portance. Many patients depend on those who provide care to coordinate services—whether tests, consultations, or procedures—to ensure that accurate and timely information reaches those who need it at the appropriate time. Patient-centered care addresses the need to manage smooth transitions from one setting to another or from a health care to a self-care setting.

  • Information, communication, and education. With respect to their health, people tend to want to know (1) what is wrong (diagnosis) or how to stay well, (2) what is likely to happen and how it will affect them (prognosis), and (3) what can be done to change or manage their prognosis. They need answers that are accurate and in a language they understand. Patients are diverse in the way they prefer to interact with caregivers: some seek ongoing personal face-to-face relationships; others prefer to interact with the health care system only when unavoidable and with no substantial interpersonal relationship, being comfortable with e-mail and other Web-based communication technologies. Common to all such interactions is the desire for trustworthy information (often from an individual clinician) that is attentive, responsive, and tailored to an individual’s needs.

  • Physical comfort. Among the committee’s more disturbing findings is the frequency with which patients experience pain, shortness of breath, or some other discomfort. Especially at the end of life, they need not undergo such suffering. Sadly, many patients fail to receive state-of-the-art pain relief or respiratory management (Ingham and Foley, 1998; SUPPORT Principal Investigators, 1995). Attention to physical comfort implies timely, tailored, and expert management of such symptoms.

  • Emotional support—relieving fear and anxiety. Suffering is more than just physical pain and other distressing symptoms; it also encompasses significant emotional and spiritual dimensions (Byock, 1998; Cassell, 1991). Patient-centered care attends to the anxiety that accompanies all injury and illness, whether due to uncertainty, fear of pain, disability or disfigurement, loneliness, financial impact, or the effect of illness on one’s family.

  • Involvement of family and friends. This dimension of patient-centered care focuses on accommodating family and friends on whom patients may rely, involving them as appropriate in decision making, supporting them as caregivers, making them welcome and comfortable in the care delivery setting, and recognizing their needs and contributions.

Health care should cure when possible, but always help to relieve suffering—both are encompassed by the notion of a healing relationship (Crawshaw et al., 1995; Quill, 1983). To accomplish these goals, both technical care and interpersonal interactions should be shaped to meet the needs and preferences of individual patients (Tressolini and The Pew-Fetzer Task Force, 1994; Veatch, 1991). Because patients are highly variable in their preferences, clinicians cannot assume that they alone can make the best decisions for their patients (Balint, 1993; Barry et al., 1995; Brock, 1991; Emanuel and Emanuel, 1992; Szasz and



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