information technologies, and in part because of trends in the health care system itself.

An uneasy shift in terminology often defines patients as “consumers.” They certainly act like consumers when they take advantage of self-help medical volumes at the local bookstore; access information about their symptoms, conditions, or treatments on the Internet; participate in online “chats” about symptoms and therapies; and join support groups. Health topics are among the most popular on the web: WebMD, the most often-consulted health site, averages 17.3 million unique users per month, according to web marketing analysts (comSource, 2008). This collection of resources of varying reliability is obviously filling a need, but people should have guidance to locate easy-to-understand and immediately accessible information from authoritative sources as well. Several government-sponsored websites aim to direct people toward those more reliable sources.7

At the same time, changes in health care delivery push Americans toward becoming better informed about their health, medical treatments, and ways of navigating the health care system. Outpatient surgery and faster hospital discharges send patients home needing significant attention and infection control; an increasing number of home care technologies—heart disease monitoring, diabetes and asthma management, kidney dialysis, analgesia pumps, and many others—require greater knowledge of both the disease and how to work with sophisticated equipment; home-based hospice teaches families to handle emergencies and to manage pain and symptoms; parents of children with severe disabilities learn to deal with respirators and feeding tubes, and to watch for early signs of impending crises.

Families dealing with elderly members aging in place are presented with a constellation of care choices and decisions, sometimes having to be made for a loved one no longer capable of participating in health-related decisions. For these families, it is essential that they have confidence in the choice they make on behalf of their loved one and the adequacy of the information on which it is based. In hospitals, the trend toward larger patient rooms with accommodation for family members is facilitating instruction of families about follow-up care and even encouraging some patient care by family members.



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