Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy.
Department of Psychoncology, University of Milan, Italy.
Epilepsy Behav. 2019 Apr;93:32-37. doi: 10.1016/j.yebeh.2019.01.037. Epub 2019 Mar 1.
This research investigates level of empowerment, decisional skills, and the perceived relationship with the clinician, of women in childbirth age, also in relationship with clinical variables such as epilepsy type, seizure frequency, therapy, and pregnancy status. In particular, as concerning therapy, we were interested in women who take valproic acid (VPA), for its specific balance of risks and benefits, especially in pregnant women.
The sample is composed of 60 women with epilepsy (6 were excluded), who underwent a standardized clinical protocol for assessment of level of empowerment, decisional skills, and of their judgment about how they feel to be involved by their clinician in medical decision making.
Overall, the sample does not show signs of low empowerment level nor of abnormal decision-making patterns. The type of epilepsy, the frequency of seizures, and the treatment type (VPA versus no VPA) do not impact on empowerment, on decision styles, nor on medical relationship, with the only exception of a specific decision style, the avoidant style, that is more frequent in women treated with VPA with respect to those taking other therapies. Interestingly, regarding VPA dosage, we found that women taking equal or more than 700 mg/day of VPA have lower scores on empowerment in all dimensions compared with women with a VPA dosage lower than 700 mg/day.
Shared decision making including improved decision quality, more informed choices and better treatment concordance, should be a central part of epilepsy care. In addition, for clinicians it would be useful to have specific tools to know if the patient has really understood the risks and benefits of antiepileptic drugs (AEDs), particularly VPA, and all treatment alternatives.
本研究调查了育龄妇女的赋权水平、决策技能以及与临床医生的感知关系，并探讨了这些因素与临床变量（如癫痫类型、发作频率、治疗方法和妊娠状况）的关系。特别是在治疗方面，我们关注的是服用丙戊酸（VPA）的女性，因为 VPA 在平衡风险和收益方面具有独特的优势，特别是对孕妇而言。
该样本由 60 名癫痫女性组成（其中 6 名被排除），她们接受了一项标准化的临床评估方案，以评估赋权水平、决策技能以及她们对自己在医疗决策中的参与程度的判断。
总体而言，该样本没有表现出低赋权水平或异常决策模式的迹象。癫痫类型、发作频率和治疗方法（VPA 与非 VPA）对赋权、决策风格或医患关系没有影响，但除了一种特定的决策风格——回避风格外，该风格在服用 VPA 的女性中比服用其他治疗方法的女性更为常见。有趣的是，关于 VPA 剂量，我们发现服用 700mg/天或以上 VPA 的女性在所有维度上的赋权得分均低于服用 700mg/天以下 VPA 的女性。
包括提高决策质量、更知情的选择和更好的治疗一致性的共同决策，应该成为癫痫治疗的核心部分。此外，对于临床医生来说，拥有特定的工具来了解患者是否真正理解抗癫痫药物（AEDs），特别是 VPA，以及所有治疗选择的风险和益处将是非常有用的。
