Society of Behavioral Medicine (SBM): Annual Meeting

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

"Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more," said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research "actually align very well with components of the meaningful use requirements."

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

"As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention," Dr. Nash said at the annual meeting of the Society of Behavioral Medicine. But "we really don’t know, though, what the optimal content and format of the [summary] might be."

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. "Some routinely print and review the [summary] with their patients, essentially every time," Dr. Nash said. "Others rarely even see or discuss it with their patients because these tasks are handled by someone else."

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians "reported a lot of confusion on the part of their patients," said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. "Some [physicians] were very concerned about showing potentially sensitive information on the patients’ records if it would automatically appear on the summary," Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

WASHINGTON – Strategies to increase adherence to headache therapy work best when multiple modalities are used together at every visit throughout the duration of treatment, according to Jeanetta C. Rains, Ph.D., of Elliot Hospital in Manchester, N.H.

"The more comprehensive the approach, the more adherence can be improved," she said at the annual meeting of the Society of Behavioral Medicine.

Relatively few studies have addressed the issue of adherence in headache treatment, but the literature definitively shows that "nonadherence with headache medication regimens is common," said Dr. Rains, who has reviewed the literature on headache treatment compliance and empirically based adherence enhancing strategies.

"And patients who don’t take their medication or who overuse symptomatic medications can aggravate their headache, create a pattern of medication-overuse headache, or transform an episodic headache into a chronic daily headache," said Dr. Rains, who directs the center for sleep evaluation at Elliot Hospital.

One large study of patients with severe headache found that 11% did not fill their initial prescriptions (high cost and concerns about side effects were common reasons) and that 70% did not adhere to their abortive medication regimen.

Other studies have shown that 25%-50% of headache patients do not adhere to their preventive medication regimen, and commonly avoid or delay the use of abortive medication because they want to "wait to see if it’s a migraine or if it’s severe," she said. Concerns about adverse effects and dependency or addiction also are cited as factors in avoiding or delaying use of abortive medications.

This makes education critical. For effective patient education about headache and forms of treatment, physicians should use simple, everyday language; limit instructions to three or four major points; supplement verbal with printed instructions; ask patients to restate the plan; and involve family members or significant others. "And remember, repetition increases retention," she said.

Moreover, "the way we engage is important," Dr. Rains said. Adherence increases "not only when we give more information to patients, but also when we ask patients about their feelings and opinions, and when we praise them when they’re doing well."

She advised forming a collaborative alliance, discussing barriers to treatment, and being supportive of patients who have difficulty meeting their goals. "At the end of a visit, you can ask your patient to rate how important it is for him or her to do the things you’ve been talking about. Then you can ask the patient to rate his or her confidence level for adhering to the treatment plan."

Behavioral strategies can help to target the many psychosocial determinants of adherence, as well as the fact that patients’ motivation for treatment often shifts over time, Dr. Rains said.

She suggested using the following strategies:

• Assess and treat comorbidities and behavioral concerns. Unaddressed depression, anxiety, somatic preoccupation, and low self-efficacy can each affect adherence and subsequent outcomes. "Patients who are depressed, for instance, are three times less likely to take [their prescribed regimens]," she said.

• Simplify the treatment regimen. Studies consistently show that adherence decreases as the number of medications and daily doses increase.

• Consider past behavior and prior experience. Positive prior experiences with medication can enhance response, while negative expectancies may worsen symptoms and amplify side-effects. Differentiating current treatment from past failures is key, she said.

• Predict a positive but realistic outcome.

• Associate any positive outcome to the patient’s behavior and perseverance.

There is no sure way to assess and track adherence accurately, but more objective, multimodal measures are best, Dr. Rains said.

Face-to-face interviewing is the most widely used tool but also the least reliable, as "self-reporting actually overestimates adherence by 30%, compared with more objective monitoring," she said. Diaries and questionnaires are better, and electronic measures are better still. "Yet, even the most objective measures are not entirely reliable," she said. "Studies have shown, for instance, that some patients dump their canisters in anticipation of their visits, and that electronic daily diaries are sometimes completed on the day of their visit."

Mechanical and electronic tools can "remind" patients to take a preset dose and track their use, but these tools do not address a patient’s conscious decision to alter a regimen, she warned.

This is why "a comprehensive, ongoing approach to assessing adherence is important," she said. Physicians generally respond to treatment failures by altering their recommendations for drug choice or for dosing rather than assessing adherence, and this, she emphasized, is a mistake. "All patients," she said, "are candidates for adherence facilitation."

Dr. Rains reported that she had no relevant disclosures.

WASHINGTON – Strategies to increase adherence to headache therapy work best when multiple modalities are used together at every visit throughout the duration of treatment, according to Jeanetta C. Rains, Ph.D., of Elliot Hospital in Manchester, N.H.

"The more comprehensive the approach, the more adherence can be improved," she said at the annual meeting of the Society of Behavioral Medicine.

