***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — Cardiac stress testing in patients at low risk for acute coronary syndrome is associated with increased false-positive test results , unnecessary downstream procedures , and increased cost . We judged it unlikely that patient preferences were driving the decision to obtain stress testing . Methods and Results — The Chest Pain Choice trial was a prospect i ve r and omized evaluation involving 204 patients who were r and omized to a decision aid or usual care and were followed for 30 days . The decision aid included a 100-person pictograph depicting the pretest probability of acute coronary syndrome and available management options ( observation unit admission and stress testing or 24–72 hours outpatient follow-up ) . The primary outcome was patient knowledge measured by an immediate postvisit survey . Additional outcomes included patient engagement in decision making and the proportion of patients who decided to undergo observation unit admission and cardiac stress testing . Compared with usual care patients ( n=103 ) , decision aid patients ( n=101 ) had significantly greater knowledge ( 3.6 versus 3.0 questions correct ; mean difference , 0.67 ; 95 % CI , 0.34–1.0 ) , were more engaged in decision making as indicated by higher OPTION ( observing patient involvement ) scores ( 26.6 versus 7.0 ; mean difference , 19.6 ; 95 % CI , 1.6–21.6 ) , and decided less frequently to be admitted to the observation unit for stress testing ( 58 % versus 77 % ; absolute difference , 19 % ; 95 % CI , 6%–31 % ) . There were no major adverse cardiac events after discharge in either group . Conclusions — Use of a  decision aid  in patients with chest pain increased knowledge and engagement in decision making and decreased the rate of observation unit admission for stress testing . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01077037 PURPOSE To examine the impact of a personal health record ( PHR ) in patients with hypertension measured by changes in biological outcomes , patient empowerment , patient perception of quality of care , and use of medical services . METHODS A cluster-r and omized effectiveness trial with PHR and no PHR groups was conducted in two ambulatory clinics . 453 of 1686 ( 26.4 % ) patients approached were included in the analyses . A PHR tethered to the patient 's electronic medical record ( EMR ) was the primary intervention and included security measures , patient control of access , limited transmission of EMR data , blood pressure ( BP ) tracking , and appointment assistance . BP was the main outcome measure . Patient empowerment was assessed using the Patient Activation Measure and Patient Empowerment Scale . Quality of care was assessed using the Clinician and Group Assessment Score ( CAHPS ) and the Patient Assessment of Chronic Illness Care . Frequency of use of medical services was self-reported . RESULTS No impact of the PHR was observed on BP , patient activation , patient perceived quality , or medical utilization in the intention-to-treat analysis . Sub- analysis of intervention patients self-identified as active PHR users ( 25.7 % of those with available information ) showed a 5.25-point reduction in diastolic BP . Younger age , self-reported computer skills , and more positive provider communication ratings were associated with frequency of PHR use . CONCLUSIONS Few patients provided with a PHR actually used the PHR with any frequency . Thus simply providing a PHR may have limited impact on patient BP , empowerment , satisfaction with care , or use of health services without additional education or clinical intervention design ed to increase PHR use . CLINICAL TRIAL REGISTRATION NUMBER http:// Clinical Trials.gov Identifier : NCT01317537 Decision aids in North American breast cancer out patients have been shown to assist with treatment decision making and reduce decisional conflict . To date , appropriate delivery formats to effectively increase patient participation in newly diagnosed breast cancer in patients have not been investigated in the context of German health care provision . The impact of a decision aid intervention was studied in patients ( n=111 ) with a strong suspicion of breast cancer in a r and omised controlled trial . The primary outcome variable was decisional conflict . Participants were followed up 1 week post-intervention with a retention rate of 92 % . Analyses revealed that the intervention group felt better informed ( ηp2=0.06 ) but did not experience an overall reduction in decisional conflict as compared with the control group . The intervention had no effect on uptake rates of treatment options , length of consultation with the surgeon , time point of treatment decision making , perceived involvement in decision making , neither decision related nor general patient satisfaction . Patients who received the decision aid intervention experienced a small benefit with regards to how informed they felt about advantages and disadvantages of relevant treatment options . Results