The brachial plexus is the network of nerves that connect the spinal cord to the muscles and skin of the shoulder, arm, and hand. In a brachial plexus injury (BPI), the nerves are damaged, leading to searing pain, loss of muscle function, and lack of sensation. While surgical treatment using nerve grafts and nerve transfers can substantially improve function of the arm, delivery of care for BPI in the United States is inefficient and suboptimal. BPI patients have expressed frustration with finding a surgeon, receiving a late diagnosis, or receiving insufficient information about their treatment options. BPI surgeons and researchers typically focus on the neurologic elements of the disease and recovery process (ie: how strong is one specific muscle?), but have not paid much attention to other non-neurologic factors that may substantially influence outcomes (such as a patient's support network, financial situation, insurance stability, and understanding of treatment options). By gathering perspectives from both patients and surgeons using qualitative research methods, we can assess how these non-neurologic factors impact care. This will allow us to select the most appropriate manner to incorporate these factors into prospective BPI outcomes evaluation. These initial qualitative assessments are critical steps in maintaining a patient-centered, function-oriented focus for research and clinical care. The overall objectives of this application are two-fold. The first objective is to assess what patients and surgeons perceive as barriers to BPI care, providing an understanding of which factors need to be assessed in prospective studies of BPI patients. The second objective is to provide the candidate with detailed, hands-on training to perform qualitative research. Qualitative methods are ideally suited to study BPI patients, as other research methods (such as administrative data research or traditional quantitative clinical studies) do not contain the breadth and depth of detail needed to understand the many factors (including social determinants of health) that influence outcomes for BPI patients. During this award, the candidate will obtain didactic training, hands-on experience, and mentorship in qualitative research, which will enable him to become a mixed-methods clinician-scientist. The candidate intends to combine these research experiences with his clinical expertise in brachial plexus surgery to obtain his long-term goal: designing a multicenter, prospective cohort study for BPI patients that assesses the influence of both neurologic and non-neurologic factors on delivery of care and clinical outcomes.
Brachial plexus injuries disrupt the network of nerves connecting the brain to the arm, leading to sudden loss of the shoulder, elbow, and hand. While the severity of the nerve injury predicts recovery fairly well, there a number of other factors (such as a patient's support network, financial situation, insurance stability, and understanding of treatment options) that may influence outcomes. In this study, we will use qualitative research methods (in-depth interviews with BPI patients) to understand how these non-neurologic considerations have impacted their experiences.
