Authors :
Presenting Author: Laura Kirkpatrick, MD – University of Pittsburgh
Erin Friel, BPhil – University of Pittsburgh
Marie Clements, MD – University of Louisville
Christina Briscoe, MD, EdM – Boston Children's Hospital
Page Pennell, MD – University of Pittsburgh
Jasmin Rivero-Guerra, n/a – University of Pittsburgh
Judy Chang, MD, MPH – University of Pittsburgh
Rationale: The American Academy of Neurology (AAN) 2017 Women with Epilepsy quality measure advises all neurologists, including child neurologists, to counsel all females with epilepsy ages 12-44 at least annually about at least 2 of the 3 following topics: folic acid supplementation, interactions between antiseizure medications (ASMs) and contraception, and the impact of epilepsy and ASMs on pregnancy and fetal/child development. Little is known about whether child neurologists are able to perform this counseling for youth with epilepsy in a guideline-concordant, factually accurate, and stylistically comprehensible manner.
Methods: We invited child neurology residents/fellows (PGY-3 and above), attending physicians, and advanced practice providers (APPs) to engage in 3 virtual scenarios, simulating telemedicine appointments, in which they were instructed to perform their best attempt at reproductive health counseling for a female youth with epilepsy +/- a parent. We provided participants with detailed medical information about the patient in advance of each scenario. We recorded and transcribed simulations. Two coders performed content analysis to identify discussion of guideline-concordant counseling topics. The coders assessed factual accuracy through consensus coding. Coders also used a codebook informed by U.S government plain language standards - as previously adapted for verbal healthcare communication studies - to deductively identify stylistic features of counseling in the transcripts that are important for clear communication of healthcare information.
Results:
Twenty-one individuals each performed 3 scenarios, including 11 attending physicians, 10 residents/fellows, and 1 APP. Twelve (57%) addressed at least 2 of the 3 topics in the AAN quality measure across all 3 scenarios. None (0%) performed guideline-concordant counseling without any factual inaccuracies or omissions of key ASM-specific information (i.e. teratogenicity or contraceptive drug interactions) across all 3 scenarios. Details of participant performance across the 3 scenarios are displayed in Figure 1.
Qualitative analysis revealed that provider communication was rarely consistent with plain language standards. Common stylistic features included: 1) long conversational turns, 2) multiple topics per turn, 3) complex sentence structures, 4) use of jargon. Representative quotations demonstrating common stylistic features of counseling are displayed in Table 1.
When stratified by attending physicians versus other professionals, there were no statistical or qualitative differences in performance for any scenario.
Conclusions: In case-based roleplay scenarios, most child neurologists discussed at least two of three AAN-recommended topics. However, factual inaccuracies, key omissions, and unclear communication were often present. Given that participants volunteered for a study on this topic, we anticipate that a random sample would have fared worse. We will develop a training intervention for child neurologists as a future direction.
Funding: Children's Trust Grantmakers' Award