title: Providers' perspectives on treating psychogenic nonepileptic seizures: frustration and hope.
abstract: Recent diagnostic and treatment advances in psychogenic nonepileptic seizures (PNES) have the potential to improve care for patients, but little is known about the current state of PNES care delivery in the Veterans Health Administration (VA). We conducted semistructured interviews with 74 health-care clinicians and workers in the VA, eliciting provider perceptions of PNES care. Data were analyzed according to principles of Grounded Theory. The results revealed variation in care and two emergent domain themes of frustration and hope. Frustration was manifest in subthemes including Complexity, Patient Acceptance, Uncertainty About Treatment, Need for Evidence-based Treatment, and Failure of Cross-Disciplinary Collaboration between neurologists and mental health providers. Hope encompassed subthemes of Positive Attitudes, Developing Cross-Disciplinary Treatment, and Specific PNES Care. Increased resources for diagnosing, treating, and researching PNES have improved awareness of the disorder. More research is needed to understand patients' and caregivers' perceptions of PNES care.
authors.affiliation: South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Electronic address: mcmillank@uthscsa.edu.
authors.forename: Katharine K
authors.initials: KK
authors.lastname: McMillan
authors.affiliation: South Texas Veterans Health Care System and VA Epilepsy Centers of Excellence, San Antonio, TX University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.affiliation: VA Connecticut Healthcare System and VA Epilepsy Centers of Excellence, USA Yale University, New Haven, CT, USA.
authors.forename: Hamada
authors.initials: H
authors.lastname: Hamid
authors.affiliation: Portland Veterans Affairs Medical Center and VA Epilepsy Centers of Excellence, Portland, Oregon Health & Sciences University, Portland, OR, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Salinsky
authors.affiliation: South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Pugh
authors.affiliation: South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Polly H
authors.initials: PH
authors.lastname: Noël
authors.affiliation: South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Medicine, and Department of Psychiatry, UT Health Science Center at San Antonio, San Antonio, TX USA.
authors.forename: Erin P
authors.initials: EP
authors.lastname: Finley
authors.affiliation: South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Luci K
authors.initials: LK
authors.lastname: Leykum
authors.affiliation: McCombs School of Business, University of Texas, Austin, TX USA.
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Lanham
authors.affiliation: Providence Veterans Affairs Medical Center and Neuropsychiatry and Behavioral Neurology Division, Rhode Island Hospital, Brown University, Alpert Medical School, Providence, RI, USA.
authors.forename: W Curt
authors.initials: WC
authors.lastname: LaFrance
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D032882:Comprehension; D004569:Electroencephalography; D005639:Frustration; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010465:Perception; D036301:Qualitative Research; D012640:Seizures / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Cognitive behavioral therapy; Diagnosis; Nonepileptic seizures; Practitioners; Treatment; Veterans