Relatively few studies have addressed the issue of adherence in headache treatment, but the literature definitively shows that "nonadherence with headache medication regimens is common," said Dr. Rains, who has reviewed the literature on headache treatment compliance and empirically based adherence enhancing strategies.

"And patients who don’t take their medication or who overuse symptomatic medications can aggravate their headache, create a pattern of medication-overuse headache, or transform an episodic headache into a chronic daily headache," said Dr. Rains, who directs the center for sleep evaluation at Elliot Hospital.

One large study of patients with severe headache found that 11% did not fill their initial prescriptions (high cost and concerns about side effects were common reasons) and that 70% did not adhere to their abortive medication regimen.

Other studies have shown that 25%-50% of headache patients do not adhere to their preventive medication regimen, and commonly avoid or delay the use of abortive medication because they want to "wait to see if it’s a migraine or if it’s severe," she said. Concerns about adverse effects and dependency or addiction also are cited as factors in avoiding or delaying use of abortive medications.

This makes education critical. For effective patient education about headache and forms of treatment, physicians should use simple, everyday language; limit instructions to three or four major points; supplement verbal with printed instructions; ask patients to restate the plan; and involve family members or significant others. "And remember, repetition increases retention," she said.

Moreover, "the way we engage is important," Dr. Rains said. Adherence increases "not only when we give more information to patients, but also when we ask patients about their feelings and opinions, and when we praise them when they’re doing well."

She advised forming a collaborative alliance, discussing barriers to treatment, and being supportive of patients who have difficulty meeting their goals. "At the end of a visit, you can ask your patient to rate how important it is for him or her to do the things you’ve been talking about. Then you can ask the patient to rate his or her confidence level for adhering to the treatment plan."

Behavioral strategies can help to target the many psychosocial determinants of adherence, as well as the fact that patients’ motivation for treatment often shifts over time, Dr. Rains said.

She suggested using the following strategies:

• Assess and treat comorbidities and behavioral concerns. Unaddressed depression, anxiety, somatic preoccupation, and low self-efficacy can each affect adherence and subsequent outcomes. "Patients who are depressed, for instance, are three times less likely to take [their prescribed regimens]," she said.

• Simplify the treatment regimen. Studies consistently show that adherence decreases as the number of medications and daily doses increase.

• Consider past behavior and prior experience. Positive prior experiences with medication can enhance response, while negative expectancies may worsen symptoms and amplify side-effects. Differentiating current treatment from past failures is key, she said.

• Predict a positive but realistic outcome.

• Associate any positive outcome to the patient’s behavior and perseverance.

There is no sure way to assess and track adherence accurately, but more objective, multimodal measures are best, Dr. Rains said.

Face-to-face interviewing is the most widely used tool but also the least reliable, as "self-reporting actually overestimates adherence by 30%, compared with more objective monitoring," she said. Diaries and questionnaires are better, and electronic measures are better still. "Yet, even the most objective measures are not entirely reliable," she said. "Studies have shown, for instance, that some patients dump their canisters in anticipation of their visits, and that electronic daily diaries are sometimes completed on the day of their visit."

Mechanical and electronic tools can "remind" patients to take a preset dose and track their use, but these tools do not address a patient’s conscious decision to alter a regimen, she warned.

This is why "a comprehensive, ongoing approach to assessing adherence is important," she said. Physicians generally respond to treatment failures by altering their recommendations for drug choice or for dosing rather than assessing adherence, and this, she emphasized, is a mistake. "All patients," she said, "are candidates for adherence facilitation."

Dr. Rains reported that she had no relevant disclosures.

WASHINGTON – Strategies to increase adherence to headache therapy work best when multiple modalities are used together at every visit throughout the duration of treatment, according to Jeanetta C. Rains, Ph.D., of Elliot Hospital in Manchester, N.H.

"The more comprehensive the approach, the more adherence can be improved," she said at the annual meeting of the Society of Behavioral Medicine.

Relatively few studies have addressed the issue of adherence in headache treatment, but the literature definitively shows that "nonadherence with headache medication regimens is common," said Dr. Rains, who has reviewed the literature on headache treatment compliance and empirically based adherence enhancing strategies.

"And patients who don’t take their medication or who overuse symptomatic medications can aggravate their headache, create a pattern of medication-overuse headache, or transform an episodic headache into a chronic daily headache," said Dr. Rains, who directs the center for sleep evaluation at Elliot Hospital.

One large study of patients with severe headache found that 11% did not fill their initial prescriptions (high cost and concerns about side effects were common reasons) and that 70% did not adhere to their abortive medication regimen.

Other studies have shown that 25%-50% of headache patients do not adhere to their preventive medication regimen, and commonly avoid or delay the use of abortive medication because they want to "wait to see if it’s a migraine or if it’s severe," she said. Concerns about adverse effects and dependency or addiction also are cited as factors in avoiding or delaying use of abortive medications.

This makes education critical. For effective patient education about headache and forms of treatment, physicians should use simple, everyday language; limit instructions to three or four major points; supplement verbal with printed instructions; ask patients to restate the plan; and involve family members or significant others. "And remember, repetition increases retention," she said.

