The difference in perceptions of educational need between epilepsy patients and medical personnel

Health Literacy in Neurosurgery: A Scoping Review

OBJECTIVE

Low health literacy is prevalent and associated with suboptimal health outcomes. In neurosurgery, social determinants of health are increasingly recognized as factors underpinning outcomes, as well as access to and use of care. We conducted a scoping review to delineate the scope of existing literature regarding health literacy in the field and facilitate future research.

METHODS

A scoping review was conducted using the PubMed, Embase, and Scopus databases. Titles and abstracts were screened for relevance. Studies meeting prespecified inclusion criteria underwent full text review. Relevant data were extracted.

RESULTS

Of 5056 resultant articles, 57 manuscripts were included. Thirty-seven studies (64.9%) investigated personal health literacy, while the remaining 20 (35.1%) investigated organizational health literacy. Domains of health literacy investigated were science (36, 63.2%), fundamental (20, 35.1%), and civic (1, 1.7%). No studies investigated numeracy. Recall among patients after discussions with neurosurgeons is low. Patient perspectives are often erroneous. Patient informational needs are often unmet. Written patient educational materials are written at a level too complex for the average patients. Videos are mostly of poor quality. Multimodal audiovisual interventions, eBooks, models, and virtual reality are shown to be effective methods for promoting recall.

CONCLUSIONS

Studies examining health literacy in neurosurgery primarily focus on the topic indirectly, most often via written educational materials and recall after educational interventions. Increasing awareness of health literacy among neurosurgeons, assessing health literacy, and incorporating health literacy-informed counseling approaches are warranted to improve patient care.

Patient Education in Neurosurgery: Part 1 of a Systematic Review

BACKGROUND

Patient education has become increasingly important in neurosurgery. However, little is known regarding how to comprehensively educate neurosurgical patients. In the first part of a 2-part systematic review, we identify baseline patient understanding and educational needs, examine existing patient education materials, and characterize shortcomings in neurosurgical patient education practices. Our findings may guide neurosurgeons, departments, and professional associations in improving communication with patients.

METHODS

A 2-part systematic review was conducted using the PubMed, Embase, and Scopus databases. Titles and abstracts were read and selected for full text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes.

RESULTS

Of 1617 resultant articles, 41 were included. Patient comprehension was low. Patient informational needs differed across patients and between patients and neurosurgeons. Patient informational needs were often unmet, promoting dissatisfaction. Written educational materials from government agencies, professional associations, neurosurgery departments, neurosurgeons, or widely read Web sites were written at a reading level above the recommended reading level, with complex topics written at a higher level. Information found on hospital and university Web sites was poor quality because of self-marketing and lack of reference to peer-reviewed literature. Educational videos created by universities and hospitals were poor quality.

CONCLUSIONS

Current in-clinic discussions and education materials show shortcomings, promoting poor comprehension. Neurosurgeons, departments, and professional organizations can act to improve the effectiveness of patient education initiatives. This policy will better inform patients, increase rapport between neurosurgeons and patients, and improve patient decision making and satisfaction.

Views of adolescents and their parents on mobile apps for epilepsy self-management

INTRODUCTION

New technologies are ubiquitous in our everyday lives, and this is especially true for teenagers. Very few mobile apps have been designed for adolescents with epilepsy. In order to better understand their expectations as well as those of their parents, we conducted a survey on this topic.

METHODS

The survey consisted of an anonymous self-administered questionnaire that was distributed to adolescents with epilepsy aged 10 to 18 years old and their parents. Questionnaires contained 15 questions including 8 multiple choice questions, 5 groups of multiple questions with a rating scale ranging from 1 to 6, and 2 open-ended questions covering the scope of the interest of epilepsy self-management apps, seizure and epilepsy management, antiseizure medications, and information on epilepsy.

RESULTS

Surveys were answered by 17 teenagers and 19 parents. It showed that adolescents embrace new technologies. Parents' highest expectations regarding mobile apps contents were seizure management and emergency information, while adolescents were expecting contents on epilepsy daily life, as well as a tool that would improve antiseizure medication compliance.

CONCLUSION

Parents and adolescents' expectations on the content of an epilepsy app were different.

Counselling in tuberous sclerosis complex: A survey on content and satisfaction in the Netherlands

BACKGROUND

Tuberous sclerosis complex (TSC) is a highly variable condition and its clinical features cannot reliably be predicted from the genotype. Counselling of parents of a child with TSC is challenging because of the variability of the condition and the changing outlook due to new treatment options. This study explored current counselling strategies in TSC in the Netherlands, with the aim of developing a recommendation for counselling.

