Barriers toward epilepsy surgery. A survey among practicing neurologists
Barriers toward epilepsy surgery. A survey among practicing neurologists
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DOI：
10.1111/j.1528-1167.2011.03282.x
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发表时间：
2012-01-01
期刊：
影响因子：
5.6
通讯作者：
Pupillo, Elisabetta
中科院分区：
文献类型：
--
作者：
Erba, Giuseppe;Moja, Lorenzo;Pupillo, Elisabetta
目的：难治性癫痫指南建议及时将潜在的手术候选人转诊到癫痫中心进行评估。然而，这种方法很少是治疗神经科医生的优先事项，可能是因为以前的做法和个人态度的惯性，导致心理社会残疾的积累和发病率和死亡率的风险增加。本研究的目的是评估知识和态度癫痫手术之间的执业神经科医生，并确定延迟treatment.Methods的障碍：我们调查了183意大利成人和儿童神经科医生与一个特设的问卷调查，探讨医生的意愿转介癫痫手术的患者时，这种治疗可能是指。14个问题中有13个问题的答案评分范围为1（不利于手术）至10（有利）。我们比较了神经科医生的总分和每个问题的得分与一组学术和临床领导人在field.Key结果：神经科医生给出的反应特点是极端的变化（即。例如，宽的四分位数范围）。专家们有更高的和更少的变量评分有利于手术。两组在药物治疗时间长短、手术适应症和结果等问题上存在显著差异。多因素分析显示，神经科医生的态度与转诊手术的患者数量（p <0.01）和获得专科的地理区域（p <0.01）相关。其他变量，如在实践中，癫痫治疗的患者人数，或专业类型的医生的behavior.Significance没有预测价值：大多数意大利神经科医生对癫痫手术的态度高度可变，反映了矛盾和不确定性对这种类型的治疗。大约三分之二的应答者与意见领袖不一致，主要是由于在处理药物治疗和癫痫手术信息方面的差异，这影响了他们的态度，并最终影响了患者的管理。可能解决缺乏一致性的策略包括加强耐药性和相关风险的概念，而不是手术的安全性和潜在益处，在随访期间使用癫痫质量指标，以及采用结构化转诊单和患者更多地参与决策。这些措施应有助于转诊潜在的候选人进行手术评估，并提高整体护理质量。
Purpose: Guidelines for refractory epilepsy recommend timely referral of potential surgical candidates to an epilepsy center for evaluation. However, this approach is seldom a priority for treating neurologists, possibly because of inertia of previous practice and personal attitudes, leading to a buildup of psychosocial disabilities and increased risk of morbidity and mortality. The aim of this study was to assess knowledge and attitudes toward epilepsy surgery among practicing neurologists and identify the barriers that delay the treatment.Methods: We surveyed 183 Italian adult and child neurologists with an ad hoc questionnaire exploring physicians' willingness to refer patients for epilepsy surgery when such treatment may be indicated. Thirteen of 14 questions had graded answers ranging from 1 (unfavorable to surgery) to 10 (favorable). We compared the overall scores and per-question scores of the neurologists versus a group of academic and clinical leaders in the field.Key Findings: The neurologists gave responses characterized by extreme variability (i. e., wide response interquartile range) around intermediate scores. Experts had higher and less variable scores favoring surgery. The two groups differed significantly on issues such as how long to pursue pharmacologic treatment and information about indications and outcome of surgery. Multivariate analysis indicated that neurologists' attitudes correlated with the number of patients referred for surgery (p < 0.01) and the geographical region where specialty was attained (p < 0.01). Other variables such as years in practice, number of patients treated for epilepsy, or type of specialty had no predictive value on physicians' behavior.Significance: The majority of Italian neurologists have highly variable attitudes toward epilepsy surgery, reflecting ambivalence and uncertainty toward this type of treatment. About two thirds of responders are nonaligned with the opinion leaders, mainly due to differences in handling pharmacologic treatment and information regarding epilepsy surgery, which affect their attitudes and ultimately patient management. Strategies that may solve the lack of agreement include reinforcing the concept of pharmacoresistance and associated risks, as opposed to the safety and potential benefits of surgery, the use of epilepsy quality measures during follow-up, and the adoption of structured referral sheets and greater involvement of patients in decision making. These measures should facilitate the referral of potential candidates for surgical evaluation and improve overall quality of care.