Williams et al Physicians may give information of their own accord or in response to a request by the patient (Street 1991). Information that is given to patients in medical visits may affect not only how satisﬁed patients are with their care, but also how well they subsequently adhere to medical recommendations. Adherence can ultimately determine long term health outcomes (Hays et al 1994; DiMatteo et al 2002). Some studies have suggested that older patients are not as satisﬁed as younger patients with the information given to them by their physicians during the medical visit (Greene et al 1994a), and that older patients are actually given less information than those who are younger. While it important for physicians to be informative and to educate older patients to take responsibility for their health and actively manage their chronic conditions, navigating this process of information delivery can be complicated. There may not be a “one size ﬁts all” approach to giving information to patients, and physicians must gauge the appropriate amount of information for each patient. Too much can overwhelm some patients, while too little may leave some distressed and confused (Roter et al 1988; Brashers et al 1999; Beach et al 2006). Appropriate information transfer for each patient is a central part of the achievement of a strong and effective therapeutic relationship and can have important effects on patients’ health (Comstock et al 1982). Choice in care is an important aspect of information sharing in the physician-patient relationship. Research comparing physicians who have a “participatory style” of communication to those who are more formal and paternalistic has established that older patients tend to be offered less participatory involvement in their care than patients younger than 30. Factors in addition to patient age, such as gender, education, ethnicity, and health status, have been found to affect the level of participation that patients experienced (Kaplan et al 1996). Further, some physicians tend to offer different levels of explanation, attention, and referral for services as a function of patients’ ethnicity and type of insurance (Stepanikova and Cook 2004). Choices offered to patients, and the quality of physician-patient communication itself, can vary considerably by non-medical factors (Stepanikova and Cook 2004). It may seem that physician information-giving is a direct response to patients’ solicitation of information and desire for active participation in their care, but this is not always the case. Research examining physician-patient communication following patient coronary angiograms has indicated that a relatively small proportion of the information that physi- cians gave to patients was in response to patient’s direct 456 questions and active involvement in their care (Gordon et al 2005). These researchers found that physicians gave less information to African-American patients than to Caucasian patients, and less information to those with less severe coro- nary disease than to those who were more severely ill. In this study, physicians who wanted to limit information actually controlled the conversations and kept them very brief. The provision of information to patients may be particularly important for those with serious illnesses where complex issues, some involving personal values, can affect decisions and treatment options. A study of cancer patients’ discussion of adjuvant treatments found that patients younger than 60 were given more thorough information than their older counterparts. In addition, older patients were spoken to with more “descriptive” terminology such as “a lot” or “a good chance” rather than being given numerical information such as statistics (Leighl et al 2001). A patient-centered context is of central importance in the development of effective communication with patients. Aspects of patient-centered care involve the development of mutual cooperation between physician and patient (Stewart 1984), focus on the patient’s point of view (Mead and Bower 2000), attentiveness to patients’ psychosocial concerns, and development of a therapeutic alliance in which physician and patient work together to improve the patient’s health. Aspects of patient-centered communication, including information- giving, psychosocial talk, and expressions of partnership are associated with greater patient satisfaction and improved patient health outcomes (Hall et al 1988; Stewart 1995). Psychosocial communication can enhance discussion of the challenges of treatment adherence and improve patients’ understanding of other issues in their lives that affect coping with the burden of chronic illness. Achieving patient-centered care depends upon complex factors including the environment and model of practice, the physician’s own communication pattern and ideas about the doctor-patient relationship, and the patient’s desires, moti- vations, communication style, and health-related quality of life (Aita et al 2005). Nonverbal communication, including behaviors such as eye contact, smiling, and facing the patient during the visit, can be a vehicle through which a physician is able to enact patient-centered care in the visit (Roter et al 2006). In patient-centered care, physician and patient work together to build partnership by sharing in decision- making (Street et al 2003) and physicians encourage their patients to be active participants in diagnosis and treatment (Makoul 1998). Such encouragement can take place via motivational interviewing, a style of treating patients that is Clinical Interventions in Aging 2007:2(3)