METHOD

We performed a nationwide survey using digital questionnaires. Questionnaires were sent to parents of children diagnosed with TSC, and to medical doctors involved in counselling, both no more than ten years prior to the study. Questions focused on general information about the child with TSC, medical doctors involved in counselling, type of information provided, mode of providing information, and recommendations for improvement of counselling.

RESULTS

Parents of 34 children diagnosed with TSC (7 prenatally) and 18 medical doctors from different departments responded to the questionnaires. Almost all parents were informed on the neurological and cardiac symptoms of TSC, other symptoms were mentioned less often. Satisfaction on counselling was higher when more information on the variability of TSC was provided, preferentially during a clinical visit, when emotional support was provided, and when parents were notified of the TSC patient society.

CONCLUSIONS

Information on the variability in expression and quality of life is highly demanded by (expecting) parents of a child with TSC. Furthermore, reference should be made to institutions such as the support organisation for patients and social services for questions and support.

First-aid management of tonic-clonic seizures among healthcare personnel: A survey by the Apulian section of the Italian League Against Epilepsy

INTRODUCTION

To evaluate the knowledge of healthcare workers about first-aid measures to be performed during and after a tonic-clonic seizure.

METHODS

One hundred and fifty-four healthcare workers (86 physicians) working at 8 tertiary hospitals in the Apulia region, Italy, responded to a questionnaire comprising of 28 questions based on available Italian and international recommendations about what to do during a tonic-clonic seizure.

RESULTS

One hundred and fifty-four healthcare workers completed and returned surveys with a response rate of 96.25%. There were 55 nurses (35.7%), 86 physicians (55.8%), and 13 healthcare workers with different roles (Electroencephalograph technicians, psychologists, social workers). Among physicians, there were 7 cardiologists, 3 surgeons, 12 infectious-disease specialists, 11 internal medicine specialists, 2 psychiatrists, 2 gynecologists, 27 specialists working in the emergency department, and 22 physicians with different specializations. Nearly 90% of the respondents identified head protection as important first aid, while 100% responded to not keep the legs elevated. To avoid tongue bite, both physicians and other healthcare workers would put something in the mouth (54.0%), like a Guedel cannula (71.0%) fingers (29.5%). Grabbing arms and legs, trying to stop the seizure, would be potentially performed by 11.6% of our sample. Physicians would administer a benzodiazepine during the seizure (65.7%) and during the postictal phase (29.2%), even if the patient is known to have epilepsy (23.7%), and in this case, 11.3% of respondents would administer the usual antiepileptic medications. More than half of respondents would call the emergency telephone number, because of necessary hospitalization in case of tonic-clonic seizure, even if it is experienced by a patient known to have epilepsy.

CONCLUSION

Our survey suggests the need for epilepsy educational programs on first-aid management of seizures among healthcare workers.

Parental Understanding of Tuberous Sclerosis Complex

Tuberous sclerosis complex is a genetic disorder with multisystem involvement that poses significant challenges to the affected child and family. Caregiver knowledge in the South African population has not previously been reported. A prospective study of the parents of 21 children with tuberous sclerosis complex was undertaken. Median parental age was 38 (interquartile range 34.5-45) years. Parents were randomly allocated to receive written information about the condition, or to receive verbal counseling already established in clinic. A significant difference (P = .001) was observed in the change in the mean knowledge scores for the parent group that received written information (34.2 at baseline, 51.7 at the second visit. This impact was higher in parents with an education level of at least grade 8 (P = .003). Parental understanding of tuberous sclerosis complex can be improved by provision of written information and should be routinely available in a readily understandable format.

'Seizure First Aid Training' for people with epilepsy who attend emergency departments, and their family and friends: study protocol for intervention development and a pilot randomised controlled trial

INTRODUCTION

People with chronic epilepsy (PWE) often make costly but clinically unnecessary emergency department (ED) visits. Offering them and their carers a self-management intervention that improves confidence and ability to manage seizures may lead to fewer visits. As no such intervention currently exists, we describe a project to develop and pilot one.

