Abstracts

Rationale: The complex nature of epilepsy, the high prevalence of psychiatric symptoms and disorders and the potential negative side effects of anti-epileptic drugs (AEDs) related to these patient characteristics mandates a careful and comprehensive assessment of epilepsy patients. Examining physician-patient communication provides insight into how these important subjects are discussed. However, many studies of physician-patient communication about epilepsy rely upon self-reported measures such as questionnaires or surveys. To date, no research has analyzed in-office conversations between physicians and their patients with epilepsy, nor have any studies compared actual dialogues to both parties’ post-visit understanding. An observational in-office linguistic study was conducted to analyze how neurologists and patients discuss side effect management, in order to identify gaps in communication and develop recommendations to improve in-office dialogue. Methods: 1493 community-based neurologists were sent invitation letters; of these, 20 met screening criteria, were available during the specified time period, and agreed to participate. Signed consent was obtained from all providers and patients with epilepsy (n=60). Discussions between patients and neurologists were recorded during a single, regularly-scheduled visit. Both parties were interviewed separately post-visit to capture the intent and comprehension of each. All dialogue components were transcribed, analyzed and correlated using validated sociolinguistic models. Results: Visits were characterized by superficial assessments of the side effects of epilepsy medications, as well as minimal attention to the psychosocial condition and possible mood/behavior issues by both patients and neurologists. Specifically: Side effects were assessed in only 75% of visits with patients already on therapy (44 of 59). Pysicians raised 71% of all side effects discussed (134 of 190); patients confirmed 27% of physician-raised side effects (36 of 134). When asked post-visit, 33% of physicians and patients did not agree on what side effects the patient actually was experiencing (20 of 60). Significantly more discussions of mood topics occurred in patient post-visit interviews than during the office visits or physician post-visit interviews (55%). Discussions of mood-related topics took place in 36% of physician post-visit interviews and only 9% of visits. Conclusions: Linguistic analysis of in-office dialogue and post-visit interviews revealed areas for improvement in both quantity and content of discussions of side effects and mood. New communication strategies may help meet the specific needs of neurologists engaging in dialogue with patients with epilepsy. The use of in-office tools or questionnaires to assess side effects and/or mood may increase office efficiency and better enable neurologists to provide customized, patient-centered care. Study sponsored by Ortho-McNeil Neurologics. Ortho-McNeil Neurologics has not influenced the content of the results summary.