The psychosocial and functional impact of an unruptured AVM diagnosis: A mixed-methods exploratory analysis

OBJECTIVES: This study aimed to explore the patient, disease and service-level factors that may influence the psychosocial and functional impact of an unruptured AVM diagnosis. METHODS: A mixed-methods study was performed in a single-centre, high-volume, tertiary neurosurgical centre. The study comprised of psychological instruments and a semi-structured interview focusing on patient experiences in the early diagnostic journey. 37 patients completed the HADS and SF-36 questionnaires and of those, 33 took part in the semi-structured interviews. HADS and SF-36 questionnaire scores were compared against UK normative data and multiple regression analyses were performed to identify significant predictors of psychosocial and functional burden. Thematic analysis of semi-structured interviews was also performed. RESULTS: All of the HADS and the majority of SF-36 sub-domains were found to be significantly worse compared to UK normative data. Previous psychiatric history was found to be significantly associated with a worsened score in the HADS Anxiety sub-domain (p = 0.024) as well as energy (p = 0.001), social function (p = 0.03) and general health (p = 0.004) SF-36 subdomains. Thematic analysis revealed key themes of functional impact, psychological impact, diagnosis and explanation, access to information and follow-up care. CONCLUSIONS: This study identifies a significant psychosocial and functional burden on those diagnosed with an unruptured AVM. Our mixed-methods analysis provide potential avenues in mitigating this effect and tailoring neurosurgical practice to improve patient care. Recommendations for further research include longitudinal study to investigate effects of time and AVM treatment on patients' psychosocial and functional burden.