平衡社区中关于癫痫手术的健康素养。

Balancing health literacy about epilepsy surgery in the community.

机构信息

Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

出版信息

Epilepsia. 2014 Nov;55(11):1754-62. doi: 10.1111/epi.12791. Epub 2014 Sep 23.

DOI:10.1111/epi.12791

PMID:25251908

Abstract

OBJECTIVE

Despite significant underutilization of surgical treatment for drug-resistant epilepsy, no studies have quantified patient desire for surgery within a representative population. The main objective was to determine desire for surgery in a sample with a high proportion of potential candidates to characterize patient-related barriers to the treatment. Secondary objectives included assessing clinical predictors of attitudes toward surgery and evaluating the impact of passive knowledge translation on desire for surgery.

METHODS

An online survey was administered to all clients connected with a core epilepsy community access center. It obtained information about demographics, clinical characteristics, knowledge of epilepsy surgery, and interest in receiving surgery before and after receiving risk/benefit information about it.

RESULTS

Of 118 potential respondents, 48 (41%) completed the questionnaire, of which 67% had failed more than two AEDs and 78% experienced seizures in the past year. Eleven (26%) were uninterested in receiving surgery at baseline, and this decreased significantly to 7 (16%) following knowledge translation regarding the benefits (p = 0.001). Significance was lost with subsequent complication rate information despite fewer respondents still being uninterested compared to baseline (20% vs. 26%). Having experienced seizures within the past month was correlated with being interested in or undecided regarding surgery at baseline and following all steps of knowledge translation. Subjects had conservative views regarding the benefits of surgery and largely overestimated the risks.

SIGNIFICANCE

A significant portion of those with active epilepsy in the community do not desire surgical treatment. Passive knowledge translation regarding the risks and benefits enhanced optimistic attitudes and mobilized interest within a subset of participants. Preexisting views regarding the risks of surgery were exaggerated, and analysis suggests that these views can be modified with information about the benefits of surgery. However, exaggerated risk perceptions return following crude descriptions of the risks, underlying the importance of sensitive counseling from primary care physicians.

摘要

目的

尽管手术治疗耐药性癫痫的应用明显不足，但尚无研究定量评估代表性人群中患者对手术的需求。本研究的主要目的是在一个潜在手术候选者比例较高的样本中确定对手术的需求，以明确与治疗相关的患者障碍。次要目标包括评估对手术的态度的临床预测因素，并评估被动知识转化对手术需求的影响。

方法

向核心癫痫社区准入中心联系的所有患者在线发放调查问卷。它获取了有关人口统计学，临床特征，癫痫手术知识以及在接受手术风险/获益信息前后对手术的兴趣的信息。

结果

在 118 名潜在受访者中，有 48 名（41％）完成了问卷，其中 67％的患者服用两种以上的抗癫痫药物失败，78％的患者在过去一年中有癫痫发作。有 11 名（26％）患者在基线时对接受手术不感兴趣，而在接受关于手术益处的知识转化后，这一比例显著下降至 7 名（16％）（p = 0.001）。尽管与基线相比，仍然对手术不感兴趣的患者人数减少，但由于随后的并发症发生率信息，其相关性不再显著（20％比 26％）。在过去一个月内有癫痫发作与在基线和所有知识转化步骤后对手术感兴趣或不确定相关。患者对手术的益处持保守态度，并且在很大程度上高估了手术风险。

意义

社区中活跃的癫痫患者中有很大一部分不希望接受手术治疗。关于风险和益处的被动知识转化增强了一部分参与者的乐观态度并调动了他们的兴趣。患者对手术风险的先存观点被夸大了，并且分析表明，通过有关手术益处的信息可以修改这些观点。但是，在对手术风险进行粗略描述后，夸大的风险感知又回来了，这突显了初级保健医生进行敏感咨询的重要性。