Exploring the Patient Pathway to Focused Ultrasound Ablation for Essential Tremor: A Mixed-Method Approach

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Introduction Focused ultrasound ablation (FUSA) is an emerging treatment for Essential Tremor (ET). While disparities in access to deep brain stimulation for ET have been identified, potential barriers to FUSA remains understudied. Methods A single tertiary-care center, mixed methods study was completed of medication-refractory ET patients presenting for FUSA consultation. Baseline demographics and tremor scores were obtained. A semi-structured questionnaire and focus group discussion was implemented to estimate delays in care, quality of life (QOL) differences, and treatment barriers. Quantile regression, log normal regression, and Fisher's exact tests were used in the quantitative statistical analysis. Thematic and descriptive analyses were used for qualitative data. Results Forty patients, with similar demographics and tremor scores, were enrolled. Patients spent nearly a decade awaiting ET diagnosis and medical treatment, followed by another four years before undergoing FUSA consultation. Although there were no significant differences in delays between genders, the mean number of provider contacts prior to diagnosis was significantly higher for women compared to men (7.5 vs. 0.9, p=0.029). Those with lower socioeconomic status (≤$50,00) had significantly longer diagnostic (15 vs. 3.3, p=0.056) and FUSA consultation delays (35 vs. 10.2, p=0.015). At presentation, women reported worse QOL (70 vs. 85, p=0.037) and overall general health status (70 vs. 85, p=0.013) than men, with tremor significantly impacting their hobbies and leisure subscores. Women cited more hesitation and concerns regarding the surgery than men such as pre-procedure hair shave. Although men reported longer time from failure of medication therapy to FUSA consultation compared to women (4.0 vs. 2.0 years), more men ultimately underwent the procedure (10 vs. 4, p=0.04). Discussion We identified a variety of socioeconomic and gender differences along the patient pathway to FUSA for ET. Although women presented with worse QOL because of their tremor, they were still less likely to undergo FUSA compared to men. Further investigation and patient-centered interventions is needed to achieve equity of care in this patient population.