Abstracts

Rationale: Patients of some ethnic minorities are less likely to proceed with surgical treatment for epilepsy than their Caucasian counterparts when given the opportunity. This may be due to cultural reasons, preference for medical management, lower expectations or distrust of the medical system. We sought to better understand the decision making process and motivating factors for patients who underwent epilepsy surgery at the Los Angeles County Medical Center. Patients are referred to a specialized intractable epilepsy clinic for presurgical workup, therefore access to care is not a factor. Methods: Patients who had undergone temporal lobectomy at Los Angeles County Medical Center between 2004 and 2009 were interviewed either in person or by phone. Patients were asked to rank different factors in making their decision for surgery using a modified Likert Scale. Patients were also asked questions regarding their doctor patient relationship. Results: Fifteen out of 32 patients completed questionnaires, 7 males and 8 females. Average age was 41 years. Country of origin was: USA n=2, Central America n=12 (Mexico =9, Guatamala=1, El Salvador=2), South America n=1. All patients reported household incomes below the poverty level. Four out of 15 (26.6%) had some high school or college education. When asked “How important on a scale of 1-5 (1 = most significant, 5 = least significant) were these people in affecting your decision to have epilepsy surgery?” Self was most important followed by physician and family (average score 1.1, 1.6, and 2.1 respectively). Friends and another patient with epilepsy were least important (average score 3.3 and 4.2 respectively). When asked “How important on a scale of 1-5 (1 = most significant, 5 = least significant) were these factors in affecting your decision to have epilepsy surgery?” Taking care of your family was the most important factor followed by ability to work and ability to drive (average score 1.1, 2.4, 3.1 respectively). School and finding a partner (average score 3.8 and 4.1 respectively) were less motivating factors even though 80% were single or divorced. Eighty six percent felt that they had a good relationship with their physician although only 53% remembered the name of their physician(s). Sixty six percent of the Hispanic patients used an interpreter when speaking with their physician. All patients felt epilepsy surgery was the best decision for them. Eighty six percent had Engel Class I outcome. Conclusions: Patients who proceeded with epilepsy surgery over medical management in our urban, predominantly Hispanic low income population felt that they and their physicians were the most important people driving their decision. A desire to take care of one’s family was a more important reason to proceed with surgery than the specific activities of working and driving. Perceived good relationship with physician and internal locus of control in decision making as well as the need to care for family members may lead to utilization of surgical options in this group. Further studies, especially of those who refuse surgery, are warranted.