Ettinger Alan B, Carter John A, Rajagopalan Krithika
Safe Passage EEG Services, 915 Broadway, Suite 1200, New York, NY 10010, United States.
EPI-Q, Inc., 1315 W 22nd St, Suite 410, Oak Brook, IL 60523, United States.
Epilepsy Behav. 2018 Mar;80:247-253. doi: 10.1016/j.yebeh.2018.01.025. Epub 2018 Feb 10.
This assessment was conducted to quantify and compare patient and neurologist preferences regarding antiepileptic drug (AED) attributes for treating epilepsy.
Patients with epilepsy (≥18years, treated with AEDs) and neurologists were recruited from nationally representative US panels to complete an online survey that included a discrete choice experiment (DCE). Participants chose between two hypothetical AEDs, characterized by six attributes in the DCE, which included 1) level of seizure control/reduction; 2) dosing frequency, 3) diminished coordination and balance, 4) psychiatric issues, 5) diminished energy level, and 6) dietary restrictions. The Sawtooth Software Choice-Based Conjoint (CBC) System for CBC Analysis was used to estimate treatment attribute ranking and weighting.
Of the 720 respondents (518 patients and 202 neurologists), both patients and neurologists ranked seizure control as the most important attribute (rank 1) and dietary restrictions as the least important attribute (rank 6). However, seizure control had a significantly greater weighting in neurologists' decision-making than among patients (45% vs 32%, p<0.005). On the other hand, patients considered the risks of psychiatric adverse effects (19% vs 15%), diminished coordination and balance (16% vs 10%), and fatigue or diminished energy (13% vs 11%) as significantly more important (p<0.05) than did neurologists.
Patients and neurologists had similar preference ranking order, with seizure reduction being ranked the most important attribute. However, neurologist treatment preferences were significantly more influenced by seizure reduction while patient preferences were significantly more influenced by adverse effects that may impact their quality of life. Understanding how patient and neurologist perspectives differ should encourage dialog to communicate the potential risks and benefits of AED therapy and assist in the shared decision-making process.
进行此项评估以量化并比较患者和神经科医生在治疗癫痫的抗癫痫药物（AED）属性方面的偏好。
从具有全国代表性的美国样本中招募癫痫患者（≥18岁，正在接受AED治疗）和神经科医生，以完成一项包括离散选择实验（DCE）的在线调查。参与者在两种假设的AED之间进行选择，这两种AED在DCE中由六个属性表征，包括1）癫痫发作控制/减少程度；2）给药频率；3）协调性和平衡能力下降；4）精神问题；5）精力水平下降；6）饮食限制。使用基于锯齿软件的基于选择的联合分析（CBC）系统进行CBC分析，以估计治疗属性的排名和权重。
在720名受访者（518名患者和202名神经科医生）中，患者和神经科医生均将癫痫发作控制列为最重要的属性（排名第1），而饮食限制列为最不重要的属性（排名第6）。然而，癫痫发作控制在神经科医生的决策中所占权重明显高于患者（45%对32%，p<0.005）。另一方面，患者认为精神不良反应风险（19%对15%）、协调性和平衡能力下降（16%对10%）以及疲劳或精力下降（13%对11%）比神经科医生认为的重要得多（p<0.05）。
患者和神经科医生的偏好排名顺序相似，癫痫发作减少被列为最重要的属性。然而，神经科医生的治疗偏好受癫痫发作减少的影响明显更大，而患者的偏好受可能影响其生活质量的不良反应的影响明显更大。了解患者和神经科医生观点的差异应鼓励开展对话，以交流AED治疗的潜在风险和益处，并有助于共同决策过程。
