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García-Bravo C, Martínez-Piédrola RM, García-Bravo S, Rodríguez-Pérez MP, Martín-Gómez AS, Fernández-Gómez G, Palacios-Ceña D. Living with and managing seizures among parents of children diagnosed with Phelan-McDermid syndrome: a qualitative study using in-depth interviews. Eur J Pediatr 2024; 183:253-262. [PMID: 37870610 DOI: 10.1007/s00431-023-05285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
To describe the experience of parents of children diagnosed with Phelan-McDermid syndrome (PMS) in relation to epileptic seizures and/or convulsions, their daily management and impact on family life. A qualitative descriptive study was conducted. The study included parents of children diagnosed with PMS by a medical specialist. Purposive sampling was used, and data were collected via in-depth interviews. A thematic analysis was performed on the data. This study was conducted according to the Standards for Reporting Qualitative Research. Thirty-two parents were recruited. Four themes were identified: (a) the first epileptic seizure, where the first seizure appears abruptly and unexpectedly; (b) living with seizures, seizures generate high concern about the evolution of the disease and the future of children with PMS; (c) treatment of epileptic seizures, obtaining an adequate treatment is a long process that involves decision making by parents; (d) the impact of epilepsy on the family, where there is a change in the functioning and relationships among family members. Conclusions: It is necessary to develop programs where parents can discuss treatment decisions with professionals and provide coping strategies for the management of epilepsy and seizures. What is Known: • Children with Phelan-McDermid syndrome may develop epilepsy. Parents receive insufficient information for the management and control of seizures. • Parents describe concerns about the evolution of epilepsy in their children's adulthood, along with the impact of seizures and/or convulsions on their children. What is New: • Epilepsy and seizures force the entire family to adapt their lifestyle and give up activities that can trigger seizures. • Parents pointed out the need to create programs to inform about the benefits and disadvantages of pharmacological treatments in order to improve decision making.
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Affiliation(s)
- Cristina García-Bravo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability (TO+IDI) and Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), 28922, Alcorcón, Spain
| | - Rosa Mª Martínez-Piédrola
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability (TO+IDI), Universidad Rey Juan Carlos, Avenida de Atenas S/N, 28922, Alcorcón, Spain.
| | - Sara García-Bravo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain, Physiocare Madrid, Physiotherapy Clinic, 28026, Madrid, Spain
| | - Mª Pilar Rodríguez-Pérez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability (TO+IDI), Universidad Rey Juan Carlos, Avenida de Atenas S/N, 28922, Alcorcón, Spain
| | - Ana San Martín-Gómez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos (Hum&QRinHS), 28922, Alcorcón, Spain
| | - Gemma Fernández-Gómez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability (TO+IDI), Universidad Rey Juan Carlos, Avenida de Atenas S/N, 28922, Alcorcón, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos (Hum&QRinHS), 28922, Alcorcón, Spain
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2
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Asadi-Pooya AA, Shafaei R, Abdolrezaee M, Mohammad Ali Razavizadegan S, Ashjazadeh N. Opinions about epilepsy surgery in adults with epilepsy. Epilepsy Behav 2023; 142:109176. [PMID: 36989567 DOI: 10.1016/j.yebeh.2023.109176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE The goal of the current study was to investigate the opinions of adult patients with epilepsy (PWE) with regard to the application of epilepsy surgery for their condition. METHODS We surveyed all the consecutive adult PWE with at least one year history of epilepsy who were referred to our neurology clinics (Shiraz University of Medical Sciences) from September 2022 until January 2023. Using a questionnaire, the degree of acceptance of epilepsy surgery was measured depending on the chance of seizure freedom and risk for surgery complications. RESULTS In total, 393 adult PWE participated in the study; 180 patients (45.8%) expressed that they would be willing to have surgery if their epilepsy doctor told them that brain surgery was guaranteed to stop their seizures, without regard to the potential surgery complications. The most common reasons for the patients to be willing to have epilepsy surgery were as follows: to become seizure-free and to be able to discontinue their antiseizure medications. The most common reasons for the patients not to be willing to have epilepsy surgery were as follows: feeling of having the seizures under the control with antiseizure medications and fear of surgery complications. CONCLUSION Many patients with epilepsy are willing to have epilepsy surgery if their physician presented epilepsy surgery to them as an established safe and effective treatment option. The important values and priorities of PWE must be considered when designing epilepsy surgery educational materials and programs for preoperative counseling for PWE with drug-resistant seizures.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA.