Moreover, "the way we engage is important," Dr. Rains said. Adherence increases "not only when we give more information to patients, but also when we ask patients about their feelings and opinions, and when we praise them when they’re doing well."

She advised forming a collaborative alliance, discussing barriers to treatment, and being supportive of patients who have difficulty meeting their goals. "At the end of a visit, you can ask your patient to rate how important it is for him or her to do the things you’ve been talking about. Then you can ask the patient to rate his or her confidence level for adhering to the treatment plan."

Behavioral strategies can help to target the many psychosocial determinants of adherence, as well as the fact that patients’ motivation for treatment often shifts over time, Dr. Rains said.

She suggested using the following strategies:

• Assess and treat comorbidities and behavioral concerns. Unaddressed depression, anxiety, somatic preoccupation, and low self-efficacy can each affect adherence and subsequent outcomes. "Patients who are depressed, for instance, are three times less likely to take [their prescribed regimens]," she said.

• Simplify the treatment regimen. Studies consistently show that adherence decreases as the number of medications and daily doses increase.

• Consider past behavior and prior experience. Positive prior experiences with medication can enhance response, while negative expectancies may worsen symptoms and amplify side-effects. Differentiating current treatment from past failures is key, she said.

• Predict a positive but realistic outcome.

• Associate any positive outcome to the patient’s behavior and perseverance.

There is no sure way to assess and track adherence accurately, but more objective, multimodal measures are best, Dr. Rains said.

Face-to-face interviewing is the most widely used tool but also the least reliable, as "self-reporting actually overestimates adherence by 30%, compared with more objective monitoring," she said. Diaries and questionnaires are better, and electronic measures are better still. "Yet, even the most objective measures are not entirely reliable," she said. "Studies have shown, for instance, that some patients dump their canisters in anticipation of their visits, and that electronic daily diaries are sometimes completed on the day of their visit."

Mechanical and electronic tools can "remind" patients to take a preset dose and track their use, but these tools do not address a patient’s conscious decision to alter a regimen, she warned.

This is why "a comprehensive, ongoing approach to assessing adherence is important," she said. Physicians generally respond to treatment failures by altering their recommendations for drug choice or for dosing rather than assessing adherence, and this, she emphasized, is a mistake. "All patients," she said, "are candidates for adherence facilitation."

Dr. Rains reported that she had no relevant disclosures.

WASHINGTON – Strategies to increase adherence to headache therapy work best when multiple modalities are used together at every visit throughout the duration of treatment, according to Jeanetta C. Rains, Ph.D., of Elliot Hospital in Manchester, N.H.

"The more comprehensive the approach, the more adherence can be improved," she said at the annual meeting of the Society of Behavioral Medicine.

Relatively few studies have addressed the issue of adherence in headache treatment, but the literature definitively shows that "nonadherence with headache medication regimens is common," said Dr. Rains, who has reviewed the literature on headache treatment compliance and empirically based adherence enhancing strategies.

"And patients who don’t take their medication or who overuse symptomatic medications can aggravate their headache, create a pattern of medication-overuse headache, or transform an episodic headache into a chronic daily headache," said Dr. Rains, who directs the center for sleep evaluation at Elliot Hospital.

One large study of patients with severe headache found that 11% did not fill their initial prescriptions (high cost and concerns about side effects were common reasons) and that 70% did not adhere to their abortive medication regimen.

Other studies have shown that 25%-50% of headache patients do not adhere to their preventive medication regimen, and commonly avoid or delay the use of abortive medication because they want to "wait to see if it’s a migraine or if it’s severe," she said. Concerns about adverse effects and dependency or addiction also are cited as factors in avoiding or delaying use of abortive medications.

This makes education critical. For effective patient education about headache and forms of treatment, physicians should use simple, everyday language; limit instructions to three or four major points; supplement verbal with printed instructions; ask patients to restate the plan; and involve family members or significant others. "And remember, repetition increases retention," she said.

Moreover, "the way we engage is important," Dr. Rains said. Adherence increases "not only when we give more information to patients, but also when we ask patients about their feelings and opinions, and when we praise them when they’re doing well."

She advised forming a collaborative alliance, discussing barriers to treatment, and being supportive of patients who have difficulty meeting their goals. "At the end of a visit, you can ask your patient to rate how important it is for him or her to do the things you’ve been talking about. Then you can ask the patient to rate his or her confidence level for adhering to the treatment plan."

Behavioral strategies can help to target the many psychosocial determinants of adherence, as well as the fact that patients’ motivation for treatment often shifts over time, Dr. Rains said.

She suggested using the following strategies:

• Assess and treat comorbidities and behavioral concerns. Unaddressed depression, anxiety, somatic preoccupation, and low self-efficacy can each affect adherence and subsequent outcomes. "Patients who are depressed, for instance, are three times less likely to take [their prescribed regimens]," she said.

• Simplify the treatment regimen. Studies consistently show that adherence decreases as the number of medications and daily doses increase.