METHODS AND ANALYSIS

To develop the intervention, an existing group-based seizure management course that has been offered by the Epilepsy Society within the voluntary sector to a broader audience will be adapted. Feedback from PWE, carers and representatives from the main groups caring for PWE will help refine the course so that it addresses the needs of ED attendees. Its behaviour change potential will also be optimised. A pilot randomised controlled trial will then be completed. 80 PWE aged ≥16 who have visited the ED in the prior 12 months on ≥2 occasions, along with one of their family members or friends, will be recruited from three NHS EDs. Dyads will be randomised to receive the intervention or treatment as usual alone. The proposed primary outcome is ED use in the 12 months following randomisation. For the pilot, this will be measured using routine hospital data. Secondary outcomes will be measured by patients and carers completing questionnaires 3, 6 and 12 months postrandomisation. Rates of recruitment, retention and unblinding will be calculated, along with the ED event rate in the control group and an estimate of the intervention's effect on the outcome measures.

ETHICS AND DISSEMINATION

Ethical approval: NRES Committee North West-Liverpool East (Reference number 15/NW/0225). The project's findings will provide robust evidence on the acceptability of seizure management training and on the optimal design of a future definitive trial. The findings will be published in peer-reviewed journals and presented at conferences.

TRIAL REGISTRATION NUMBER

ISRCTN13 871 327.

Employability among people with uncontrolled seizures: An interpretative phenomenological approach

PURPOSE

This study aimed to explore positive and negative factors affecting the employability in patients with uncontrolled seizures.

METHOD

Semistructured interviews with 21 patients with uncontrolled seizures were analyzed using interpretative phenomenological analysis.

RESULT

Eleven (52.4%) of the participants interviewed were employed; 7 were holding full-time position with more than 4years of working experience. The mean age was 34.6years, 71.4% were female, 38% were married, 71.4% had at least 11years of education, 38% had a driving license, 19% received government monetary aid, 66.7% had seizure onset before reaching 17years of age, 66.7% experienced monthly seizures, and 76% were on polytherapy. A total of 6 main themes were found to be affecting the employability among people with uncontrolled seizures: (a) ability to work; (b) intention to work; (c) support and stigma at workplace; (d) family support, overdependence, and protection; (e) life event; and (f) government and welfare support. Subthemes under the main theme ability to work included education, cognitive and physical functions, ability to continue working after seizures, ability to travel to work, self-perceived ability to work, and ability to cope with stress. Many shared the same idea that employment is important, but their intention to work varied. The employed group tended to work for a future goal and self-satisfaction, and the unemployed group tended to have no or lack intention to work. Positive factors were noted in the following themes: ability to work; intention to work; support and stigma at workplace; and family support, overdependence, and protection.

CONCLUSION

There were internal and external factors affecting the employability among people with uncontrolled seizures both positively and negatively. Positive internal factors such as ability and intention to work require further exploration.

[Assessment of education needs of adolescents and parents of children with epilepsy]

INTRODUCTION

Education program for patients (EPP) is now a part of the management of patients with chronic disease. According to WHO, the EPP is designed to help patients to maintain or gain self-care skills and adaptive skills necessary to improve their health and their quality of life. Patient education programs have been developed in recent years in several chronic diseases such as diabetes and asthma. In the field of epilepsy, however, adult and child programs have been developed only recently in France. We evaluate the interests for the establishment of an EPP and the topics that the parents and the adolescents would like to be discussed in such courses.

METHODS

We conducted a qualitative survey, based on interviews of parents of epileptic children and adolescents. The survey was conducted between April and November 2010 in pediatric neurology services of four French university hospitals: Amiens, Nancy, Marseille, and in Robert Debré (Paris) hospital. We investigated the following issues: treatment and self-management, and seizure management, psychosocial difficulties related to epilepsy, anatomical and physiological knowledge of epilepsy and lifestyle.

RESULTS

Two topics seem to have the greatest interest for parents of children with epilepsy and adolescents: knowledge about seizures and knowledge of anatomy and physiology of the brain. Adolescents involved in this study gave consistently lower scores in all items compare to parents of children.

CONCLUSION

The medical management of children and adolescents with epilepsy, and their caregivers, is a comprehensive care including the EPP in order to provide a full management of all issues raised by epilepsy. The survey identified key-points that parents and their children would like to learn in an EPP. These data would be helpful to design an EPP.

Patients' knowledge about their disorder: perspective of patients with epilepsy in a tertiary health facility in southwestern Nigeria

OBJECTIVE

Previous studies have shown that patients with epilepsy do not have adequate knowledge about their disorder, suggesting that patient education is a vital part of comprehensive care for epilepsy. The goal of this study was to evaluate what Nigerian patients with epilepsy know about their disorder.

METHODS

Forty-six patients with EEG- and clinically confirmed epilepsy participated in the study. The patients completed the Epilepsy Patients Knowledge Questionnaire. The questionnaire includes topics related to etiology of epilepsy, safety, compliance, legal issues of driving, and employment. The questionnaire scores were correlated with demographic variables, duration of epilepsy, and level of education of the patients.

