Abstracts

Rationale: Family-Centred Care (FCC) is a clinical approach in paediatric medicine that treats children within the context of the family. To provide this form of care is to become cognizant of the psychological and social implications of a chronic condition - in this case, epilepsy. A diagnosis of epilepsy is often associated with stigma that modifies family dynamics and isolates children from their peers. FCC has the potential to negate some of the impacts on the child and his or her family, including psychosocial adjustment and parental stress. Originally developed for children with chronic physical conditions, the MPOC-20 asks parents how family-centred they perceive their child's care to have been in the past year. The MPOC-20 measures FCC across five domains: Enabling and Partnership, Providing General Information, Providing Specific Information, Coordinated and Comprehensive Care, and Respectful and Supportive Care. Evidence suggests that the MPOC-20 may be suitable for use in assessing the impact of FCC on child and family outcomes. Because treatment for children with epilepsy differs from that of children with other chronic physical conditions, it is important to examine whether the MPOC-20 is acceptable for use in this population or whether it needs to be adapted to reflect differences in care. The objectives of this study are to i) test whether the 5-domain structure of the MPOC-20 is observed in a sample of children with epilepsy and ii) to propose adaptations to improve its utility in this population. Methods: Data came from the Health-related Quality of Life of Children with Epilepsy Study (HERQULES), a multi-centre prospective cohort study (n=374) following children 4-12 years of age for 2 years after diagnosis. Using Confirmatory Factor Analysis (CFA), the 5 domains were tested on a sample of children with epilepsy approximately 6 months following diagnosis. After ascertaining goodness-of-fit statistics, sources of ill model fit were examined for direction on how to modify the questionnaire, with the theoretical framework of FCC used to guide decision-making. Results: The 5 domains proposed by the originators of the MPOC-20 were found to be inadmissible, with 4 of the 5 factors demonstrating high correlations (r > 0.85). After collapsing the inter-correlated factors, a 2-domain solution with a mediocre fit emerged (RMSEA=0.098, CFI=0.901, SRMR=0.053). The Lagrange Multiplier test statistics identified 5 items as the source of poor model fit. Removing the 5 items and re-running the CFA resulted in an adequate model fit (RMSEA=0.074, CFI=0.943, SRMR=0.037). Conclusions: Results suggest that two domains, captured by 15 items of the MPOC-20, better reflect FCC in children with epilepsy than the original MPOC-20. Using the domains of ‘Family-Centred Care' and ‘Providing General Information,' researchers can better characterize the impact that FCC has on a number of outcomes for children with epilepsy, including health-related quality of life.