• Consider past behavior and prior experience. Positive prior experiences with medication can enhance response, while negative expectancies may worsen symptoms and amplify side-effects. Differentiating current treatment from past failures is key, she said.

• Predict a positive but realistic outcome.

• Associate any positive outcome to the patient’s behavior and perseverance.

There is no sure way to assess and track adherence accurately, but more objective, multimodal measures are best, Dr. Rains said.

Face-to-face interviewing is the most widely used tool but also the least reliable, as "self-reporting actually overestimates adherence by 30%, compared with more objective monitoring," she said. Diaries and questionnaires are better, and electronic measures are better still. "Yet, even the most objective measures are not entirely reliable," she said. "Studies have shown, for instance, that some patients dump their canisters in anticipation of their visits, and that electronic daily diaries are sometimes completed on the day of their visit."

Mechanical and electronic tools can "remind" patients to take a preset dose and track their use, but these tools do not address a patient’s conscious decision to alter a regimen, she warned.

This is why "a comprehensive, ongoing approach to assessing adherence is important," she said. Physicians generally respond to treatment failures by altering their recommendations for drug choice or for dosing rather than assessing adherence, and this, she emphasized, is a mistake. "All patients," she said, "are candidates for adherence facilitation."

Dr. Rains reported that she had no relevant disclosures.

WASHINGTON – Strategies to increase adherence to headache therapy work best when multiple modalities are used together at every visit throughout the duration of treatment, according to Jeanetta C. Rains, Ph.D., of Elliot Hospital in Manchester, N.H.

"The more comprehensive the approach, the more adherence can be improved," she said at the annual meeting of the Society of Behavioral Medicine.

Relatively few studies have addressed the issue of adherence in headache treatment, but the literature definitively shows that "nonadherence with headache medication regimens is common," said Dr. Rains, who has reviewed the literature on headache treatment compliance and empirically based adherence enhancing strategies.

"And patients who don’t take their medication or who overuse symptomatic medications can aggravate their headache, create a pattern of medication-overuse headache, or transform an episodic headache into a chronic daily headache," said Dr. Rains, who directs the center for sleep evaluation at Elliot Hospital.

One large study of patients with severe headache found that 11% did not fill their initial prescriptions (high cost and concerns about side effects were common reasons) and that 70% did not adhere to their abortive medication regimen.

Other studies have shown that 25%-50% of headache patients do not adhere to their preventive medication regimen, and commonly avoid or delay the use of abortive medication because they want to "wait to see if it’s a migraine or if it’s severe," she said. Concerns about adverse effects and dependency or addiction also are cited as factors in avoiding or delaying use of abortive medications.

This makes education critical. For effective patient education about headache and forms of treatment, physicians should use simple, everyday language; limit instructions to three or four major points; supplement verbal with printed instructions; ask patients to restate the plan; and involve family members or significant others. "And remember, repetition increases retention," she said.

Moreover, "the way we engage is important," Dr. Rains said. Adherence increases "not only when we give more information to patients, but also when we ask patients about their feelings and opinions, and when we praise them when they’re doing well."

She advised forming a collaborative alliance, discussing barriers to treatment, and being supportive of patients who have difficulty meeting their goals. "At the end of a visit, you can ask your patient to rate how important it is for him or her to do the things you’ve been talking about. Then you can ask the patient to rate his or her confidence level for adhering to the treatment plan."

Behavioral strategies can help to target the many psychosocial determinants of adherence, as well as the fact that patients’ motivation for treatment often shifts over time, Dr. Rains said.

She suggested using the following strategies:

• Assess and treat comorbidities and behavioral concerns. Unaddressed depression, anxiety, somatic preoccupation, and low self-efficacy can each affect adherence and subsequent outcomes. "Patients who are depressed, for instance, are three times less likely to take [their prescribed regimens]," she said.

• Simplify the treatment regimen. Studies consistently show that adherence decreases as the number of medications and daily doses increase.

• Consider past behavior and prior experience. Positive prior experiences with medication can enhance response, while negative expectancies may worsen symptoms and amplify side-effects. Differentiating current treatment from past failures is key, she said.

• Predict a positive but realistic outcome.

• Associate any positive outcome to the patient’s behavior and perseverance.

There is no sure way to assess and track adherence accurately, but more objective, multimodal measures are best, Dr. Rains said.

Face-to-face interviewing is the most widely used tool but also the least reliable, as "self-reporting actually overestimates adherence by 30%, compared with more objective monitoring," she said. Diaries and questionnaires are better, and electronic measures are better still. "Yet, even the most objective measures are not entirely reliable," she said. "Studies have shown, for instance, that some patients dump their canisters in anticipation of their visits, and that electronic daily diaries are sometimes completed on the day of their visit."

Mechanical and electronic tools can "remind" patients to take a preset dose and track their use, but these tools do not address a patient’s conscious decision to alter a regimen, she warned.

This is why "a comprehensive, ongoing approach to assessing adherence is important," she said. Physicians generally respond to treatment failures by altering their recommendations for drug choice or for dosing rather than assessing adherence, and this, she emphasized, is a mistake. "All patients," she said, "are candidates for adherence facilitation."

