Looking Inside Our Heads – Brain Imaging and Patient Adherenceby David Hagedorn, PhD | June 16, 2016
The ultimate goal of healthcare professionals is to achieve well-being in patients, which, as a matter of course usually requires patients’ adherence (also termed compliance) to prescribed therapies. Despite the best intentions and efforts of healthcare professionals, resolution of issues cannot so readily be achieved if patients aren’t adherent in following prescriptions. Therapeutic adherence includes not only patient compliance with taking medications, but also typically with changes in diet, exercise, and lifestyle.
According to a study conducted in 2004, patient compliance with therapies prescribed by healthcare professionals is historically quite low. One study concluded these figures to be the average rates of compliance:
- Compliance rate of long-term medication therapies is estimated to be between 40% and 50%
- The rate of compliance for short-term therapy is higher, at between 70% and 80%
- Compliance with lifestyle changes is lowest, at 20%–30%
Non-adherence with prescribed therapies has a variety of undesirable impacts, including not only urgent care, hospitalizations, and higher treatment costs, but also greater financial burdens on society in general; not to mention potential negative effects for patients themselves.
The empirical evidence of a broken bone is difficult for a patient to challenge, but even then we see that rates of patient adherence with prescribed courses of therapy are low. So, how can doctors achieve patient adherence when addressing health issues that cannot so readily be seen, in situations in which the health issue is one literally in the patient’s own head? When neurological problems or injuries do become manifest, it can be challenging for healthcare professionals to bring patients around to understanding both the nature of the problem, and the rationale behind proposed courses of therapy.
Neurological issues range across concussion, depression, memory, and pain, among others. While a patient may be aware of the symptoms of a neurological problem, such as a traumatic brain injury brought on through concussion, the internalized nature of the injury can make it more difficult to achieve adherence. Fortunately, the development of neuroimaging technologies that enable doctors to peer into our brains themselves, mapping brain activity and tracking changes over time, has opened new doors in diagnosing, prescribing for, and managing these conditions.
In a 2008 study of 60 psychiatrists and psychologists, 85 percent agreed or strongly agreed that neuroimaging data would be a valuable adjunctive diagnostic tool for clinical evaluation. This study was conducted in the context of imagining that brain scans are used to materialize images related to depression; a condition in which it is often particularly difficult to achieve acceptance with patients due to societal stigma.
Among the 72 patients who participated in the study, 92% responded favorably to the idea of having a brain scan performed to diagnose depression if such a scan were to be made available to them. Perhaps even more notably, 76% of the respondent patients said that a brain scan would help them accept their condition and 66% responded that it would increase their confidence in a provider’s diagnosis.
The study concludes:
“From responses of 52 providers and 72 patients, we found high receptivity to brain scans for treatment tailoring and choice, for improving understanding of and coping with disease, and for mitigating the effects of stigma and self-blame. Our results suggest that, once ready, roll out of the fully validated technology has significant potential to reduce social burden associated with highly stigmatized illnesses like depression.”
This study lends remarkable support to the notion that helping patients to visualize the nature of their healthcare issues is a critical step in achieving acceptance of a diagnosis, and therefore adherence with an agreed upon course of treatment. And it is easy to extrapolate from these results that neuroimaging promises to be effective in helping patients understand other brain related injuries and illnesses.
Evoke Neuroscience has developed a device that allows physicians to measure how well a patient’s brain is functioning and allows them to share the objective data with the patients. Dr. John McGee, Board Certified Internal Medicine, remarks that for his patients with memory difficulties, “eVox helps me help my patients ‘see’ how their brain is functioning and why they may have memory loss.” In many cases, this is the first time patients have seen their illusive cognitive symptoms represented by numbers and images on a report; often having a profound impact on their ability to understand and cope with their condition.
The capability to collect and share neurological data in a compelling visual form with patients aids healthcare professionals not only in helping patients to better understand their injuries and illnesses, but also in motivating them to adhere to agreed-upon therapies to reverse and/or manage them.
Non-invasive neuroimaging is an important medical advancement contributing to an understanding of the brain and also the quality of care that can be achieved. Neuroimaging technologies can help bring about a collaborative process between patients and doctors, in which patients themselves have the knowledge and understanding to play an informed, active, and decision-making role in their manner of therapy.
DiMatteo, M. (2004). Social Support and Patient Adherence to Medical Treatment: A Meta-Analysis. Health Psychology, 23 (2), 207-218 DOI: 10.1037/0278-6188.8.131.52
Illes J, Lombera S, Rosenberg J, & Arnow B (2008). In the mind’s eye: provider and patient attitudes on functional brain imaging. Journal of psychiatric research, 43 (2), 107-14 PMID: 18423669
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