Research shows that patient satisfaction with medical care correlates strongly with how satisfied they are with the ease of getting information from their providers regarding their medical condition. Although the Internet is a wonderful source of information for patients, research has shown that, unmediated, it comprises a potential quagmire of information poorly matched to users needs. Providers typically do not have enough time to fulfill all of their patients' information needs. One strategy to meeting the patient's information needs is to introduce librarians trained and experienced in consumer health information services into the relationship between the patient and the provider. One recently described tactic is for providers to provide information the way they of provide treatment-through an information prescription (IRx) filled by a librarian. The librarian fills the prescription by offering information services tailored to the needs of individual patients. At Johns Hopkins, we have piloted such a tactic, and in this project, extend and evaluate it. The research hypothesis is that provision of an IRx will improve patient satisfaction, provider knowledge and attitudes regarding patient information needs, and the efficiencies of care.

The goal of this research is to evaluate IRx, to provide enough data so care organizations can decide whether to implement this in their own environment.

To that end, our specific aims are:

1. To evaluate the impact of IRx on patients. We are performing a randomized clinical trial, comparing IRx with standard provision of information. The primary outcome is patient satisfaction.
2. To evaluate the impact of IRx on providers. As part of the trial, provider perceptions and behavior will be assessed.
3. To evaluate the impact of IRx on the health-care system. As part of the trial, costs entailed and resources utilized will be assessed.
4. To evaluate how IRx generalizes across service environments. The trial will be performed in two environments: adult breast cancer and neonatal intensive care.

At the heart of this proposal are the randomized clinical trials. In each, patients in both intervention and control groups will receive standard clinical care in their clinic visits. Patients randomized to the intervention group will receive information services from a specially trained librarian; patients in the control groups will receive routine, current information provision. For Aim 1, immediately after their clinic visits and four weeks later, all participants will report their satisfaction on a survey that include measures of patient-provider communication. For Aim 2, participating providers are surveyed for their perceptions of information needs being met and about patient-provider interaction. For Aim 3, costs of care and costs of providing the IRx environment will be tabulated.

Inclusion Criteria:

• Breast Cancer: any new patient seen in Johns Hopkins medical oncology for Breast Cancer
• Neonatal Intensive care:Biological mothers (or consenting guardians) of premature infants born and admitted or transferred in to Johns Hopkins Hospital or Bayview Medical Center neonatal intensive care units.

Exclusion Criteria:

• Breast Cancer: None
• Neonatal Intensive Care: Parents with infants whose SNAP mortality >= 80%(J Pediatr. 2001 Jan;138(1):92-100)