Expectations of hydrocephalus treatment: A comparison between primary caregiver and surgeon
The outcome of surgical treatment depends strongly on patients" expectations. Although optimal management of idiopathic normal pressure hydrocephalus (iNPH) by central nervous system shunt placement is evident, symptom response rates are variable. The aim of this study was to investigate the expectations of patients' relatives and treating surgeons regarding the iNPH treatment outcome.
Following ethics committee approval in December 2021, patients diagnosed with iNPH and selected for CNS shunt surgery were considered for inclusion in this prospective longitudinal clinical trial. iNPH symptoms were assessed using well-established grading scales (iNPH grading scale; Kiefer score) at baseline and follow-up. Similarly, primary caregivers, neurosurgical residents, and neurosurgeons recorded their expectations regarding the presumed outcome of surgical treatment. Expectations were correlated with outcome data, and statistical analyses were performed using the Pearson correlation test and Wilcoxon signed-rank test. Additionally, factors that might influence the accuracy of expectations, such as age, gender, education level, Charlson comorbidity index, duration of symptoms, and adverse events, were assessed.
Since January 2022, 25 iNPH patients were screened, with 20 eligible for study participation (55% male, median age 73.1 years). All underwent ventriculoperitoneal shunt placement. Median follow-up at 57.1 days showed significant symptom improvement (p<0.001). Using the Pearson correlation test, the expectations of neurosurgeons and residents showed a strong correlation with postoperative outcomes (r=0.74; r=0.64), whereas the expectations of primary caregivers correlated less strongly (r=0.61). A Wilcoxon test revealed a significant difference between expectations of primary caregivers and actual postoperative outcomes (p=0.001). In contrast, neurosurgeons' and residents' expectations showed no significant difference compared to postoperative outcomes (p > 0.05), indicating an agreement between expectations and treatment outcomes.
Our results underline that shunt placement improves symptoms in iNPH patients. Surgeons and patients' relatives have different expectations regarding the outcome following shunt surgery. The patients" relatives had much more optimistic expectations than the surgeons. These findings emphasize the importance of realistic expectations and aim to encourage better communication among surgeons and patients and their relatives.
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