Table 3.

Barriers for the implementation of advanced therapies in Parkinson’s disease

Barrier	Reference
Direct barriers
Limited number of randomised trials directly comparing advanced treatments to guide treatment decision	[64]
Various patients are considered too late for advanced therapies, leading to general under-treatment of advanced PD	[65]
Limited expertise among clinicians due to a lack of treatment experience or availability of advanced treatments	[72]
PD patients are involved in the decision-making processes; however, they often feel ill-equipped and unsupported by the medical specialists. Neurologists mention limited decision-making capacity in PD patients as an additional barrier to SDM in advanced PD, related to disease severity, and associated cognitive deficits	[59, 60]
Treatment complications of advanced therapies, including increased risk of falling or development of hallucinations	[73, 74]
Other potential barriers
Pre-intervention:	[65]
•Appropriate patient selection
•Management by an experienced Movement disorders service
During intervention	[65]
•Inpatient versus outpatient model
Post-intervention	[65]
•Structured daily routine
•Support from partner
•Support from health care professionals at home