RESULTS

The mean age of the respondents was 26.78 ± 9.27 years; there were 27 males and 19 females. The mean duration of epilepsy in the group was 7.6 ± 7.5 years. The mean rates of correct responses to the issues of safety and compliance were 31.6 and 76.8%, respectively. The mean scores on legal issues of driving and employment were 45.7 and 42.4%, respectively. The lowest score (10.9%) was on the etiology of epilepsy.

CONCLUSION

Nigerian patients with epilepsy lack adequate knowledge about their disorder, and there is a need for improved educational intervention in these patients.

Initial Perspectives from Midwestern Neurologists: Epilepsy Patients' Barriers and Motivators for Seeking Treatment

PURPOSE

Epilepsy is a chronic neurological illness that affects 2.7 million people in the United States, but remains poorly understood. Care providers may not recognize their patients' need for epilepsy information, contributing to treatment barriers, such as stigmatization and poor patient-provider communication.

METHODS

The current study piloted a survey of epilepsy-related attitudes and perceptions of 33 Midwestern neurologists. The survey included questions about perceived barriers to and motivators for treatment, thoughts on misperceptions of epilepsy in the community and in the patient population, and potential interventions to address misperceptions.

RESULTS

Respondents perceived misinformation and lack of knowledge in patients and the general public that could be contributing to the barriers that exist to treat patients adequately. Respondents suggested potential methods for addressing misperceptions effectively.

DISCUSSION

This study of neurologists' perceptions about epilepsy barriers and needs provides an important perspective for the development of interventions to address misperceptions and barriers among patients and the public.

E-Learning Courses in Epilepsy?Concept, Evaluation, and Experience with the E-Learning Course "Genetics of Epilepsies"

PURPOSE

To evaluate the efficacy of the e-learning course "Genetics of Epilepsies" and to assess the experiences of the participants and e-moderators with this new approach.

METHODS

Prospective, controlled study with waiting group (control group, n = 18) and e-learning group (n = 20). The control group got the same reference literature list as the e-learning group. Both groups were assessed twice: The e-learning group before and after the course; the control group was assessed at the same times.

PRIMARY OUTCOME MEASURE

increase in knowledge about genetics of epilepsies using questionnaires based on items formulated by experts (internal consistency, Cronbach's alpha = 0.86). Main hypothesis: greater increase of knowledge in the e-learning group compared to control group.

SECONDARY OUTCOME MEASURES

assessment of the educational course and learning environment by participants and by tutors/e-moderators.

RESULTS

Significant time x group interaction and group effect (ANOVA, each p < 0.01) with regard to knowledge. At baseline, the groups did not differ with respect to knowledge about genetics of epilepsy. In contrast to the control group, the increase of knowledge in the e-learning group was highly significant (p < 0.001). The majority of the participants of the e-learning course was content with their personal learning process (75% agree, 15% strongly agree). Most of them reported a gain in competence in the treatment and counseling of people with epilepsy (38.9% agree, 50% strongly agree). All participants would recommend this course to others and all but one participant are interested in other e-learning courses.

CONCLUSION

The study indicates e-learning courses are an appropriate tool to improve knowledge of physicians in genetics of epilepsy.

Common misconceptions in people with epilepsy

Background and Purpose

This study was undertaken to determine the knowledge that people with epilepsy (PWE) have regarding the nature of epilepsy and its management, and also to identify the factors contributing to their knowledge of epilepsy.

Methods

We studied 79 consecutive PWE who visited the outpatient clinic of Seoul National University Hospital using a structured questionnaire consisting of 27 questions in 3 categories. The mean correct response rate was 61%, with 81% believing that brain cells die during a seizure, 29% considering it dangerous to take a bath or shower alone, and more than 70% believing that taking antiepileptic drugs (AEDs) will impair memory and damage the liver and kidneys.

Results

The mean overall correct-answer rate was significantly related to gender, length of education, type of seizures, and regularity of hospital visits (all p<0.05).

Conclusions

The level of knowledge deviated significantly from the scientific data, especially in the causes of epilepsy, safety issues, and side effects of AEDs. A large-scale study should identify those PWE with the lowest knowledge of epilepsy, and then develop and implement suitable educational intervention programs to improve their knowledge.