Dr. Rains reported that she had no relevant disclosures.

WASHINGTON – Strategies to increase adherence to headache therapy work best when multiple modalities are used together at every visit throughout the duration of treatment, according to Jeanetta C. Rains, Ph.D., of Elliot Hospital in Manchester, N.H.

"The more comprehensive the approach, the more adherence can be improved," she said at the annual meeting of the Society of Behavioral Medicine.

Relatively few studies have addressed the issue of adherence in headache treatment, but the literature definitively shows that "nonadherence with headache medication regimens is common," said Dr. Rains, who has reviewed the literature on headache treatment compliance and empirically based adherence enhancing strategies.

"And patients who don’t take their medication or who overuse symptomatic medications can aggravate their headache, create a pattern of medication-overuse headache, or transform an episodic headache into a chronic daily headache," said Dr. Rains, who directs the center for sleep evaluation at Elliot Hospital.

One large study of patients with severe headache found that 11% did not fill their initial prescriptions (high cost and concerns about side effects were common reasons) and that 70% did not adhere to their abortive medication regimen.

Other studies have shown that 25%-50% of headache patients do not adhere to their preventive medication regimen, and commonly avoid or delay the use of abortive medication because they want to "wait to see if it’s a migraine or if it’s severe," she said. Concerns about adverse effects and dependency or addiction also are cited as factors in avoiding or delaying use of abortive medications.

This makes education critical. For effective patient education about headache and forms of treatment, physicians should use simple, everyday language; limit instructions to three or four major points; supplement verbal with printed instructions; ask patients to restate the plan; and involve family members or significant others. "And remember, repetition increases retention," she said.

Moreover, "the way we engage is important," Dr. Rains said. Adherence increases "not only when we give more information to patients, but also when we ask patients about their feelings and opinions, and when we praise them when they’re doing well."

She advised forming a collaborative alliance, discussing barriers to treatment, and being supportive of patients who have difficulty meeting their goals. "At the end of a visit, you can ask your patient to rate how important it is for him or her to do the things you’ve been talking about. Then you can ask the patient to rate his or her confidence level for adhering to the treatment plan."

Behavioral strategies can help to target the many psychosocial determinants of adherence, as well as the fact that patients’ motivation for treatment often shifts over time, Dr. Rains said.

She suggested using the following strategies:

• Assess and treat comorbidities and behavioral concerns. Unaddressed depression, anxiety, somatic preoccupation, and low self-efficacy can each affect adherence and subsequent outcomes. "Patients who are depressed, for instance, are three times less likely to take [their prescribed regimens]," she said.

• Simplify the treatment regimen. Studies consistently show that adherence decreases as the number of medications and daily doses increase.

• Consider past behavior and prior experience. Positive prior experiences with medication can enhance response, while negative expectancies may worsen symptoms and amplify side-effects. Differentiating current treatment from past failures is key, she said.

• Predict a positive but realistic outcome.

• Associate any positive outcome to the patient’s behavior and perseverance.

There is no sure way to assess and track adherence accurately, but more objective, multimodal measures are best, Dr. Rains said.

Face-to-face interviewing is the most widely used tool but also the least reliable, as "self-reporting actually overestimates adherence by 30%, compared with more objective monitoring," she said. Diaries and questionnaires are better, and electronic measures are better still. "Yet, even the most objective measures are not entirely reliable," she said. "Studies have shown, for instance, that some patients dump their canisters in anticipation of their visits, and that electronic daily diaries are sometimes completed on the day of their visit."

Mechanical and electronic tools can "remind" patients to take a preset dose and track their use, but these tools do not address a patient’s conscious decision to alter a regimen, she warned.

This is why "a comprehensive, ongoing approach to assessing adherence is important," she said. Physicians generally respond to treatment failures by altering their recommendations for drug choice or for dosing rather than assessing adherence, and this, she emphasized, is a mistake. "All patients," she said, "are candidates for adherence facilitation."

Dr. Rains reported that she had no relevant disclosures.

WASHINGTON – Strategies to increase adherence to headache therapy work best when multiple modalities are used together at every visit throughout the duration of treatment, according to Jeanetta C. Rains, Ph.D., of Elliot Hospital in Manchester, N.H.

"The more comprehensive the approach, the more adherence can be improved," she said at the annual meeting of the Society of Behavioral Medicine.

Relatively few studies have addressed the issue of adherence in headache treatment, but the literature definitively shows that "nonadherence with headache medication regimens is common," said Dr. Rains, who has reviewed the literature on headache treatment compliance and empirically based adherence enhancing strategies.

"And patients who don’t take their medication or who overuse symptomatic medications can aggravate their headache, create a pattern of medication-overuse headache, or transform an episodic headache into a chronic daily headache," said Dr. Rains, who directs the center for sleep evaluation at Elliot Hospital.

One large study of patients with severe headache found that 11% did not fill their initial prescriptions (high cost and concerns about side effects were common reasons) and that 70% did not adhere to their abortive medication regimen.

