testimonials describing outcomes of treatment. Benefits include improved functional outcomes, increased confidence in treatment, and increased satisfaction with decision making (Flood et al., 1996; Liao et al., 1996; Barry et al., 1997). Following similar interventions, others have noted changes in patients’ treatment choices, favoring less invasive treatment (Mazur and Merz, 1996). O’Connor and colleagues (1995) note that these types of decision aids, compared with usual care, yield improvements in patients’ knowledge of their disease and its treatment, more realistic expectations, less decisional conflict, more active participation in office visits, and less indecision about options. No effect on patient anxiety was observed. Videos with or without supporting materials have been shown to enhance patients’ understanding of treatment options (Onel et al., 1998) and physician–patient communication during office visits (Frosch et al., 2001; Brown et al., 2004a). In a review of small media interventions, counseling and small-group education sessions, or a combination of these approaches, Briss and colleagues (2004) found that while such interventions increased patients’ knowledge about their disease and the accuracy of their risk perceptions, whether such interventions lead to increased patient participation in treatment decisions has been less well studied.

Other interventions to improve patient participation in care, such as the use of question-prompt sheets, audiotaping of visits, or more basic decision aids, have been linked with greater patient involvement in treatment decisions (Butow et al., 1994; Guadagnoli and Ward, 1998; Cegala et al., 2000; Maly et al., 2004; Gaston and Mitchell, 2005).


Despite strong evidence for the importance of effective patient–provider communication and patients’ participation in decision making in achieving better health care outcomes, such communication is not yet the norm. As described above and in Chapter 1, physician–patient communication is generally inadequate, and patients are poorly prepared for communicating effectively (whether this involves simple information-seeking skills or more active involvement in treatment decisions). Physicians, too, are poorly prepared to elicit patients’ information needs and preferences for involvement in their care. There is a need for more creative and intensive interventions to enhance patient–physician communication and support patient decision making, targeting in particular those most at risk (e.g., older adults, those of lower socioeconomic status, and those with comorbid conditions including psychosocial distress and decreased cognition). Many approaches are being tested to meet this need. These approaches require more rigorous evaluation, especially in less well-organized health care settings.

NCI’s state-of-the-science report on patient-centered communication in cancer care (Epstein and Street, 2007) can inform clinical practice, as well

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