Why patients say no: Patient barriers to epilepsy surgery among patients with drug‐resistant epilepsy in Singapore

Objective Epilepsy surgery is globally underutilized due to disease‐, system‐, and patient‐related barriers. These barriers are suboptimally understood in Asia. Patient‐related barriers are of particular interest because they are culture‐specific and may present a significant obstacle regardless of resource availability. This study aims to identify patient‐related barriers in Singapore, an ethnically heterogeneous Asian country. Methods We conducted a cross‐sectional survey of focal drug‐resistant epilepsy (DRE) patients attending the neurology specialist outpatient clinic of a major tertiary hospital in Singapore. The survey contained 28 items assessing patient perceptions of epilepsy and its treatment, and 7 items on the patient's socioeconomic status. It was adapted with permission from a previous Canadian study. Results A total of 66 patients completed the survey. Most patients (74.2%) were aware of surgery as an option for the treatment of epilepsy, and patients with university degrees were more likely to be aware ( p = 0.007). Most (69.7%) viewed surgery as a “last resort,” and 83.3% overestimated the risks of surgery. Even when hypothetically offered guarantees of surgical success, only 57.6% of patients responded favorably to surgery, with those acknowledging their seizures as disabling being more likely to respond favorably ( p = 0.027). Financial considerations did not significantly influence reactions to hypothetically successful surgery ( p = 1.000). Significance There are major patient‐related barriers to epilepsy surgery among DRE patients in Singapore, contributed by an overestimation of surgical risks and an indifference to seizure‐related disability in some patients. Based on our findings, financial subsidies alone may not suffice in addressing patient‐related barriers; accompanying patient education efforts may be important. Plain Language Summary A survey of patients with refractory epilepsy in Singapore revealed that patients are relatively averse to undergoing pre‐surgical evaluation and surgical treatment for epilepsy, despite scientific evidence of effectiveness. Some of the major barriers include patients overestimating the risks of epilepsy surgery and perceiving seizures to be non‐disabling. Our findings suggest that financial subsidies for surgery alone may not overcome patients' aversion to surgery, and that patient education is also required.