Development of a rapid screener to elicit patient preferences for antiseizure medication discontinuation

Objective: While guidelines encourage individualized discussions of the risks and benefits of antiseizure medication (ASM) withdrawal after a period of seizure-freedom, no formal methods exist for assessing patient preferences. We report the initial development of a rapid patient preferences screener. Methods: We conducted a mixed-methods study of adults who were ≥1 year seizure-free and seen for epilepsy across three institutions. We reviewed existing questionnaires and adapted three questions measuring core constructs influencing ASM decisions – views about ASMs, driving restrictions, and seizures. We added one additional “global” question, for 4 total questions. Participants rated question clarity and utility from 1 (low) to 7 (high). Results: Of 32 participants, the median patient age was 46 (interquartile range [IQR] 33–56), with a median 3 years since their last seizure (IQR 2–11). Median responses were: 2 (IQR 1–5) for being bothered by ASMs, 2 (IQR 1–6) for feeling that a driving restriction would be disruptive, and 5 (IQR 4–7) for feeling that another seizure would be serious. Respondents tended to disagree that ASMs are doing more harm than good (median 1, IQR 1–2). Participants rated question clarity (median 6, IQR 6–7) and utility (median 7, IQR 6–7) highly. Conclusions: We report the initial development of a pre-visit rapid screener of patient preferences pertinent to ASM withdrawal in well-controlled epilepsy. Patients endorsed the utility of such a screener and provided guidance to improve items. We hope that this work will ultimately improve shared decision-making.