Disparities in the Clinical Provision of Deep Brain Stimulation: A Systematic Scoping Review and Grounded-Theory Qualitative Analysis.

Abstract

Background: Deep Brain Stimulation (DBS) has been an established treatment for movement disorders since its FDA approval in 1996. However, disparities in DBS care, particularly concerning race, gender, socioeconomic status, and geography, remain a significant concern globally.

Objectives: This systematic scoping review and grounded theory qualitative analysis aimed to synthesize existing research on worldwide disparities in DBS provision and to develop theoretical solutions to enhance equity and improve the quality of research in DBS disparities.

Methods: A systematic search identified 46 studies, which were critically appraised for quality and analyzed using grounded theory methods to extract core conceptual categories.

Results: We characterized three principles of DBS disparities: intersectionality, reciprocal interactivity and influence of patients and providers, and the interposition of simultaneous barriers; together these highlight the role of individual, systemic, and structural factors in generating DBS disparities. Racial minorities, women, socioeconomically disadvantaged individuals, and patients in certain geographic regions were consistently found to have reduced access to DBS. Gaps in the research include a calcified research infrastructure, insufficient attention to cultural and societal contexts, and reliance on conjecture without empirical support.

Conclusions: We propose a multi-level approach to address DBS disparities, including reciprocal education between patients and clinicians, enhanced screening and referral networks, and policy reforms at institutional and governmental levels. These findings will facilitate further hypothesis-driven research and foster more equitable access to DBS globally.