Gender and Health Risk Attitudes Shape Acceptance and Maximum Acceptable Risk for Deep Brain Stimulation and Focused Ultrasound in Essential Tremor
Han-Yun Tseng1, Bridget Ollesch3, Drew Kern3, Michelle Fullard2
1Neurology, University of Colorado Anschutz, 2University of Colorado Anschutz, 3University of Colorado
Objective:

To examine how gender and health risk attitudes relate to maximum acceptable risk (MAR) for side effects for deep brain stimulation (DBS) and focused ultrasound (FUS) among individuals with essential tremor (ET).

Background:

Choosing between DBS and FUS requires balancing trade-offs in reversibility, uncertainty, and risks of functional loss. Understanding how gender and health attitudes influence acceptance of these procedures may clarify observed gender disparities in surgical uptake.

Design/Methods:

Ninety-one adults with ET (M_age = 71.71 ± 8.86 years; 32% women) completed the Health Risk Attitude Scale and scenario-based measures of acceptance and MAR for DBS (infection, bleeding, dysarthria) and FUS (abnormal sensation, gait disturbance) risks. Analyses examined gender differences and the predictive value of three health risk attitude domains, namely health disengagement, willingness to take health-related risks, and ambiguity tolerance, adjusting for age, disease severity, and caregiving burden.

Results:

Across risk scenarios, participants showed trend-level higher MAR for DBS than for FUS, F(1, 82) = 3.31, p = .073. Women reported significantly lower acceptance (β = -0.66, p = .003) and MAR (β = -0.34, p = .001) for FUS-related gait disturbance. Ambiguity tolerance predicted higher acceptance (β = 0.39, p < .001) and MAR (β = 0.32, p = .005) for gait disturbance, and health disengagement similarly predicted higher MAR (β = 0.21, p = .044). No significant gender/risk attitude interactions were detected, likely due to limited power in this preliminary sample.

Conclusions:
Two complementary pathways may explain procedural acceptance in ET: one reflecting gendered sensitivity to losses in mobility, and the other reflecting individual differences in attitudes toward health-related uncertainty and engagement. Recognizing women may perceive gait-related risks as greater threats, while others differ in how they appraise uncertainty and engage with health decisions, can help clinicians tailor risk communication and potentially reduce gender disparities in the uptake of advanced therapies. 
10.1212/WNL.0000000000217383
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