Intervention Study of Communication in Oncologist-Patient Encounters (COPE)

Inclusion Criteria:

1. speak English;
2. have a diagnosis of advanced cancer (Stage IV or however defined for that disease group), metastatic disease, or refractory or recurrent illness;
3. have access to a telephone; and,
4. have regular access to a computer with broadband Internet service and an email account.

Exclusion Criteria:

1. incompetent for interview (documented diagnosis of active psychosis or dementia) or unable to provide informed consent as assessed by the interviewer;
2. hearing impaired or have a speech disorder;
3. physically impaired in such a way that precludes the use of a computer;
4. simply too sick to participate, and cannot realistically participate in the interview, as judged by the research assistant; or
5. does not have another appointment with an enrolled oncologist within three months.
6. has dial-up Internet service, or
7. does not meet IES Score.

While only patient subjects with advanced cancer will be eligible for randomization into one of the study arms, healthy volunteers (providers and third parties) will be enrolled in the study, too. Patients will be recruited from the practices of participating oncologists; therefore, physicians will be enrolled prior to their patients. All medical, surgical and radiation oncology faculty and hematology/oncology fellows who see patients in the participating clinics will be eligible for the study. We also will enroll the mid-level providers (i.e., physician assistants and nurse practitioners) who work with many of these oncologists and any third party (friends, family members) who comes to clinic with the enrolled patient.