Project Summary

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Patients who can speak openly with their doctors are more likely to get care that addresses what matters most to them. But research shows that patients often hesitate to talk openly with their doctors because they fear being labeled as difficult. Doctors also may not be prepared to answer all the questions a patient may have.

Many approaches can help doctors improve communication with patients, but studies have not compared these approaches. This study compares three approaches, one of which improved communication between patients and doctors in earlier studies.  

Who can this research help?

Doctors and leaders at healthcare organizations can use findings from the study to improve communication with patients. Findings from the study can help patients get more out of visits with doctors.

What is the research team doing?

This research is building on a previous study of an approach called Open Communication. The previous study showed that patients and doctors who used Open Communication had better communication than did patients who had usual care. In the current study, the research team is comparing three approaches to improve how patients and their doctors interact. Two approaches—Open High Touch and Open High Tech—are new and build on the initial Open Communication approach.

The research team is also comparing a third approach called Ask, Share, Know, or ASK. The team wants to learn whether one of the three approaches works better than the others. The team also wants to know if one approach is easier than the others for healthcare organizations to put into practice.

The research team includes researchers at three large healthcare organizations in two states. Twenty-one clinics and 105 primary care doctors are taking part in the study. The team is testing each of the three approaches with 5,250 patients.

The team is assigning clinics, by chance, to use one of three communication approaches:

  • Open High Touch—Patients use an electronic system, called a patient portal, to prepare for office visits and communicate with their doctors. Before an office visit, patients are using the portal to answer questions about what they want to discuss with the doctor. Patients also watch a video about how to prepare for the upcoming appointment and get the most from the visit. Doctors are receiving in-person training on how to discuss what matters most to patients.
  • Open High Tech—Patients use the patient portal in the same manner as the patients in the Open High Tech group. Doctors receive training via a mobile app instead of in person.
  • ASK—Clinics that use this approach place posters in exam rooms that encourage patients to ask their doctors the following questions: What are my options? What are the possible risks and benefits of each option? How likely are the benefits of each option to occur to me?

Patients, a patient advocacy group, doctors, clinic staff, and leaders in two large healthcare organizations meet regularly with the research team to guide the study’s progress.

Research methods at a glance

Design Elements Description
Design Randomized controlled trial
  • Adults 18 years and older who read and write English or Spanish, have an appointment with their primary care provider during the study period, and are willing to complete online questionnaires
  • Primary care providers, nurses, and medical assistants who work at clinics participating in the study and who are willing to complete online questionnaires
  • Open High Touch
  • Open High Tech
  • ASK

Primary: patient-reported experience with care

Secondary: written instructions provided to the patient after a visit with the provider

Timeframe 3-month follow-up for primary outcome

Project Information

Ming Tai-Seale, PhD, MPA
University of California, San Diego^
Improving Patient-Centered Communication in Primary Care: A Cluster Randomized Controlled Trial of the Comparative Effectiveness of Three Interventions

Key Dates

December 2016
July 2023

Study Registration Information

^Palo Alto Medical Foundation Research Institute was the original organization associated with this project


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Funding Opportunity Type
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
Research Priority Area
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: November 30, 2022