The Lived Experiences of People with Progressive Supranuclear Palsy and Their Caregivers

Plain Language Summary Progressive supranuclear palsy (PSP) is a rare brain disorder caused by damaged nerve cells. PSP is often misdiagnosed as Parkinson's disease. Sufferers typically have issues with walking, eye movement, mood and memory, all of which worsen over time, and they often become entirely dependent on caregivers. Sadly, there is no cure, but day-to-day living can be supported. In this study, the researchers wanted to understand the lived experience of patients and families. First, researchers collected information from published sources about what it is like to live with PSP. Then they spoke with PSP experts, key opinion leaders, patients, caregivers, patient organisations, neurologists and nurses in the UK, France, Italy, Germany, Spain, the USA and Japan. This revealed important learnings about the clinical and emotional journey in PSP. There is a need for patients, caregivers and healthcare professionals to have open dialogue and build trust. Moreover, a closer collaboration between patient organisations and healthcare professionals could lead to improved care. Caregivers emerged as invisible heroes, and PSP care must prioritise support for them, in addition to patients. This study provides invaluable insights into the lived experience of patients and caregivers, as well as recommendations for supporting their clinical and emotional journey. Introduction Progressive supranuclear palsy (PSP) is a neurodegenerative disorder initially characterised by disturbances in gait, balance and posture, with death occurring after several years of progressive physical and cognitive decline. This, along with a low index of suspicion, a high degree of diagnostic uncertainty and no approved treatment options, greatly impacts the lives of patients and caregivers. This research was conducted to (i) gain insight into the clinical and emotional journey of patients with PSP, (ii) assess experiences and perspectives, (iii) understand disease impact and (iv) identify key challenges and unmet needs. Methods A literature search and qualitative interviews with six PSP experts were conducted to map the clinical pathway and identify breakpoints. The pathway was validated by key opinion leaders in seven countries. Qualitative research was conducted over 6 months in seven countries with PSP stakeholders (N = 112) to explore the emotional journey. The approach included self-ethnography, 60-min telephone interviews and the completion of 7-day smartphone diaries. Results The current PSP clinical journey can take many different pathways, with patients cycling through the healthcare system before a correct referral is made and a possible/probable diagnosis received. Breakpoints contribute to delays in accessing appropriate clinical care, a high degree of diagnostic divergence and suboptimal management of the disease. The emotional journey is dominated by negative feelings, although some moments of positivity were noted. The research highlighted a lack of disease understanding amongst all stakeholders and a lack of support for patients/caregivers. The authors make a number of recommendations for care improvements, including longer consultation times, closer collaboration among healthcare professionals and patient organisations, and more varied support and information for patients/caregivers. Conclusion This work represents a major collaborative effort to understand the lived experience of PSP. The research illustrates that a coordinated effort from all stakeholders is required to address ongoing needs and challenges within PSP.