| | - Razieh Shafaei
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Maryam Abdolrezaee
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Nahid Ashjazadeh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Singh RK, Eschbach K, Samanta D, Perry MS, Liu G, Alexander AL, Wong-Kisiel L, Ostendorf A, Tatachar P, Reddy SB, McCormack MJ, Manuel CM, Gonzalez-Giraldo E, Numis AL, Wolf S, Karia S, Karakas C, Olaya J, Shrey D, Auguste KI, Depositario-Cabacar D. Responsive Neurostimulation in Drug-Resistant Pediatric Epilepsy: Findings From the Epilepsy Surgery Subgroup of the Pediatric Epilepsy Research Consortium. Pediatr Neurol 2023; 143:106-112. [PMID: 37084698 DOI: 10.1016/j.pediatrneurol.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/22/2023] [Accepted: 03/02/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Responsive neurostimulation (RNS), a closed-loop intracranial electrical stimulation system, is a palliative surgical option for patients with drug-resistant epilepsy (DRE). RNS is approved by the US Food and Drug Administration for patients aged ≥18 years with pharmacoresistant partial seizures. The published experience of RNS in children is limited. METHODS This is a combined prospective and retrospective study of patients aged ≤18 years undergoing RNS placement. Patients were identified from the multicenter Pediatric Epilepsy Research Consortium Surgery Registry from January 2018 to December 2021, and additional data relevant to this study were retrospectively collected and analyzed. RESULTS Fifty-six patients received RNS during the study period. The mean age at implantation was 14.9 years; the mean duration of epilepsy, 8.1 years; and the mean number of previously trialed antiseizure medications, 4.2. Five patients (9%) previously trialed dietary therapy, and 19 patients (34%) underwent prior surgery. Most patients (70%) underwent invasive electroencephalography evaluation before RNS implantation. Complications occurred in three patients (5.3%) including malpositioned leads or transient weakness. Follow-up (mean 11.7 months) was available for 55 patients (one lost), and four were seizure-free with RNS off. Outcome analysis of stimulation efficacy was available for 51 patients: 33 patients (65%) were responders (≥50% reduction in seizure frequency), including five patients (10%) who were seizure free at follow-up. CONCLUSIONS For young patients with focal DRE who are not candidates for surgical resection, neuromodulation should be considered. Although RNS is off-label for patients aged <18 years, this multicenter study suggests that it is a safe and effective palliative option for children with focal DRE.
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Affiliation(s)
- Rani K Singh
- Department of Pediatrics, Atrium Health-Levine Children's Hospital, Charlotte, North Carolina; Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Krista Eschbach
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Debopam Samanta
- Child Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Alaska
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Neurosciences Center, Cook Children's Medical Center, Ft Worth, Texas
| | - Gang Liu
- Department of Pediatrics, Atrium Health-Levine Children's Hospital, Charlotte, North Carolina
| | - Allyson L Alexander
- Department of Neurosurgery, School of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado
| | | | - Adam Ostendorf
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | | | - Shilpa B Reddy
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael J McCormack
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad M Manuel
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Adam L Numis
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Steven Wolf
- Department of Pediatrics, Boston Children's Health Physicians, New York, New York
| | - Samir Karia
- Division of Child Neurology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Cemal Karakas
- Division of Child Neurology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Joffre Olaya
- Department of Neurosurgery, Children's Hospital Orange County, Orange, California
| | - Daniel Shrey
- Department of Neurosciences, Children's Hospital Orange County, Orange, California
| | - Kurtis I Auguste
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
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Bergeron D, Iorio-Morin C, Bonizzato M, Lajoie G, Orr Gaucher N, Racine É, Weil AG. Use of Invasive Brain-Computer Interfaces in Pediatric Neurosurgery: Technical and Ethical Considerations. J Child Neurol 2023; 38:223-238. [PMID: 37116888 PMCID: PMC10226009 DOI: 10.1177/08830738231167736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/11/2023] [Accepted: 03/17/2023] [Indexed: 04/30/2023]
Abstract
Invasive brain-computer interfaces hold promise to alleviate disabilities in individuals with neurologic injury, with fully implantable brain-computer interface systems expected to reach the clinic in the upcoming decade. Children with severe neurologic disabilities, like quadriplegic cerebral palsy or cervical spine trauma, could benefit from this technology. However, they have been excluded from clinical trials of intracortical brain-computer interface to date. In this manuscript, we discuss the ethical considerations related to the use of invasive brain-computer interface in children with severe neurologic disabilities. We first review the technical hardware and software considerations for the application of intracortical brain-computer interface in children. We then discuss ethical issues related to motor brain-computer interface use in pediatric neurosurgery. Finally, based on the input of a multidisciplinary panel of experts in fields related to brain-computer interface (functional and restorative neurosurgery, pediatric neurosurgery, mathematics and artificial intelligence research, neuroengineering, pediatric ethics, and pragmatic ethics), we then formulate initial recommendations regarding the clinical use of invasive brain-computer interfaces in children.
