Commentary

The conclusions of this review by Scott et al are limited by the marked heterogeneity of the populations studied, unstated hypotheses, a paucity of intention to treat studies, and the possibility of inadequate sample sizes. The goal is laudable, however, because patients recall information poorly and benefit when information is provided effectively.¹ Extensive guidelines for providing medical information, including bad news, have been published and include checking a patient's baseline understanding, encouraging questions, categorising information, and using patient centered communication and relational skills.²

The studies included in this review describe exciting, innovative approaches for enhancing recall, but we do not know whether other principles of effectively providing information were missed. For example, were the physicians systematically trained, and how patient centred were they, if at all? Was patient centred communication measured? A systematic patient centred method that includes patient education can be effectively learned and used by physicians. ³

I am concerned that simply providing a tape or written summary to patients without attending to the other principles of patient education will not educate patients adequately. This concern is particularly relevant to patients with cancer because physicians are known to have more difficulty with patient education in such emotion laden situations.^{4, 5}

The published evidence suggests that the simple provision of tapes or summaries to patients assists in recall and informing family, but it is otherwise insufficient. It remains to be shown how such simple methods compare with alternative approaches to the complex, multidimensional task of patient education.