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Table 6 Highest priority evidence gaps

From: Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods

PICOTS DomainEvidence Gap
PopulationResearch is needed with patients who are earlier in their course of illness and studies specifically focused on older adults with epilepsy. Evaluation of interventions and barriers/facilitators to implementation and adoption of self-management interventions with patients and in large health systems is missing.
Interventions• Self-management interventions are needed that incorporate patient, caregiver, and clinician interventionist input, account for cognitive limitations, incorporate peer support and address other barriers to engagement and adherence.
• The role of technology (e.g., smart-phones, web-based support) has not been well studied in patients with epilepsy.
• Patients with epilepsy expressed a desire for an intervention team composed of a person with epilepsy and a clinician interventionist to provide self-management education and support. Future research should further examine the composition of this interventionist dyad and identify who the clinician interventionist should be (e.g., registered nurse, advanced practice registered nurse, physician, physician assistant).
• Future research should focus on the extent to which these intervention components (e.g., peer support), use of technology, and other identified barriers/facilitators, influence the person with epilepsy’s initial and sustained engagement in an epilepsy self-management program.
ComparatorsActive controls, including usual care, are appropriate and should be described carefully.
OutcomesFuture research is needed that specifically addresses the implementation and adoption of epilepsy self-management programs, as there may be additional personal, program, and site/system level barriers that need to be identified and addressed.
TimingSelf-management skills can take time to master and may take longer for patients with cognitive difficulty. Consensus, or research, on the time required to acquire self-management skills and the time required for new skills to potentially improve clinical outcomes is needed.
SettingFew studies have examined interventions delivered outside of clinical settings. Future research should determine the preferred location for a self-management program for patients with epilepsy and their caregivers.