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Affiliation(s)
- David Bergeron
- Division of Neurosurgery, Université de Montréal, Montreal, Québec, Canada
| | | | - Marco Bonizzato
- Electrical Engineering Department, Polytechnique Montréal, Montreal, Québec, Canada
- Neuroscience Department and Centre
interdisciplinaire de recherche sur le cerveau et l’apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada
| | - Guillaume Lajoie
- Mathematics and Statistics Department, Université de Montréal, Montreal, Québec, Canada
- Mila - Québec AI Institute, Montréal,
Québec, Canada
| | - Nathalie Orr Gaucher
- Department of Pediatric Emergency
Medicine, CHU Sainte-Justine, Montréal, Québec, Canada
- Bureau de l’Éthique clinique, Faculté
de médecine de l’Université de Montréal, Montreal, Québec, Canada
| | - Éric Racine
- Pragmatic Research Unit, Institute de
Recherche Clinique de Montréal (IRCM), Montreal, Québec, Canada
- Department of Medicine and Department
of Social and Preventative Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Alexander G. Weil
- Division of Neurosurgery, Department
of Surgery, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Département de
Pédiatrie, Université de Montréal, Montreal, Québec, Canada
- Department of Neuroscience, Université de Montréal, Montréal, Québec, Canada
- Brain and Development Research Axis,
CHU Sainte-Justine Research Center, Montréal, Québec, Canada
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5
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Nemati H, Asadi-Pooya AA. Parents' opinions about epilepsy surgery in children with epilepsy. Epilepsy Behav 2022; 137:108949. [PMID: 36327643 DOI: 10.1016/j.yebeh.2022.108949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/02/2022] [Accepted: 10/07/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This survey aimed to investigate the opinions of the parents of children with epilepsy with regard to the application of epilepsy surgery for their children. METHODS We surveyed all the parents of children with epilepsy referred to our neurology clinic (Shiraz University of Medical Sciences) in April-July 2022. We collected their opinions about epilepsy surgery based on a predesigned questionnaire. The inclusion criteria included parents of all children with epilepsy (1 to 16 years of age, with at least one-year history of epilepsy, and with at least one drug used in the past 12 months). RESULTS In total, 472 people participated in the study; 277 participants (58.7%) were willing to have epilepsy surgery for their child; the most common reason was to be able to discontinue the drugs. Sex (male), age (younger), and education (college) of the parents had significant associations with the parental willingness to have surgery for their children. The patient's drug regimen (polytherapy) and history of ictal injury (in the child) also had significant associations with the parental willingness to have surgery for the children. CONCLUSION Most parents of children with epilepsy are willing to have epilepsy surgery for their children if their physician presents epilepsy surgery to them as an established, safe, and effective treatment option. Patient and parental-related factors should be considered when designing educational materials and programs for preoperative counseling for the parents of children with drug-resistant seizures.
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Affiliation(s)
- Hamid Nemati
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA.