Other studies have shown that 25%-50% of headache patients do not adhere to their preventive medication regimen, and commonly avoid or delay the use of abortive medication because they want to "wait to see if it’s a migraine or if it’s severe," she said. Concerns about adverse effects and dependency or addiction also are cited as factors in avoiding or delaying use of abortive medications.

This makes education critical. For effective patient education about headache and forms of treatment, physicians should use simple, everyday language; limit instructions to three or four major points; supplement verbal with printed instructions; ask patients to restate the plan; and involve family members or significant others. "And remember, repetition increases retention," she said.

Moreover, "the way we engage is important," Dr. Rains said. Adherence increases "not only when we give more information to patients, but also when we ask patients about their feelings and opinions, and when we praise them when they’re doing well."

She advised forming a collaborative alliance, discussing barriers to treatment, and being supportive of patients who have difficulty meeting their goals. "At the end of a visit, you can ask your patient to rate how important it is for him or her to do the things you’ve been talking about. Then you can ask the patient to rate his or her confidence level for adhering to the treatment plan."

Behavioral strategies can help to target the many psychosocial determinants of adherence, as well as the fact that patients’ motivation for treatment often shifts over time, Dr. Rains said.

She suggested using the following strategies:

• Assess and treat comorbidities and behavioral concerns. Unaddressed depression, anxiety, somatic preoccupation, and low self-efficacy can each affect adherence and subsequent outcomes. "Patients who are depressed, for instance, are three times less likely to take [their prescribed regimens]," she said.

• Simplify the treatment regimen. Studies consistently show that adherence decreases as the number of medications and daily doses increase.

• Consider past behavior and prior experience. Positive prior experiences with medication can enhance response, while negative expectancies may worsen symptoms and amplify side-effects. Differentiating current treatment from past failures is key, she said.

• Predict a positive but realistic outcome.

• Associate any positive outcome to the patient’s behavior and perseverance.

There is no sure way to assess and track adherence accurately, but more objective, multimodal measures are best, Dr. Rains said.

Face-to-face interviewing is the most widely used tool but also the least reliable, as "self-reporting actually overestimates adherence by 30%, compared with more objective monitoring," she said. Diaries and questionnaires are better, and electronic measures are better still. "Yet, even the most objective measures are not entirely reliable," she said. "Studies have shown, for instance, that some patients dump their canisters in anticipation of their visits, and that electronic daily diaries are sometimes completed on the day of their visit."

Mechanical and electronic tools can "remind" patients to take a preset dose and track their use, but these tools do not address a patient’s conscious decision to alter a regimen, she warned.

This is why "a comprehensive, ongoing approach to assessing adherence is important," she said. Physicians generally respond to treatment failures by altering their recommendations for drug choice or for dosing rather than assessing adherence, and this, she emphasized, is a mistake. "All patients," she said, "are candidates for adherence facilitation."

Dr. Rains reported that she had no relevant disclosures.

WASHINGTON – Strategies to increase adherence to headache therapy work best when multiple modalities are used together at every visit throughout the duration of treatment, according to Jeanetta C. Rains, Ph.D., of Elliot Hospital in Manchester, N.H.

"The more comprehensive the approach, the more adherence can be improved," she said at the annual meeting of the Society of Behavioral Medicine.

Relatively few studies have addressed the issue of adherence in headache treatment, but the literature definitively shows that "nonadherence with headache medication regimens is common," said Dr. Rains, who has reviewed the literature on headache treatment compliance and empirically based adherence enhancing strategies.

"And patients who don’t take their medication or who overuse symptomatic medications can aggravate their headache, create a pattern of medication-overuse headache, or transform an episodic headache into a chronic daily headache," said Dr. Rains, who directs the center for sleep evaluation at Elliot Hospital.

One large study of patients with severe headache found that 11% did not fill their initial prescriptions (high cost and concerns about side effects were common reasons) and that 70% did not adhere to their abortive medication regimen.

Other studies have shown that 25%-50% of headache patients do not adhere to their preventive medication regimen, and commonly avoid or delay the use of abortive medication because they want to "wait to see if it’s a migraine or if it’s severe," she said. Concerns about adverse effects and dependency or addiction also are cited as factors in avoiding or delaying use of abortive medications.

This makes education critical. For effective patient education about headache and forms of treatment, physicians should use simple, everyday language; limit instructions to three or four major points; supplement verbal with printed instructions; ask patients to restate the plan; and involve family members or significant others. "And remember, repetition increases retention," she said.

Moreover, "the way we engage is important," Dr. Rains said. Adherence increases "not only when we give more information to patients, but also when we ask patients about their feelings and opinions, and when we praise them when they’re doing well."

She advised forming a collaborative alliance, discussing barriers to treatment, and being supportive of patients who have difficulty meeting their goals. "At the end of a visit, you can ask your patient to rate how important it is for him or her to do the things you’ve been talking about. Then you can ask the patient to rate his or her confidence level for adhering to the treatment plan."

