Schofield and Butow, 2003; Maliski et al., 2004). Patients of physicians who involve them in treatment decisions during office visits have better health outcomes than those of physicians who do not (Kaplan et al., 1995; Adams et al., 2001; Gattellari et al., 2001; Hack et al., 2006). Physicians’ participatory decision-making style also is positively related to the quality and outcomes of patient care generally (Guadagnoli and Ward, 1998), including continuity of care (Kaplan et al., 1996), health outcomes (Adams et al., 2001; van Roosmalen et al., 2004), decreased psychological distress (Zachariae et al., 2003), trust in the physician (Berrios-Rivera et al., 2006; Gordon et al., 2006a,b), more preventive health services (Woods et al., 2006), better communication with physicians (Thind and Maly, 2006), and satisfaction with care (Kaplan et al., 1996; Adams et al., 2001). Similar benefits are found specifically in cancer care (Arora, 2003).

Interventions to Improve Communication

Many clinicians have identified a need for stronger communication skills for themselves, their patients, and families. Interventions to improve physician–patient communication have targeted either physicians or patients; few have targeted both simultaneously (Epstein and Street, 2007).

Training physicians to negotiate with patients has been found to increase patient involvement in treatment decisions (Timmermans et al., 2006). A substantial literature also documents the effects of interventions aimed at improving patients’ participation in their care (Epstein and Street, 2007). Such interventions include those aimed at improving patients’ participation in multiple decisions over multiple visits with physicians (e.g., question asking, decision elicitation, and negotiation skills), enhancing the presentation of options, tailoring risk information, and providing testimonials describing outcomes of treatment to help patients participate in single or discrete decisions and improve information seeking (question asking).

The means used to deliver these interventions also vary widely. “Coached care” for chronic disease makes use of patient medical records, guidelines for clinical care management reviewed with patients before office visits, and coaching in using information to participate effectively with physicians. This approach has been linked with improved physiological and functional patient outcomes and increased patient participation in physician–patient communication among patients with chronic disease (Greenfield et al., 1988; Kaplan et al., 1989; Rost et al., 1991; Keeley et al., 2004). Decision aids to assist patients in choosing among treatment options have been shown to decrease decisional conflict, increase satisfaction with treatment decisions (Whelan et al., 2004), and decrease adjuvant therapy for low-risk patients with breast cancer (Peele et al., 2005; Siminoff et al., 2006b).

An extensive literature documents the beneficial effects of interactive videos presenting treatment options, tailored risk information, and patient



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