Perspectives of adults with epilepsy and their support persons on self-management support

Rare, epilepsy-related disorder including intellectual disability - A scoping review of caregivers' identified information needs

AIMS

The aims of this review were: (1) to obtain an overview of caregiver-reported information needs; and (2) to investigate if there are information needs that are unique for caregivers of persons with rare epilepsies.

METHOD

We followed the scoping review framework outlined by Arksey and O'Malley and the preferred reporting items outlined by PRISMA.

RESULTS

Among the 17 articles that met the inclusion criteria, 5 included caregivers of persons with rare epilepsies. Categories of information needs: (1) Medical information; (2) Information on how to cope with emotional distress; (3) Experiential information from peers; and (4) Interdisciplinary information exchange. The need for disorder-specific information seemed particularly important for caregivers of persons with rare epilepsies.

CONCLUSION

There is a need for further studies, particularly on formal caregivers' information needs.

Use of the self- and family management framework and implications for further development

BACKGROUND

The Self- and Family Management Framework (SFMF) was created in 2006 and revised in 2015 to guide research on self- and family management of chronic conditions. There has been no review of use of the SFMF.

PURPOSE

We reviewed articles citing the SFMF to identify the frequency and nature of use.

METHOD

We conducted a citation analysis, searching Web of Science, Scopus, and Google Scholar databases and extracted key data from identified articles.

FINDINGS

Of 126 articles, 84(66%) cited the 2006 SFMF, 37(29%) cited the 2015 SFMF, and 6(5%) cited both. The SFMF was used most to inform study design. Users noted strengths (e.g., considers family context) and limitations (e.g., non-specification of patient- family caregiver synergies) of the framework.

DISCUSSION

The SFMF has been used broadly to guide research on self- and family management of chronic conditions. Findings will inform development of a third version of the SFMF.

Reciprocal burden: Adults with drug-resistant epilepsy reflect upon informal caregiver support

PURPOSE

To explore how a sample of people with uncontrolled seizures describe their experiences of receiving informal supportive care.

METHODS

Using constructivist grounded theory, in-person, semi-structured interviews were conducted in 35 adults with drug-resistant epilepsy. These 20 (57%) women and 15 (43%) men were aged 18-68 years (mean= 35.6 years), with a range of verbal comprehension scores. The majority, 28 (80%) lived in nuclear family settings.

RESULTS

Unpredictable seizures disrupted personal autonomy and generated unique challenges for everyday life. While supportive care was deemed necessary to survival, subjective reflections around the implications of care-receiving and caregiving, were ultimately experienced as mutually burdensome. Four dynamic and interactive dimensions revealed a mirrored, interactive perspective of what it meant to be a care-recipient: assuming responsibility; protecting and supervising; acknowledging reliance and setting boundaries. Care-recipience was not one-sided, but included actively hiding personal struggles as a way to shield the caregiver from the emotional and physical demands of caregiving. Relationship dynamics between caregivers and care-recipients played a major role in treatment decision-making. A clinically useful Theory of Reciprocal Burden resulted from our study.

CONCLUSIONS

This study adds an explanatory dimension to the concept of illness burden from the perspective of care-recipients. Relationship dynamics play a key role in patient-centered epilepsy care, with clinical implications for guiding supportive caregiving, fostering independence and promoting self-management strategies.

Interrogating the promise of technology in epilepsy care: systematic, hermeneutic review

Technology development is gathering pace in epilepsy with seizure detection devices promising to transform self-care and service provision. However, such accounts often neglect the uncertainties, displacements and responsibilities that technology-supported care generates. This review brings together a heterogeneous literature, identified through systematic searches in 8 databases and snowball searching, to interrogate how technology becomes positioned in epilepsy care. We took a hermeneutic approach in our analysis of the 206 included articles, which resulted in the development of a conceptual framework surfacing the underlying logics by which technology-supported epilepsy care is organised. Each of these logics enacts different techno-scientific futures and carries specific assumptions about how (often imagined) 'users' and their bodies become co-constituted. Our review shows that studies in this area remain primarily deterministic and technology-focused. Few draw phenomenological insights on lived experiences with epilepsy or use social theory to problematise the role of technology. We propose future directions for sociotechnical, theory-driven studies of technology in epilepsy care and offer a framework transferable across other long-term conditions.

Functional Mastery in Patients With Inflammatory Bowel Disease

BACKGROUND

Inflammatory bowel disease (IBD) is an incurable autoimmune disease causing overwhelming physical distress and psychological adaptation.

PURPOSE

To explore the associations between foundational influences and personal characteristics predictors to the achievement of mastery of health in patients with IBD.

THEORY

Orem's Theory of Self-Care, Resnick's Theory of Self-Efficacy, and Pearlin and Schooler's study of the structure of coping guided this study. The conceptual framework used was the Functional Mastery of Health Ownership (FMHO) model.

