Abstracts

Rationale: Epilepsy surgery outcomes research has predominantly focused on improvement of seizures and less frequently on quality of life measurements (QOL). Although patient satisfaction is important to evaluate therapeutic interventions, it is rarely directly measured following epilepsy surgery. This may be due to lack of clarity in the meaning of satisfaction and its presumed overlap with QOL measures.1 However, the assumption that positive QOL is indicative of the patient’s satisfaction with treatment can be misleading.2 Further, differentiating satisfied from dissatisfied patients is of direct relevance to clinicians in post-surgical management and provides an important framework to view surgical outcomes. Methods: We reviewed theoretical constructs of patient satisfaction models including health state measurement (e.g., Valuation of Health States, Health State Preferences and Utilities) and models of patient satisfaction with care and treatment.1 We also reviewed epilepsy-specific QOL scales for patient satisfaction content. Medline and PsycInfo databases were searched from 1950 to 2008. Keywords included ‘epilepsy surgery’, ‘patient satisfaction’, and ‘perceived impact’. Articles were selected if they described a post-epilepsy surgery study in which patient satisfaction with surgical outcome was measured. Results: We found 4 studies specifically addressing satisfaction with results of epilepsy surgery.3-6 Three studies employed global affective evaluation of satisfaction assessed with a single question (i.e., “how satisfied are you with surgery outcome?”)3,5-6. While one study used a dichotomous rating of satisfaction (yes/no) 3, all other studies utilized Likert-type scales. Two studies employed a behavioral intention dimension (i.e., If you could do it over again, would you have epilepsy surgery?”)4,6. Results were consistent across studies. A substantial proportion of patients reported high levels of satisfaction (75%3, 52%5, 78%6) and indicated they would undergo surgery again (85% 4; 75% 6). Seizure freedom was correlated with satisfaction ratings. The association between satisfaction and QOL was not assessed. The commonly used epilepsy-specific instruments (QOLIE-89 and EFA Concerns Index) 7,8 as well as the only epilepsy surgery specific instrument (ESI-55)9 do not address patient satisfaction with treatment in general or with surgery. Conclusions: Few studies have systematically analysed patient satisfaction with epilepsy surgery. Those that have used global measures and found a high degree of satisfaction with surgery outcome. Although global satisfaction measures are direct and easy to use, they do not provide information on 1) specific factors that may underlie treatment satisfaction, or 2) how different components could be combined or weighted to maximize sensitivity and responsiveness of satisfaction measures. Existing studies also do not inform on the relationship between satisfaction and QOL, nor on the influence of pre-surgical expectations in shaping post-operative satisfaction. Possible new approaches to evaluating patient satisfaction with surgery are discussed.