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6
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Alam A, Parfyonov M, Huang CY, Gill I, Connolly MB, Illes J. Targeted Whole Exome Sequencing in Children With Early-Onset Epilepsy: Parent Experiences. J Child Neurol 2022; 37:840-850. [PMID: 35921196 PMCID: PMC9554160 DOI: 10.1177/08830738221113901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study investigated the experiences of 25 caregivers of children with early-onset, treatment-resistant epilepsy who pursued whole exome sequencing to determine the impact of the test results on their child's treatment. Caregivers who consented to be recontacted were recruited from a previous study investigating the diagnostic yield of whole exome sequencing. A semistructured interview addressed questions based on one of 2 study phases. The first phase discussed the decision-making process for genetic testing (15 interviews), which revealed 4 major themes: (1) prognosis, (2) engagement, (3) concerns, and (4) autonomy. The second phase discussed the impact of genetic testing on treatment (10 interviews), which revealed 3 major themes: (1) testing features, (2) emotional impact, and (3) treatment outcomes. Overall, parents pursued genetic testing to obtain a clear prognosis, inform treatment decisions, engage with other families, and exercise autonomy. Caregivers felt that early testing is warranted to inform their child's diagnostic odyssey.
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Affiliation(s)
- Armaghan Alam
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maksim Parfyonov
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Camille Y. Huang
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Inderpal Gill
- Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Mary B. Connolly
- Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Judy Illes, CM, PhD, Professor of Neurology, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC V6T 2B5 Canada.
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Apantaku GO, McDonald PJ, Aguiar M, Cabrera LY, Chiong W, Connolly MB, Hrincu V, Ibrahim GM, Kaal KJ, Lawson A, Naftel R, Racine E, Safari A, Harrison M, Illes J. Clinician preferences for neurotechnologies in pediatric drug-resistant epilepsy: A discrete choice experiment. Epilepsia 2022; 63:2338-2349. [PMID: 35699675 PMCID: PMC9796345 DOI: 10.1111/epi.17328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Novel and minimally invasive neurotechnologies offer the potential to reduce the burden of epilepsy while avoiding the risks of conventional resective surgery. Few neurotechnologies have been tested in randomized controlled trials with pediatric populations, leaving clinicians to face decisions about whether to recommend these treatments with insufficient evidence about the relevant risks and benefits. This study specifically explores the preferences of clinicians for treating pediatric drug-resistant epilepsy (DRE) with novel neurotechnologies. METHODS A discrete-choice experiment (DCE) was designed to elicit the preferences of clinicians with experience in treating children with DRE using novel neurotechnological interventions. The preferences for six key attributes used when making treatment decisions (chances of clinically significant improvement in seizures, major and minor risks from intervention, availability of evidence, financial burden for the family, and access to the intervention) were estimated using a conditional logit model. The estimates from this model were then used to predict the adoption of existing novel neurotechnological interventions. RESULTS Sixty-eight clinicians completed the survey: 33 neurosurgeons, 28 neurologists, and 7 other clinicians. Most clinicians were working in the United States (74%), and the remainder (26%) in Canada. All attributes, apart from the nearest location with access to the intervention, influenced preferences significantly. The chance of clinically significant improvement in seizures was the most positive influence on clinician preferences, but low-quality evidence and a higher risk of major complications could offset these preferences. Of the existing neurotechnological interventions, vagus nerve stimulation was predicted to have the highest likelihood of adoption; deep brain stimulation had the lowest likelihood of adoption. SIGNIFICANCE The preferences of clinicians are drive primarily by the likelihood of achieving seizure freedom for their patients, but preferences for an intervention are largely eradicated if only low quality of evidence supporting the intervention is available. Until better evidence supporting the use of potentially effective, novel neurotechnologies becomes available, clinicians are likely to prefer more established treatments.
