Introduction

In the second article of this series (BMJ 2005;331: 625-7) Ms Patel found a lot of material on the internet and spoke to family members about their health and the causes of death of some family members. Ms Patel discussed this information with her general practitioner (GP), who then referred Ms Patel to a clinical genetics centre. The genetics clinic team converted Ms Patel's understanding of the situation into a genogram using Risk Assessment in Genetics software (RAGs).

A cancer registry had died overseas. By integrating multiple sources of information the genetics clinic team could advise Ms Patel that her lifetime risk of developing breast cancer was about 30%, and that she would probably benefit from further investigation. If Ms Patel was investigated and shown to carry the BRCA1 gene, the risk estimate for Ms Patel's nieces would be higher.

Before doctors introduce information to patients they should determine the way in which patients want to look for information, discover their level of knowledge on the subject, elicit any specific concerns they have, and find out the information that they need. Interactive health communication applications, such as decision support tools and websites, give doctors and patients additional ways to share understanding of patients' reasons for consulting, and they can then work together to solve patients' problems. The benefits to patients of using interactive health communication applications include a better understanding of their health problems, reduced uncertainty, and the feeling that they are getting better support from their carers.

Many of these tools are new and unfamiliar to patients and doctors. The best way to use them to achieve better outcomes for patients during the time available in consultations remains to be established. Research indicates that patients would like to be directed to a high quality interactive health communication application at …