Abstracts

Rationale: Patients with medically refractory epilepsy may opt for surgery as a potential treatment if the source of the seizures can be localized. Seizure free rates following epilepsy surgery are between 48-84%, but prior research shows that surgery is underutilized in minority patients. There is scant data that accounts for this disparity. The purpose of this study is to determine if social determinants of health, including health literacy, patient trust, and self-efficacy, play a role in patients' attitudes toward more advanced treatment options. This would help to improve the quality of care for many minority and low-income patients. Methods: In this prospective cohort study, a survey was given to subjects with established diagnosis of epilepsy and a chief complaint of seizures. The survey consisted of five sections, including demographic questions, instruments to assess health literacy, patient self-efficacy, patient trust, and finally descriptions of four treatment options (experimental drug trial, vagus nerve stimulator, Neuropace, epilepsy surgery) with a question to gauge interest in these advanced therapies. A Likert scale ranging from 1-5 was used for all questions. Interest in advanced therapy options was analyzed as binary variables with scores 3-5 as amenable/interested and 1-2 as not interested. The survey was offered in both English and Spanish. Statistical analysis involved multivariate analysis using interest in advanced therapy as the primary outcome and social determinants of health as predictor variables. Results: A total of 72 patients with complete survey data were included for analysis. The survey population included 26 African-Americans, 30 Whites, 12 Latino, and 4 Other. The average composite score for health literacy was 3.53, self-efficacy was 4.07, and patient trust was 3.71. The average interest scores in advanced treatment options were as follows: new medication trial = 2.75, VNS = 2.64, Neuropace = 2.33, and epilepsy surgery = 2.07. In multivariate analysis, Latino subjects were more interested in epilepsy surgery (OR=1.44, 95% CI=1.05-1.98, p=0.025), VNS (OR=1.47, 95% CI=1.05-2.05, p= 0.026), and Neuropace (OR=1.51, 95% CI=1.09-2.07, p=0.014) than other groups, and men were more likely to be interested in Neuropace than women (OR=1.33, 95% CI=1.07-1.66, p=0.012). When controlling for demographics, there were no significant effects of self-efficacy, health literacy, and patient trust on interest in advanced therapy. Conclusions: The aim of this study was to find out why minority patients are not getting epilepsy surgery as much as their counterparts. While we did see low interest in the treatment options and a downward trend as the options got more invasive, we were unable to prove whether social determinants of health play a role in this lack of interest. We did not find all minorities to be less interested in epilepsy surgery, and in fact show that Latino patients would be more interested in some of the more advanced treatment options than the other groups in our study population. Some of the limitations of the study were a small sample size and including epilepsy patients that were not surgical candidates. Also several patients felt the questions used to determine epilepsy self-efficacy were vague, therefore a more precise instrument could be used. We took particular interest in subjects that chose neutral for the different treatment options. What would it take to convince these individuals of a medical device or surgical procedure if their epilepsy was severely limiting their quality of life? More research is certainly needed to help understand patients' opinions of more advanced treatment options so we can help to address those issues and improve quality of care. Funding: AAN Medical Student Summer Research Scholarship