Results Summary

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.


When patients and doctors communicate well and work together to make decisions about care, patients often have better health outcomes and a better experience with their health care. Some research studies have found that patients may be nervous about asking their doctor too many questions or disagreeing with their doctor’s recommendations. Patients worry they might not get the best care if the doctor thinks they are difficult.

Project Purpose

Researchers created a program to help patients and doctors make decisions together. They called the program Open Communication, and it consisted of video and print materials for patients and in-person training for doctors. They tested the program to find out whether patients who used it felt more satisfied with their doctor’s visit compared to those who used an existing program called Ask, Share, Know (ASK).


The research team worked with patients and doctors to create Open Communication. The program has three parts:

  • A two-minute video to help patients prepare for a doctor visit
  • A four-page booklet patients can bring to their doctor visit, including space to write down what they want to discuss during the visit and what they need to do after their visit
  • A training session for doctors on good communication strategies, such as setting an agenda for the visit or discussing next steps

The ASK program provided patients and doctors with a handout with three questions to guide their conversations:

  • What are my options?
  • What are the possible benefits and harms of each option?
  • How likely is it that any of those benefits and harms will happen to me?

The researchers worked with four primary care clinics in California. Each clinic was assigned at random to use one of four approaches:

  • Open Communication
  • ASK
  • Open Communication and ASK
  • No program (usual care)

A total of 300 patients, 26 doctors, and 54 medical assistants participated in the study. Patients were age 18 or older, spoke English, and had an appointment with a doctor at one of the four clinics.

The patients filled out a survey right after a visit with their doctor. Using the survey responses, the research team looked at how involved patients felt in making decisions about their care and whether they thought their doctor was doing a good job communicating.

The research team also selected 10 patients from each clinic by chance and audio recorded their visits. The research team listened to the recordings and scored how much shared decision making happened between the patient and the doctor.

The research team then compared patient responses from the clinic using the Open Communication program with responses from the clinics using the three other approaches.


Patients who participated in the Open Communication program by itself felt more involved in their care than patients who went to clinics that used the other three approaches. Patients from the clinics that used either Open Communication or ASK believed that doctors helped them feel involved in making a decision more than patients at the clinics that used usual care or a combination of the two programs together.

By listening to the audio recordings, the researchers found that doctors and patients using either Open Communication or ASK participated in more shared decision making than doctors and patients who used the other two approaches. Visits with patients who did not have a college education contained less shared decision making than visits with patients who did have a college education.


This study looked at only four clinics. The researchers can’t be sure whether the differences in the results were because of the care program each clinic used or because of other differences among the clinics.

People who want to have better doctor-patient communication may have been more likely to join the study than other people. That could have affected the results by making the program appear more effective than it would be in real life.

Doctors also used the programs in different ways than the researchers expected. For example, some doctors only used the program with patients they had seen before, not new ones. The results might be different if all the doctors and patients at a clinic used the care program the same way.


Programs that help both patients and doctors have better conversations about healthcare decisions may improve the patient experience.

Sharing the Results

The research team

  • Shared their findings with conferences, schools, healthcare systems, and government officials
  • Published articles in professional research journals
  • Held a webinar to present the study findings
  • Created a video about the care program and shared it online

More to Explore...

PCORI Stories

Creating a "Zone of Openness" at the Doctor's Office
A narrative about how California researchers develop a tool to eliminate patients' fear of reduced care quality when they disagree with their doctor.


Creating a Zone of Openness
Learn more about this project and how it uses decision-support tools to encourage shared decision making between patients and their clinicians.

Improving Patient-Centered Communication
Ming Tai-Seale, PhD, MPH, describes her PCORI-funded research project that looked into whether shared decision making in primary care settings changed the behavior of both patients and providers.

Project Information

Ming Tai-Seale, PhD, MPH^
Palo Alto Medical Foundation Research Institute
Creating a Zone of Openness to Increase Patient-Centered Care

Key Dates

June 2012
June 2015

Study Registration Information

^Dominick Frosch, PhD was the original principal investigator for this project.


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Last updated: March 4, 2022