Table 2. Barriers to communication about off periods in Parkinson’s disease.

Barrier	Type of Interview Participant
	PwP	Care- partner	GN	Specialist
Patient-level factors
Difficulty describing experiences	x		x	x
Cognitive changes	x		x	x
Impaired speech	x
Anxiety				x
Lack of insight			x
Lack of English as first language			x
Pride	x
Embarrassment	x
Willingness to admit something is happening	x
Reluctance to describe symptoms		x
Symptom recall			x	x
Wanting to give physician a good report	x
Understanding of PD symptoms			x
Lack of questioning when physician explanation unclear				x
Carepartner-level factors
Absence of carepartner at visits	x	x
Caregiver cognitive impairment			x
Differing accounts from patient			x	x
Physician-level factors
Non-appreciation of impact of off periods	x	x
Lack of interest		x
Failure to involve carepartner		x
Distraction by technology	x	x
Failure to provide education on what to expect	x
Other factors
Difficulty linking symptoms to medication timing and distinguishing fluctuating symptoms			x	x
Distinguishing off tremor from dyskinesia				x
Difficulty identifying non-motor off symptoms				x
Variability of symptoms between individuals				x
Time	x	x	x
Infrequent visits		x
Lack of a reliable historian			x
Lack of a shared vocabulary	x		x	x
Different expectations for medication response				x
Lack of ancillary team support			x

“x” indicates that the barrier was described by the category of interview participant for that column

PwP: person with Parkinson’s, GN: general neurologist, PD: Parkinson’s disease