are discussed in terms of context ual factors and individual differences as moderators of treatment decision aid effectiveness Background —Percutaneous coronary intervention ( PCI ) for stable coronary artery disease does not reduce the risk of death and myocardial infa rct ion compared with optimal medical therapy ( OMT ) , but many patients think otherwise . PCI Choice , a decision aid ( DA ) , was design ed for use during the clinical visit and includes information on quality of life and mortality outcomes for PCI with OMT versus OMT alone for stable coronary artery disease . Methods and Results —We conducted a r and omized trial to assess the impact of the PCI Choice DA compared with usual care when there is a choice between PCI and optimal medical therapy . Primary outcomes were patient knowledge and decisional conflict , and the secondary outcome was an objective measure of shared decision making .  A total of 124 patients were eligible for final analysis .  Knowledge was higher among patients receiving the DA compared with usual care ( 60 % DA ; 40 % usual care ; P=0.034 ) , and patients felt more informed ( P=0.043 ) . Other measures of decisional quality were not improved , and engagement of the patient by the clinician in shared decision making did not change with use of the DA . There was evidence that clinicians used the DA as an educational tool . Conclusions —The PCI Choice DA improved patient knowledge but did not significantly impact decisional quality . Further work is needed to effectively address clinician knowledge gaps in shared decision-making skills , even in the context of carefully design ed DAs . Clinical Trial Registration —URL : https://www . clinical trials.gov/. Unique identifier : NCT01771536 Background Professional societies recommend shared decision making ( SDM ) for prostate cancer screening , however , most efforts have promoted informed rather than shared decision making . The objective of this study is to 1 ) examine the effects of a prostate cancer screening intervention to promote SDM and 2 ) determine whether framing prostate information in the context of other clearly beneficial men ’s health services affects decisions . Methods We conducted two separate r and omized controlled trials of the same prostate cancer intervention ( with or without additional information on more clearly beneficial men ’s health services ) . For each trial , we enrolled a convenience sample of 2 internal medicine practice s , and their interested physicians and male patients with no prior history of prostate cancer ( for a total of 4 practice s , 28 physicians , and 128 men across trials ) . Within each practice site , we r and omized men to either 1 ) a video-based decision aid and research er-led coaching session or 2 ) a highway safety video . Physicians at each site received a 1-hour educational session on prostate cancer and SDM . To assess intervention effects , we measured key components of SDM , intent to be screened , and actual screening . After finding that results did not vary by trial , we combined data across sites , adjusting for the r and om effects of both practice and physician . Results Compared to an attention control , our prostate cancer screening intervention increased men ’s perceptions that screening is a decision ( absolute difference + 41 % ; 95 % CI 25 to 57 % ) and men ’s knowledge about prostate cancer screening ( absolute difference + 34 % ; 95 % CI 19 % to 50 % ) , but had no effect on men ’s self-reported participation in shared decisions or their participation at their preferred level . Overall , the intervention decreased screening intent ( absolute difference −34 % ; 95 % CI −50 % to −18 % ) and actual screening rates ( absolute difference −22 % ; 95 % CI −38 to −7 % ) with no difference in effect by frame . Conclusions SDM interventions can increase men ’s knowledge , alter their perceptions of prostate cancer screening , and reduce actual screening . However , they may not guarantee an increase in shared decisions . Trial registration # Background Patient-centered diabetes care requires shared decision making ( SDM ) . Decision aids promote SDM , but their efficacy in nonacademic and rural primary care clinics is unclear . Methods We cluster-r and omized 10 practice s in a concealed fashion to implement either a decision aid ( DA ) about starting statins or one about choosing antihyperglycemic agents . Each practice served as a control group for another practice implementing the other type of DA .  