Exploring the Attitudes, Barriers, Concerns, Differences, and Ethics (ABCDEs) of Healthcare Decision Making of Vagus Nerve Stimulation

TRD stakeholders reported delayed approvals, high out-of-pocket costs, and frequent ethical concerns about informed consent and impaired decision-making, linked to higher stigma and reluctance toward surgical VNS.

• Why it matters: Even with established VNS efficacy for TRD and epilepsy, uptake in psychiatric care is limited, and stakeholder barriers and ethics may restrict equitable, acceptable adoption.
• What they did: In a mixed-methods study, six focus groups and 20 semi-structured interviews with patients, clinicians, and one support person integrated qualitative themes with quantitative stigma and treatment-barrier data across epilepsy, depression, heart failure, and rheumatoid arthritis.
• The result: Participants generally agreed VNS appropriateness should match disease severity and quality-of-life impact, and many cautiously supported VNS for HF and RA when strong efficacy evidence is available.

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