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Affiliation(s)
- Glory O. Apantaku
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Patrick J. McDonald
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Division of Neurosurgery, Department of Surgery, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Section of Neurosurgery, Department of SurgeryUniversity of ManitobaWinnipegManitobaCanada
| | - Magda Aguiar
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Laura Y. Cabrera
- Department of Science and Mechanics, Center for Neural EngineeringPennsylvania State UniversityUniversity ParkPennsylvaniaUSA,Rock Ethics InstitutePennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Mary B. Connolly
- Division of Neurology, Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Viorica Hrincu
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - K. Julia Kaal
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ashley Lawson
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Robert Naftel
- Department of NeurosurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Eric Racine
- Pragmatic Health Ethics Research UnitInstitut de recherches cliniques de MontréalMontréalQuébecCanada,Department of Preventive and Social Medicine, Faculty of MedicineUniversité de MontréalMontréalQuébecCanada,Department of Neurology and Neurosurgery, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Abdollah Safari
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Mark Harrison
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Centre for Health Evaluation and Outcome SciencesSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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8
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Illes J, Lawson A, McDonald PJ. Ethical Considerations for Discrete Choice Experiments with Caregivers. J Empir Res Hum Res Ethics 2022; 17:426-430. [PMID: 35849082 PMCID: PMC9398987 DOI: 10.1177/15562646221112339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We discuss research ethics challenges experienced while running a discrete choice
experiment administered to caregivers of children with treatment resistant pediatric
epilepsy. We highlight ethical considerations around the study design of the discrete
choice experimental paradigm that pertain to vulnerability of and caregiving burden on the
population, imbalance of benefit-to-load of participation, and limitations of cultural
meaningfulness and generalizability.
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Affiliation(s)
- Judy Illes
- Division of Neurology, Department of Medicine, Neuroethics Canada, University of British Columbia, Vancouver, Canada
| | - Ashley Lawson
- Division of Neurology, Department of Medicine, Neuroethics Canada, University of British Columbia, Vancouver, Canada
| | - Patrick J McDonald
- Division of Neurology, Department of Medicine, Neuroethics Canada, University of British Columbia, Vancouver, Canada.,Section of Neurosurgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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9
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Apantaku G, Aguiar M, Kaal KJ, McDonald PJ, Connolly MB, Hrincu V, Illes J, Harrison M. Understanding Attributes that Influence Physician and Caregiver Decisions About Neurotechnology for Pediatric Drug-Resistant Epilepsy: A Formative Qualitative Study to Support the Development of a Discrete Choice Experiment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:219-232. [PMID: 34431073 PMCID: PMC8866382 DOI: 10.1007/s40271-021-00544-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study reports formative qualitative research used to analyze decision making regarding neurotechnological interventions for pediatric drug-resistant epilepsy from the perspective of physicians and caregivers and the derivation of attributes for a discrete choice experiment. METHODS Purposive and convenience sampling was used to recruit physicians and caregivers. Physician focus group sessions were held at key national conferences in the USA and Canada. Caregivers were approached through clinics with established epilepsy surgery programs in the USA and Canada. Thematic analysis was used to identify critical features of decisions about treatment outcomes, procedural trade-offs, values, and concerns surrounding conventional and novel pediatric drug-resistant epilepsy interventions among physicians and caregivers. RESULTS The results highlight the presence of central attributes that are considered by both groups in decision making, such as "chances of seizure freedom", "risk", "availability of evidence", and "cost to families", as well as attributes that reflect important differences between groups. Physicians were focused on the specifics of treatment options, while caregivers thought more holistically, considering the overall well-being of their children. DISCUSSION The findings shaped the development of a discrete choice experiment to understand the likely uptake of different neurotechnologies. We identified differences in decision making and thus designed two discrete choice experiments to elicit preferences for pediatric drug-resistant epilepsy treatments, one aimed at clinicians and one at caregivers. The variation we observed highlights the value of seeking to understand the influences at the point of clinical decision making and incorporating this information into care.
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Affiliation(s)
- Glory Apantaku
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver Campus, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Magda Aguiar
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver Campus, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - K Julia Kaal
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver Campus, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Patrick J McDonald
- Division of Neurology, Department of Medicine, Neuroethics Canada, University of British Columbia, 2211 Wesbrook Mall, Koerner, S124, Vancouver, BC, V6T 2B5, Canada.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Viorica Hrincu
- Division of Neurology, Department of Medicine, Neuroethics Canada, University of British Columbia, 2211 Wesbrook Mall, Koerner, S124, Vancouver, BC, V6T 2B5, Canada
| | - Judy Illes
- Division of Neurology, Department of Medicine, Neuroethics Canada, University of British Columbia, 2211 Wesbrook Mall, Koerner, S124, Vancouver, BC, V6T 2B5, Canada.
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver Campus, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.
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