From April 2011 to July 2012 , 103 ( DA=53 ) patients with type 2 diabetes participated in the trial . We used patient and clinician surveys administered after the clinical encounter to collect decisional outcomes ( patient knowledge and comfort with decision making , patient and clinician satisfaction ) . Medical records provided data on metabolic control . Pharmacy fill profiles provided data for estimating adherence to therapy . Results Compared to usual care , patients receiving the DA were more likely to report discussing medications ( 77 % vs. 45 % , p<.001 ) , were more likely to answer knowledge questions correctly ( risk reduction with statins 61 % vs. 33 % , p=.07 ; knowledge about options 57 % vs. 33 % , p=.002 ) and were more engaged by their clinicians in decision making ( 50 . vs. 28 , difference 21.4 ( 95 % CI 6.4 , 36.3 ) , p=.01 ) . We found no significant impact on patient satisfaction , medication starts , adherence or clinical outcomes , in part due to limited statistical power . Conclusion DAs improved decisional outcomes without significant effect on clinical outcomes . DAs design ed for point-of-care use with type 2 diabetes patients promoted shared decision making in nonacademic and rural primary care practice s . Trial Registration OBJECTIVE To test the effect of three questions ( what are my options ? what are the benefits and harms ? and how likely are these ? ) , on information provided by physicians about treatment options . METHODS We used a cross-over trial using two unannounced st and ardized patients ( SPs ) simulating a presentation of mild-moderate depression . One SP was assigned the intervention role ( asking the questions ) , the other the control role . An intervention and control SP visited each physician , order allocated r and omly . The study was conducted in family practice s in Sydney , Australia , during 2008 - 09 . Data were obtained from consultation audio-recordings . Information about treatment options and patient involvement were analyzed using the Assessing Communication about Evidence and Patient Preferences ( ACEPP ) tool and the OPTION tool . RESULTS Thirty-six SP visits were completed ( 18 intervention , 18 control ) . Scores were higher in intervention consultations than controls : ACEPP scores 21.4 vs. 16.6 , p<0.001 , difference 4.7 ( 95 % CI 2.3 - 7.0 ) and OPTION scores 36 vs. 25 , p=0.001 , difference 11.5 ( 95 % CI 5.1 - 17.8 ) , indicating greater information provision and behavior supporting patient involvement . CONCLUSION Asking these three questions improved information given by  family physicians  and increased physician facilitation of patient involvement . Practice implication s. These questions can drive evidence -based practice , strengthen patient-physician communication , and improve safety and quality Purpose . To conduct a pilot test of a decision aid design ed to help patients choose among currently recommended colorectal cancer screening programs . Methods . R and omized controlled trial comparing a patient decision aid based on multi criteria decision-making theory with a simple educational intervention . Patient population . 96 patients at average risk for colorectal cancer seen in an Internal Medicine practice in Rochester , New York . Outcome measures . The two primary outcome measures were patient decision process and the decision outcome . Patient decision process was assessed using the decisional conflict scale . Decision outcome was defined as the proportion of colorectal cancer screening plans carried out . Results . After controlling for the effects of the physicians in a factorial analysis of variance , patients who used the decision aid had lower decisional conflict regarding colorectal cancer screening decisions ( F ratio6.47 , P = 0.01 ) due to increased knowledge , better clarity of values , and higher ratings of the quality of the decisions they made . There was no difference between the groups in decision outcomes : 52 % of patients in the control group and 49 % in the experimental group completed planned screening tests ( P = 1.0 ) . Conclusions . In a pilot study , a multi criteria -based patient decision aid for colorectal cancer screening improved patients ’ decision-making processes but had no effect on the implementation of screening plans Purpose Many patients with schizophrenia have a desire for shared decision-making ( SDM ) . However , in clinical practice SDM often does not take place . One cause might be that many patients behave passively in the medical encounter , therefore not facilitating SDM . It was the aim of the study to evaluate the effects of a patient directed SDM-training on patients ’ communicative behavior in the consultation , their attitudes towards decision-making and their long-term adherence . Methods R and omized-controlled trial comparing a five-session SDM-training for  in patients with schizophrenia with five sessions of non-specific group training . The SDM-training sessions included motivational ( e.g. prospect s of participation , patient rights ) and behavioral aspects ( e.g. role plays ) and addressed important aspects of the patient – doctor interaction such as question asking or giving feedback . Results N = 264 patients were recruited in four psychiatric hospitals in Germany . The SDM-training yielded no group differences regarding the main outcome measure ( treatment adherence ) at 6 and 12 
    Output:
    
There was insuffient information to determine the effects on decision regret , physical or mental health-related quality of life , or consultation length or costs .