Improving Patient Engagement in Value-Based Care

Apathy is a feeling that greatly affects the delivery of value based care. Apathetic patients with Parkinson’s disease have lower levels of quality of life which can be hard for family members to address successfully. Physicians need to evolve to understand an apathetic patient and the clinical, behavioral, and physiological reasons behind why they cannot be engaged in their care.

One solution researchers suggested was the idea of goal-directed behavior. This thought process focuses on the outcome of a situation, and what actions a person needs to take to acquire it for themselves. Some patients with Parkinson’s disease find a goal to be a motivator while they receive care. A new study explores this theory, and if patients that know their outcome choices have lower levels of apathy towards their own care.

In this study, researchers discovered that patients with Parkinson’s disease that were apathetic made less accurate choices when it came to choosing the best treatment option for themselves. In the experiment, they also received less rewards because of their apathy. This suggests that apathetic patients no longer care about the dynamic between the choices they make and their outcome. Some of them believing that any choice will lead to the same outcome anyways, so why does the choice matter? They also found that the apathetic patients made more random exploratory choices and less exploitative choices in their experiment. Showcasing that the patients were having difficulty understanding the value in the choices they were making.

In their research, they explored the regions of the brain where changes in the blood oxygen level could be correlated with the feeling of reward. This theory showed no results as patients with and without apathy had similar blood oxygen levels in all parts of the brain. Then they compared brain activity. When patients made exploratory choices there was greater activity in the midbrain areas for the non-apathetic patients, which may show that patients with apathy lack a mechanism in the brain that protects them from over-development of the feeling. However, one question this study could not answer was if apathy occurs because of altered learning styles like exploratory vs exploitative.

The results of this study may not have confirmed any theories about why patients with Parkinson’s disease develop apathy, however it did raise a good question of if apathy can be found in the brain of patients. The changes in exploratory and exploitation choices between patients with and without apathy, as well as the differences in thalamo-cortical activations prompts for future research in new studies.

Reference

Campbell LH, Chong TTJ. Learning the value of experience. Brain. Published online March 26, 2024. doi.org/10.1093/brain/awae084