Anxiety in patients with epilepsy: systematic review and suggestions for clinical management

Up to 50 or 60% of patients with chronic epilepsy have various mood disorders including depression and anxiety. Whereas the relationship between epilepsy and depression has received much attention, less is known about anxiety disorders. It is now recognized that anxiety can have a profound influence on the quality of life of patients with epilepsy. The relationship between anxiety disorders and epilepsy is complex. It is necessary to distinguish between different manifestations of anxiety disorder: ictal, postictal, and interictal anxiety. Preexisting vulnerability factors, neurobiological factors, iatrogenic influences (antiepileptic drugs, epilepsy surgery), and psychosocial factors are all likely to play a role, but with considerable individual differences. Despite the high prevalence of anxiety disorders in patients with epilepsy, there are no systematic treatment studies or evidence-based guidelines for best treatment practice. Nevertheless, a practical approach based on the temporal relationship between anxiety and epileptic seizures allows clinicians to consider appropriate treatment strategies to reduce the psychiatric comorbidity in patients with epilepsy.

What stroke patients want to know and what medical professionals think they should know about stroke: Korean perspectives

BACKGROUND AND PURPOSE

Patients and medical professionals are likely to have different perspectives of stroke, making what patients want to know about stroke different from what medical professionals think they should know. We wished to determine these differences for patients and medical professionals in South Korea, as well as to identify patients' characteristics associated with perceptions of stroke education.

METHODS

Fifty consecutive patients with acute stroke admitted to Asan Medical Center, Seoul, Korea, and 88 medical professionals (31 doctors and 57 nurses) working in the Departments of Neurology or Neurosurgery were administered a structured questionnaire regarding various aspects of patient education concerning stroke.

RESULTS

The average ranking of total items for stroke education was higher in nurses than in doctors or patients (P < 0.01 for each). Patients gave higher rankings than doctors for 'possibility to cure with drug treatment' (P < 0.01), 'stress management' (P < 0.01), and most items concerning 'general medical knowledge' and 'post-stroke diet management,' whereas doctors gave higher rankings than patients for most items concerning risk factor management and treatment with surgery. Items concerning 'post-stroke diet management' were ranked lower by male patients than females patients (P < 0.005), and were ranked lower by doctors than by patients or nurses (P < 0.001). Younger patients gave higher rankings than older patients for items concerning 'medical knowledge regarding stroke,' 'exercise,' and 'post-stroke sexual activities' (P < 0.001 for each).

CONCLUSIONS

Perspectives on stroke education differ among doctors, nurses and patients. They also differ according to the situation of the patient. Education of stroke patients should be based on an understanding of these differences.

Familiarity with, knowledge of, and attitudes toward epilepsy in residents of Seoul, South Korea

BACKGROUND AND PURPOSE

The aim of this study was to investigate the perceptions of epilepsy in Seoul, South Korea, a country where social stigma toward epilepsy is still pronounced.

METHODS

We randomly selected 1000 persons living in Seoul and performed telephone interviews regarding public awareness, knowledge, and attitudes toward epilepsy.

RESULTS

Among 1000 respondents, the 92% who had read or heard about epilepsy became the subjects of the study. Word of mouth was most often referenced as a source of knowledge (78%). Forty-seven percentage believed that epilepsy is inheritable, whereas 5% thought that epilepsy is a mental illness. Marriage of their children to an epileptic person, childbearing by women with epilepsy, and employing a person with epilepsy were opposed by more than 50% of respondents. The reasons for the negative attitudes were that epilepsy was hereditary and untreatable (P < 0.05, respectively).

CONCLUSIONS

Our study revealed that there still remains negative attitudes regarding the marriage, childbearing, and employment of persons with epilepsy, which may stem from misconceptions about the cause and treatability of epilepsy, possibly due in part to the influence of herbal medicine, and South Korea's ethnic homogeneity. Public health education either through media or school health education is urgently needed to improve knowledge about, and attitudes toward epilepsy.

Patient's perspective on epilepsy: self-knowledge among Omanis

Improving patients' knowledge has been suggested to improve their symptoms and prognosis. Very little is known about epileptic patient's knowledge of their illness in cross-cultural settings. This pilot study investigated what Omani patients know about their disorder. Patients attending a tertiary hospital completed a structured knowledge questionnaire to elicit information pertaining to aetiology, safety, compliance with medication regimes, legal and employment issues concerning epilepsy.Although correctly endorsing issues related to their medication, this cross-cultural sample was found to have limited knowledge about their condition. In particular, most patients were unable to give accurate indications of epilepsy, neither were they able to give correct responses to questions pertaining to safety and compliance. There is a need for improving patient's knowledge. As with other chronic disorders, people with epilepsy in Oman should receive systematic health education about how to manage the condition most effectively.