METHODS

A predictive correlational study design using self-administered questionnaires was used. A convenience sample of 151 adults with a diagnosis of IBD for at least 1 year was recruited from the patient population of a gastroenterology medical practice.

RESULTS

Data were analyzed using multiple regression with standard entry factor loading. Portions of the model were found to be significant and account for 44% of the variance (p < .001; R ² = .44, Adjusted R ² = .41). Significant relationships were found among mastery and IBD self-efficacy, perception of mastery, and current health status. Females had higher mastery scores than males.

SIGNIFICANCE

These findings support the use of a modified FMHO model to predict needs that enable individualized stewardship of health for patients with IBD.

Written Accounts of Living With Epilepsy or Psychogenic Nonepileptic Seizures: A Thematic Comparison

This study examines the subjective experience of living with epilepsy or psychogenic nonepileptic seizures (PNES) by thematically comparing individuals' written accounts of their condition. Five key differences emerged. Theme 1: "Seizure onset" revealed differences in how individuals think about and ruminate over the possible causes of their condition. Theme 2: "Emotive tone" demonstrated that writings of those with epilepsy reflected stable emotions (no intense emotional reactions), whereas those of writers with PNES reflected anxiety and low mood. Theme 3: "Seizure symptoms" showed differences in the conceptualization of seizures. Theme 4: "Treatment" explored differences in the diagnostic journey and experiences of health care professionals. Theme 5: "Daily life" revealed that those with epilepsy perceived sequelae and seizures as something that must be fought, whereas those with PNES tended to describe their seizures as a place they enter and something that has destroyed their lives. The findings have implications for treatment and management.

Functional mastery of health ownership: A model for optimum health

The aim of this paper is to introduce the Functional Mastery of Health Ownership (FMHO) model and to develop an operational definition of functional mastery as it applies to a positive health outcome for patients with chronic illness or an altered life situation. Daily functioning within the negative disease burden of chronic illness is the goal of individuals living within the constraints of morbidity. Functional mastery fosters health ownership and helps to predict successful control over life circumstances for optimum wellness within the parameters of the limitations of the effects of illness. Significant to nursing, the FMHO conceptual framework uses four foundational influences to assess a patient's ability to not only master function within the disease process, but also to sustain function and best health over time. The FMHO model provides a tool for practitioners to enable individualized care as patients move through the disease process and adapt to changes over time.

Barriers and facilitators to epilepsy self-management for patients with physical and psychological co-morbidity

Objectives This exploratory study identifies barriers and facilitators to self-management to inform future epilepsy self-management interventions for persons who have epilepsy complicated by co-morbid mental health conditions and serious medical events. Methods Focus group methods were used in a series of community advisory board meetings. Analysis was conducted using a thematic, constant comparative approach aiming to describe the range of barriers and facilitators salient to participants. There were a total of 22 participants, including 8 health professionals, 9 patients with epilepsy, and 5 care partners. Mean age was 49.1 (SD = 11.0, range 32-69), 11 (50%) were female, and 11 (50%) were male. For those with epilepsy, mean years having epilepsy was 24.7 (SD = 19.9, range 1-58 years). Results Individual psychological barriers (mental illness, fatigue, and psychological distress) prominently interfered with health behaviors. Community and family barriers included stigma, lack of epilepsy knowledge, and poor social support. Facilitators included planning for seizures, learning about medications, stress management, socializing with others, and talking with other epilepsy patients. Discussion Qualitative evidence in this study suggests a linkage between social integration and positive health behaviors. Future efforts to embed patients with epilepsy and their caregivers into clinical care processes could offset barriers and enhance facilitators.

A dyadic model of living with epilepsy based on the perspectives of adults with epilepsy and their support persons

Epilepsy is a chronic condition that significantly affects the lives of individuals with epilepsy and their support persons, though few studies have examined the experiences of both. To examine these experiences and explore the interpersonal relationships between dyad members, we conducted in-depth interviews with 22 persons with epilepsy and 16 support persons. Data analysis was guided by a grounded theory perspective. We developed a model that shows how epilepsy impacts the lives of both persons with epilepsy and their support persons and how the experiences of persons with epilepsy and supporters influence one another. The core model elements were seizure and treatment factors, relationship characteristics, self-management, seizure control, support provided, illness intrusiveness, and quality of life. Persons with epilepsy moved through the model in five trajectories depending on seizure control, relationship type, and gender. Support providers followed four trajectories based on seizure control, perception of burden, and support for themselves. Persons with epilepsy and their primary support providers have varied experiences in how epilepsy affects their lives. This model could serve as a basis for future research and intervention efforts focused on ways to reduce illness intrusiveness and improve quality of life for persons with epilepsy and their supporters.