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For example, patients described how use of the EHR may deter patients' use of active participatory communication. CONCLUSIONS These results are important for understanding how patients' use of active participatory communication is influenced by their beliefs and expectations, physicians' behaviors, and structural factors. The results may be useful for educational efforts to increase patient, physician, and healthcare systems awareness of problems that patients perceive when communicating with physicians.BACKGROUND The subcutaneous implantable cardio