Results Summary

What was the research about?

Patients work with their primary care providers, or PCPs, to make decisions about their care. This process can improve patient experiences and health outcomes. But patients may be nervous about asking questions or disagreeing with their PCPs. PCPs may also lack training in the best ways to involve patients in decision making.

In this study, the research team compared three approaches to improve how patients and their PCPs make decisions together: 

  • In-person coaching. Before their visit, patients received a survey that asked what they wanted to talk about with their PCPs. They also received a video about preparing for their visit. PCPs received in-person training on involving patients in decision making.
  • Mobile app coaching. Patients received the same survey and video as the in-person coaching group. PCPs received training videos and tips in a mobile app on involving patients in decision making.
  • Ask Share Know Poster (ASK). Posters placed in exam rooms urged patients to ask their PCPs three specific questions during the visit.

What were the results?

After their appointments, patients in the three approaches didn’t differ in:

  • How well they felt their PCP involved them in making decisions about their care
  • Plans to follow their care plan

After three months, compared with patients receiving care at the in-person coaching clinics, patients receiving care at the mobile app coaching clinics:

  • Had less confidence in managing their health
  • Were less likely to recommend their PCP to others

Who was in the study?

The study included 4,852 adults receiving care from one of 114 PCPs. Of patients, 78 percent were White, 12 percent were Asian, 2 percent were Black, 1 percent were Native Hawaiian or Pacific Islander, 2 percent were multiple races, and 5 percent did not report their race. The average age was 53, and 64 percent were women. All could communicate in English and had access to a patient portal, which is a secure website to view health records and test results, and send messages to PCPs.

What did the research team do?

The research team worked with PCPs at 21 primary care clinics. The team assigned clinics by chance to use one of the three approaches to improve patients’ communication with their PCPs.

The research team then surveyed patients about how well their PCPs explained health problems and treatment options. The team also asked about how much PCPs involved patients in decisions about their care and care plan. Patients completed surveys within seven days of their visit and again three months later.

Patients and PCPs from the clinics helped design the study.

What were the limits of the study?

The survey questions may not have worked well enough to detect differences across approaches.

Future research could use improved surveys to look at patients’ experiences and engagement with decision making.

How can people use the results?

Clinics can use these results when considering how to improve communication between PCPs and patients.

Final Research Report

This project's final research report is expected to be available by September 2024.

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

Project Information

Ming Tai-Seale, PhD, MPH
University of California, San Diego^
$5,664,527
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
2016
2023

Study Registration Information

^The Palo Alto Medical Foundation Research Institute was the original organization associated with this study when it was initially funded.

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Last updated: December 27, 2023