Complex therapies for advanced Parkinson's disease: what is the role of doctor-patient communication?

objectivesCommunication processes play a key role in the patient-doctor relationship. Few studies have considered communicative processes in advanced Parkinson's disease (PD), and in particular in the phase of proposing complex therapies (CT). Therefore, we explored the role of communication and patient-doctor relationship in the transition phase to CT for advanced PD, analysing satisfaction, factors influencing the relationship and patients' unmet needs. MATERIALS AND

methodsTwenty-four PD patients (mean age 61.7 ± 8.8 years; mean disease duration 12 ± 4.8 years) eligible for deep brain stimulation or infusion therapies were submitted to a semi-structured interview aimed to investigate communication-related cognitions, feelings and behaviours concerning PD and the possible transition towards CT. The Patient-Doctor Relationship Questionnaire (PDRQ-9) was administered along with neuropsychological and behavioural screening tests.

resultsAll patients discussed the possible transition to CT with a neurologist. A high degree of satisfaction about the relationship with the neurologist was revealed (mean PDRQ-9 score 37.3 ± 7.3). The communication not only aroused feelings of fear (11/24 patients) and concern (15/24 patients), but also fostered the hope for motor improvement (15/24 patients). Half the patients (12/24) wanted to receive more information about CT after communication.

conclusionsThis pilot study highlights the importance of doctor-patient communication in PD when facing the transition to CT. Trust in the physician emerged as a key point in favour of the therapeutic alliance. Neurologists should carefully consider patients' reactions and preferences for eliciting collaboration and treatment adherence, favouring a patient-centred standard of care.