Behavioral strategies can help to target the many psychosocial determinants of adherence, as well as the fact that patients’ motivation for treatment often shifts over time, Dr. Rains said.

She suggested using the following strategies:

• Assess and treat comorbidities and behavioral concerns. Unaddressed depression, anxiety, somatic preoccupation, and low self-efficacy can each affect adherence and subsequent outcomes. "Patients who are depressed, for instance, are three times less likely to take [their prescribed regimens]," she said.

• Simplify the treatment regimen. Studies consistently show that adherence decreases as the number of medications and daily doses increase.

• Consider past behavior and prior experience. Positive prior experiences with medication can enhance response, while negative expectancies may worsen symptoms and amplify side-effects. Differentiating current treatment from past failures is key, she said.

• Predict a positive but realistic outcome.

• Associate any positive outcome to the patient’s behavior and perseverance.

There is no sure way to assess and track adherence accurately, but more objective, multimodal measures are best, Dr. Rains said.

Face-to-face interviewing is the most widely used tool but also the least reliable, as "self-reporting actually overestimates adherence by 30%, compared with more objective monitoring," she said. Diaries and questionnaires are better, and electronic measures are better still. "Yet, even the most objective measures are not entirely reliable," she said. "Studies have shown, for instance, that some patients dump their canisters in anticipation of their visits, and that electronic daily diaries are sometimes completed on the day of their visit."

Mechanical and electronic tools can "remind" patients to take a preset dose and track their use, but these tools do not address a patient’s conscious decision to alter a regimen, she warned.

This is why "a comprehensive, ongoing approach to assessing adherence is important," she said. Physicians generally respond to treatment failures by altering their recommendations for drug choice or for dosing rather than assessing adherence, and this, she emphasized, is a mistake. "All patients," she said, "are candidates for adherence facilitation."

Dr. Rains reported that she had no relevant disclosures.

WASHINGTON – Strategies to increase adherence to headache therapy work best when multiple modalities are used together at every visit throughout the duration of treatment, according to Jeanetta C. Rains, Ph.D., of Elliot Hospital in Manchester, N.H.

"The more comprehensive the approach, the more adherence can be improved," she said at the annual meeting of the Society of Behavioral Medicine.

Relatively few studies have addressed the issue of adherence in headache treatment, but the literature definitively shows that "nonadherence with headache medication regimens is common," said Dr. Rains, who has reviewed the literature on headache treatment compliance and empirically based adherence enhancing strategies.

"And patients who don’t take their medication or who overuse symptomatic medications can aggravate their headache, create a pattern of medication-overuse headache, or transform an episodic headache into a chronic daily headache," said Dr. Rains, who directs the center for sleep evaluation at Elliot Hospital.

One large study of patients with severe headache found that 11% did not fill their initial prescriptions (high cost and concerns about side effects were common reasons) and that 70% did not adhere to their abortive medication regimen.

Other studies have shown that 25%-50% of headache patients do not adhere to their preventive medication regimen, and commonly avoid or delay the use of abortive medication because they want to "wait to see if it’s a migraine or if it’s severe," she said. Concerns about adverse effects and dependency or addiction also are cited as factors in avoiding or delaying use of abortive medications.

This makes education critical. For effective patient education about headache and forms of treatment, physicians should use simple, everyday language; limit instructions to three or four major points; supplement verbal with printed instructions; ask patients to restate the plan; and involve family members or significant others. "And remember, repetition increases retention," she said.

Moreover, "the way we engage is important," Dr. Rains said. Adherence increases "not only when we give more information to patients, but also when we ask patients about their feelings and opinions, and when we praise them when they’re doing well."

She advised forming a collaborative alliance, discussing barriers to treatment, and being supportive of patients who have difficulty meeting their goals. "At the end of a visit, you can ask your patient to rate how important it is for him or her to do the things you’ve been talking about. Then you can ask the patient to rate his or her confidence level for adhering to the treatment plan."

Behavioral strategies can help to target the many psychosocial determinants of adherence, as well as the fact that patients’ motivation for treatment often shifts over time, Dr. Rains said.

She suggested using the following strategies:

• Assess and treat comorbidities and behavioral concerns. Unaddressed depression, anxiety, somatic preoccupation, and low self-efficacy can each affect adherence and subsequent outcomes. "Patients who are depressed, for instance, are three times less likely to take [their prescribed regimens]," she said.

• Simplify the treatment regimen. Studies consistently show that adherence decreases as the number of medications and daily doses increase.

• Consider past behavior and prior experience. Positive prior experiences with medication can enhance response, while negative expectancies may worsen symptoms and amplify side-effects. Differentiating current treatment from past failures is key, she said.

• Predict a positive but realistic outcome.

• Associate any positive outcome to the patient’s behavior and perseverance.

There is no sure way to assess and track adherence accurately, but more objective, multimodal measures are best, Dr. Rains said.

