"What is this brain's story?" Healthcare professionals' perspectives on managing brain tumor-related personality and behavior changes

BACKGROUND: Managing brain tumor-related personality and behavior changes (BTrPBc) is complex with contributors including tumor location, type, and grade; treatment side effects; and psychological adjustment to a primary brain tumor diagnosis. Although carers of people with high-grade glioma consistently report BTrPBc as an area where they require support, there is a lack of guidelines for healthcare professionals to address BTrPBc. We aimed to explore how neuro-oncology healthcare professionals manage personality and behavior changes in adults with a primary brain tumor.

METHODS: This study used an interpretive description approach. Semi-structured interviews were conducted with healthcare professionals practicing in neuro-oncology across Australia via face-to-face, telephone, and video conference. Codebook thematic analysis methods were used.

RESULTS: Healthcare professionals (N = 22) from a range of medical and allied health disciplines participated in interviews with an average duration of 34 minutes. Four themes described how healthcare professionals seek to manage patients' personality and behavior changes: (i) Building trusting relationships, (ii) What is this brain's story?, (iii) Brief intervention; and (iv) Targeted intervention. Sub-themes were developed within each theme.

CONCLUSIONS: Our results highlight the diverse support healthcare professionals provide for the management of BTrPBc. There is a need for interventions to be formulation-driven, involve individualized care, provide education, and focus on the patient-carer dyad. A stepped-care approach to managing BTrPBc is recommended; however, further evaluation in clinical practice is necessary.