***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 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 Whether the provision of evidence -based information improves satisfaction with decision-making is unclear . OBJECTIVE To examine whether information about risks and benefits of cancer screening leads to a higher satisfaction with the decision that was made . METHODS R and omized mail survey in the general population , among 2333 adults aged 30 - 60 years . The survey included a hypothetical cancer screening scenario that included varying amounts of information about benefits and risks of screening ( factorial r and omized design ) . The decision process was evaluated by a 6 item scale , with scores between 0 ( lowest score ) and 100 ( highest score ) . RESULTS Substantial proportions of respondents " completely agreed " that the decision reflected what was most important to them ( 61.2 % ) , were satisfied with their decision ( 56.0 % ) , were certain of their decision ( 54.1 % ) , thought that the best choice for them was obvious ( 53.5 % ) and that the decision was easy to make ( 44.1 % ) . The Cronbach alpha coefficient of the scale was 0.88 , the mean score was 82.5 , and the st and ard deviation 17.5 . Providing information about benefits increased the decision evaluation score only modestly ( + 1.1 , p=0.11 ) ; in contrast , providing information about risks sharply reduced the score ( -5.1 , p<0.001 ) . Those who refused the screening test had lower scores than those who accepted the screening test ( 69.2 versus 85.6 , p<0.001 ) . CONCLUSIONS Contrary to expectations , informing potential participants about the risks of cancer screening lowered their assessment of the decision process BACKGROUND Few health promotion trials have evaluated strategies to increase regular mammography screening . We conducted a r and omized controlled trial of two theory-based interventions in a population -based , nationally representative sample of women veterans . METHODS Study c and i date s 52 years and older were r and omly sample d from the National Registry of Women Veterans and r and omly assigned to three groups . Groups 1 and 2 received interventions that varied in the extent of personalization ( tailored and targeted vs targeted-only , respectively ) ; group 3 was a survey-only control group . Postintervention follow-up surveys were mailed to all women after 1 and 2 years . Outcome measures were self-reported mammography coverage ( completion of one postintervention mammogram ) and compliance ( completion of two postintervention mammograms ) . In decreasingly conservative analyses ( intention-to-treat [ ITT ] , modified intention-to-treat [ MITT ] , and per- protocol [ PP ] ) , we examined crude coverage and compliance estimates and adjusted for covariates and variable follow-up time across study groups using Cox proportional hazards regression . For the PP analyses , we also used logistic regression . RESULTS None of the among-group differences in the crude incidence estimates for mammography coverage was statistically significant in ITT , MITT , or PP analyses . Crude estimates of compliance differed at statistically significant levels in the PP analyses and at levels approaching statistical significance in the ITT and MITT analyses . Absolute differences favoring the intervention over the control groups were 1%-3 % for ITT analysis , 1%-5 % for MITT analysis , and 2%-6 % for the PP analysis . Results from Cox modeling showed no statistically significant effect of the interventions on coverage or compliance in the ITT , MITT , or PP analyses , although hazard rate ratios ( HRRs ) for coverage were consistently slightly higher in the intervention groups than the control group ( range for HRRs = 1.05 - 1.09 ) . A PP analysis using logistic regression produced odds ratios ( ORs ) that were consistently higher than the corresponding hazard rate ratios for both coverage and compliance ( range for ORs = 1.15 - 1.29 ) . CONCLUSIONS In none of our primary analyses did the tailored and targeted intervention result in higher mammography rates than the targeted-only intervention , and there was limited support for either intervention being more effective than the baseline survey alone . We found that adjustment for variable follow-up time produced more conservative ( less favorable ) intervention effect estimates BACKGROUND Many new drugs are aggressively promoted . The public may not realize that even with US Food and Drug Administration ( FDA ) approval , important uncertainties about the benefits and harms of these drugs remain . We assessed the US public 's underst and ing of the meaning of FDA drug approval and tested how brief explanations communicating drug uncertainties affect consumer choices . METHODS We conducted an Internet-based r and omized controlled trial using a national sample of US adults from a research panel of approximately 30,000 households . A total of 2944 participants were r and omized to receive 1 of 3 explanations about a pair of cholesterol drugs ( 1 approved based only on a surrogate outcome [ lower cholesterol ] and 1 based on a patient outcome [ reduced myocardial infa rct ions ] ) . Participants were r and omized a second time to receive 1 of 3 explanations about a pair of heartburn drugs ( 1 newly approved and 1 approved 8 years earlier ) . Controls received no explanation ; the nondirective group received explanations ( for the cholesterol drugs , surrogates do not always translate into patient outcomes ; for the heartburn drugs , it takes time to establish the safety of new drugs ) ; the directive group received explanations plus advice to " Ask for a drug shown to reduce heart attacks or ask for one with a longer track record . " The primary outcomes were choice : the cholesterol drug reducing myocardial infa rct ions , and the older heartburn drug . RESULTS Thirty-nine percent mistakenly believed that the FDA approves only " extremely effective " drugs ; 25 % mistakenly believed that the FDA approves only drugs without serious side effects . Explanations affected choices : 71 % of those in the directive group , 71 % in the nondirective group , and 59 % of controls chose the cholesterol drug that reduced myocardial infa rct ions ( absolute difference , 12 % [ 95 % confidence interval , 7%-18 % ] for each explanation vs control ) . For the heartburn drugs , 53 % of the directive group , 53 % of the nondirective group , and 34 % of controls chose the older drug ( absolute difference , 19 % [ 95 % confidence interval , 13%-24 % ] for each explanation vs control ) . CONCLUSIONS A substantial proportion of the public mistakenly believes that the FDA approves only extremely effective drugs and drugs lacking serious side effects . Brief explanations highlighting uncertainties about the benefit of drugs approved based on surrogate outcomes and the safety of new prescription drugs improved choices . Nondirective explanations worked as well as directive ones . TRIAL REGISTRATION clinical trials.gov Identifiers : NCT00950157 , NCT00950131 BACKGROUND Providing comprehensive information about the risks and benefits of cancer screening is ethically necessary , but information about risks may decrease participation . This study explored the impact of information on intended participation using a r and omised factorial design . METHODS We conducted a mail survey of 2333 adults living in Geneva , Switzerl and . Each participant was given one r and omly chosen version of a scenario that described a hypothetical cancer screening test , and was asked whether he or she would accept to undergo screening . The versions varied in terms of the amount of information about risks and benefits . RESULTS Respondents who received information about risks associated with screening were more likely to refuse participation ( odds ratio 2.6 ( 95 % confidence interval ( CI ) 2.0 - 3.5 ) ) than those who received minimal information . In contrast , information about benefits had no impact on intended participation ( odds ratio 1.0 ( 95 % CI 0.8 - 1.2 ) ) . The impact of information about risks was significantly stronger in women than in men , in respondents who were in poorer health , who have had a doctor visit in the past 6months , those who have had a cancer screening test in the past 3years , and those who reported a high desire for autonomy in medical decisions . CONCLUSIONS Informing potential participants about the risks of screening may reduce participation rates . Enhanced information about the benefits of screening does not counterbalance this effect BACKGROUND Public agencies responsible for implementing health care policies often adapt and disseminate clinical practice guidelines , but the effectiveness of mass dissemination of guidelines is unknown . AIM To study the effects of guideline dissemination on physicians ' prescribing practice s for the treatment of stable angina pectoris . DESIGN R and omized controlled trial . METHODS A sample of 3293 Quebec physicians were r and omly assigned to receive a one-page summary of clinical practice guidelines on the treatment of stable angina ( in February 1999 ) , to receive the summary and a reminder ( in February and March 1999 , respectively ) , or to receive no intervention ( controls ) . The prescribing profiles of participants , as well as sociodemographic characteristics of the physicians and their patients , were examined for June-December 1999 . RESULTS The intervention had no effect on prescription rates of beta-blockers , antiplatelet agents , or hypolipaemic drugs . Compared to 1997 data for the same physicians , there was an overall 10 % increase in appropriate prescription rates , irrespective of the intervention . DISCUSSION In-house production and dissemination of clinical practice guidelines may not improve physicians ' practice patterns if there is pre-existing substantial scientific consensus on the issue Doctors commonly use genomic testing for breast cancer recurrence risk . We sought to assess whether the st and ard genomic report provided to doctors is a good approach for communicating results to patients . During 2009–2010 , we interviewed 133 patients with stages I or II , node-negative , hormone receptor – positive breast cancer and eligible for the Oncotype DX genomic test . In a r and omized experiment , patients viewed six vignettes that presented hypothetical recurrence risk test results . Each vignette described a low , intermediate , or high chance of breast cancer recurrence in 10 years . Vignettes used one of five risk formats of increasing complexity that we derived from the st and ard report that accompanies the commercial assay or a sixth format that used an icon array . Among women who received the genomic recurrence risk test , 63 % said their doctors showed them the st and ard report . The st and ard report format yielded among the most errors in identification of whether a result was low , intermediate , or high risk ( i.e. , the gist of the results ) , whereas a newly developed risk continuum format yielded the fewest errors ( 17 % vs. 5 % ; OR 0.23 ; 95 % CI 0.10–0.52 ) . For high recurrence risk results presented in the st and ard format , women made errors 35 % of the time . Women rated the st and ard report as one of the least underst and able and least-liked formats , but they rated the risk continuum format as among the most underst and able and most liked . Results differed little by health literacy , numeracy , prior receipt of genomic test results during clinical care , and actual genomic test results . The st and ard genomic recurrence risk report was more difficult for women to underst and and interpret than the other formats . A less complex report , potentially including the risk continuum format , would be more effective in communicating test results to patients BACKGROUND Few studies compare the influence of different types of dietary interventions on the dietary practice s of Latinas in the short and long term . The present study examined the 1-year impact of two innovative behavior-change approaches to reduce dietary fat and increase fiber . DESIGN Three-group r and omized controlled 
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For KQ 1 , we found that investigators frequently blend more than one communication strategy in interventions .
For KQ 2 , we found that , compared with single dissemination strategies , multicomponent dissemination strategies are more effective at enhancing clinician behavior , particularly for guideline adherence .
Key findings for KQ 3 indicate that evidence on communicating overall strength of recommendation and precision was insufficient , but certain ways of communicating directness and net benefit may be helpful in reducing uncertainty .
The lack of comparative research evidence to inform communication and dissemination of evidence , including uncertain evidence , impedes timely clinician , patient , and policymaker awareness , uptake , and use of evidence to improve the quality of care .