Face-to-face interviewing is the most widely used tool but also the least reliable, as "self-reporting actually overestimates adherence by 30%, compared with more objective monitoring," she said. Diaries and questionnaires are better, and electronic measures are better still. "Yet, even the most objective measures are not entirely reliable," she said. "Studies have shown, for instance, that some patients dump their canisters in anticipation of their visits, and that electronic daily diaries are sometimes completed on the day of their visit."

Mechanical and electronic tools can "remind" patients to take a preset dose and track their use, but these tools do not address a patient’s conscious decision to alter a regimen, she warned.

This is why "a comprehensive, ongoing approach to assessing adherence is important," she said. Physicians generally respond to treatment failures by altering their recommendations for drug choice or for dosing rather than assessing adherence, and this, she emphasized, is a mistake. "All patients," she said, "are candidates for adherence facilitation."

Dr. Rains reported that she had no relevant disclosures.

WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.

She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.

Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.

In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.

The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.

A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.

"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."

A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.

Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.

The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).

Dr. Fang and her coinvestigators reported having no relevant financial disclosures.

WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.

She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.

Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.

In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.

The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.

A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.

"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."

A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.

Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.

The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).

Dr. Fang and her coinvestigators reported having no relevant financial disclosures.

WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.

She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.

Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.

In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.

The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.

A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.

"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."

A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.

Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.

The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).

Dr. Fang and her coinvestigators reported having no relevant financial disclosures.

WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.

She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.

Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.

In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.

The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.

A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.

"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."

A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.

Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.

The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).

Dr. Fang and her coinvestigators reported having no relevant financial disclosures.

WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.

She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.

Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.

In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.

The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.

A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.

"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."

A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.

Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.

The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).

Dr. Fang and her coinvestigators reported having no relevant financial disclosures.

WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.

She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.

Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.

In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.

The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.

A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.

"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."

A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.

Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.

The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).

Dr. Fang and her coinvestigators reported having no relevant financial disclosures.

WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.

She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.

Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.

In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.

The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.

A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.

"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."

A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.

Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.

The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).

Dr. Fang and her coinvestigators reported having no relevant financial disclosures.

WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.

She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.

Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.

In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.

The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.

A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.

"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."

A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.

Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.

The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).

Dr. Fang and her coinvestigators reported having no relevant financial disclosures.

WASHINGTON – Poorer psychosocial functioning was associated with greater expression of vascular endothelial growth factor – and greater expression, in turn, was associated with shorter disease-free survival – in a small study of patients with newly diagnosed head and neck squamous cell carcinoma.

Vascular endothelial growth factor (VEGF) not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines, according to Carolyn Y. Fang, Ph.D., who presented the findings at the annual meeting of the Society of Behavioral Medicine.

She and her team administered a battery of psychosocial questionnaires to assess perceived stress, depressive symptoms, and social support in 37 patients who had been newly diagnosed with HNSCC and sought treatment at the Fox Chase Cancer Center in Philadelphia. Expression of VEGF in tumor tissue that had been obtained during surgery was then evaluated via immunohistochemistry, and was categorized as weak, moderate, or intense.

Higher levels of perceived stress and depressive symptoms were significantly associated with greater VEGF expression in an analysis that controlled for disease stage, Dr. Fang reported. Patients with "intense" VEGF expression, for instance, had a mean perceived stress score that was approximately 47% higher than that of patients with "weak" VEGF expression.

In addition, patients who reported lower levels of social support were more likely to have intense VEGF expression, but this did not reach statistical significance, said Dr. Fang, codirector of the cancer prevention and control program at Fox Chase.

The patients were predominantly male (70.3%) with a mean age of 57 years. Most were married or living with a partner (62%), and half had a high school education or less. Primary tumor sites were the oral cavity (66%), larynx (20%), and oropharynx (14%). More than 40% were classified as having early-stage disease.

A survival analysis looking at two categories of VEGF expression – high and low – and controlling for disease stage and other relevant variables showed that patients with high VEGF expression were more than 2.5 times more likely to die than were those with low expression. "This finding is not a novel finding, but we did confirm here that VEGF expression was associated with disease-free survival," Dr. Fang said in a later interview, noting that follow-up averaged about 5 years.

"At this point, the data on VEGF are preliminary and are just a snapshot in time," Dr. Fang said. "We need to follow this up with a larger longitudinal study in which we can capture the trajectory of psychosocial functioning over time and do multiple assessments of VEGF and other biomarkers [like EGFR] over time."

A combination of previous findings prompted the investigators to do the study. These included reported associations between psychosocial factors and expression of VEGF in patients with other types of cancer, and associations of VEGF with tumor aggressiveness and poor prognosis in HNSCC populations specifically.

Dr. Fang noted that when the patient population was divided into early-stage and late-stage HNSCC, associations among psychosocial functioning and VEGF remained strong for early-stage patients, but were less apparent among late-stage patients.

The psychosocial questionnaires administered in the study were the PSS (Perceived Stress Scale), the CES-D (Center for Epidemiologic Studies–Depression Scale), and the ISEL (Interpersonal Support Evaluation List).

Dr. Fang and her coinvestigators reported having no relevant financial disclosures.