Québec</li></region><settlement><li>Montréal</li></settlement><orgName><li>Université McGill</li></orgName></list><tree><country name="Canada"><noRegion><name sortKey="Bell, Emily" sort="Bell, Emily" uniqKey="Bell E" first="Emily" last="Bell">Emily Bell</name></noRegion><name sortKey="Maxwell, Bruce" sort="Maxwell, Bruce" uniqKey="Maxwell B" first="Bruce" last="Maxwell">Bruce Maxwell</name><name sortKey="Pat Mcandrews, Mary" sort="Pat Mcandrews, Mary" uniqKey="Pat Mcandrews M" first="Mary" last="Pat Mcandrews">Mary Pat Mcandrews</name><name sortKey="Racine, Eric" sort="Racine, Eric" uniqKey="Racine E" first="Eric" last="Racine">Eric Racine</name><name sortKey="Racine, Eric" sort="Racine, Eric" uniqKey="Racine E" first="Eric" last="Racine">Eric Racine</name><name sortKey="Racine, Eric" sort="Racine, Eric" uniqKey="Racine E" first="Eric" last="Racine">Eric Racine</name><name sortKey="Sadikot, Abbas" sort="Sadikot, Abbas" uniqKey="Sadikot A" first="Abbas" last="Sadikot">Abbas Sadikot</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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