***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: 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 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 OBJECTIVE To evaluate the effects of a programme to enhance the involvement of older patients in their consultations in general practice . DESIGN Cluster r and omized trial , in which data was collected from different cohorts . SETTING AND PARTICIPANTS Twenty-five general practice s in the south-east part of the Netherl and s and their patients aged 70 years and over . INTERVENTION Patients in the intervention group received a leaflet to help them prepare for the consultation . General practitioners ( GPs ) received an outreach visit to optimize older patients ' involvement when visiting their GP . Patients in the control group received usual care . MAIN OUTCOME MEASURES Question naires measuring involvement ( COMRADE ) , enablement ( Patient Enablement Index ) and satisfaction with their care ( EUROPEP ) . RESULTS Pre-intervention 315 patients and post-intervention 263 patients were included . Subjects were satisfied with their involvement and the GP 's behaviour during the consultation . No differences in effect as a result of the leaflet on involvement , enablement or satisfaction were found between the intervention and the control group . Of 318 patients who received the leaflet and visited their GP in the intervention period , 47 patients used the leaflet . These users were more accustomed to prepare themselves for consultations . Users reported more psychological problems than non-users . CONCLUSIONS No relevant effects of the implementation programme on involvement , enablement or satisfaction were found . Other strategies are needed to enhance involvement of older patients in their care . Alternatively , older patients may perceive themselves sufficiently involved OBJECTIVE Fibromyalgia syndrome ( FMS ) patients and their doctors frequently complain on interaction difficulties . We investigated the effects of a shared decision-making ( SDM ) intervention on physician-patient interaction and health outcome . METHODS Sixty-seven FMS patients of an outpatient university setting that had been included in a r and omized controlled trial were followed up . They were either treated in an SDM group or in an information group . Both groups saw a computer based information tool on FMS , but only the SDM group was treated by doctors which underwent a special SDM communication training . A comparison group of 44 FMS patients receiving treatment as usual was recruited in rheumatological practice s. We assessed patients and their doctors using a combined qualitative and quantitative approach . Patients and doctors were followed-up after 3 months ( T2 ) and after 1 year ( T3 ) . RESULTS The significantly best quality of physician-patient interaction was reported by patients and doctors of the SDM group , followed by the information group . Coping had more often improved in the SDM group than in the information group . However directly health related outcome variables had not improved in any of the groups at T3 . CONCLUSION An SDM intervention can lead to an improved physician-patient relationship from the patients ' and from the doctors ' perspective . PRACTICE IMPLICATION S It should be considered to include SDM in st and ard care for FMS patients Abstract Objective : To determine whether a decision aid on benign prostatic hypertrophy influences decision making , health outcomes , and re source use . Design : R and omised controlled trial . Setting : 33 general practice s in the United Kingdom . Participants : 112 men with benign prostatic hypertrophy . Intervention : Patients ' decision aid consisting of an interactive multimedia programme with booklet and printed summary . Outcome measures : Patients ' and general practitioners ' perceptions of who made the decision , decisional conflict scores , treatment choice and prostatectomy rate , American Urological Association symptom scale , costs , anxiety , utility , and general health status . Results : Both patients and general practitioners found the decision aid acceptable . A higher proportion of patients ( 32 % v 4 % ; mean difference 28 % , 95 % confidence interval 14 % to 41 % ) and their general practitioners ( 46 % v 25 % ; 21 % , 3 % to 40 % ) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group . Patients in the intervention group had significantly lower decisional conflict scores than those in the control group at three months ( 2.3 v 2.6 ; −0.3 , −0.5 to −0.1 , P<0.01 ) and this was maintained at nine months . No differences were found between the groups for anxiety , general health status , prostatic symptoms , utility , or costs ( excluding costs associated with the video disc equipment ) . Conclusions : The decision aid reduced decisional conflict in men with benign prostatic hypertrophy , and the patients played a more active part in decision making . Such programmes could be delivered cheaply by the internet , and there are good arguments for coordinated investment in them , particularly for conditions in which patient utilities are important . What is already known on this topic Patients want more information about their condition and treatment options , and many want to play an active part in decision making Decision aids improve patients ' knowledge of their conditions and treatment options What this study adds The decision aid was highly acceptable to both the patients and their general practitioners Decisional conflict was reduced in the intervention group Patients who viewed the programme played a more active part in the decision making process and were less anxious than control patients Such aids could be introduced throughout the NHS at relatively low cost by using the Background . This investigation examined factors affecting  patient involvement in consultations to decide local treatment for early breast cancer and the effectiveness of two methods of preconsultation education aim ed at increasing patient participation in these discussion BACKGROUND In recent years , patients have indicated a desire for more information about their disease and to be involved in making decisions about their care . We developed an aid called the " Decision Board " to help clinicians inform patients with lymph node-negative breast cancer of the risks and benefits of adjuvant chemotherapy . We determined whether adding the Decision Board to the medical consultation improved patient knowledge and satisfaction compared with the medical consultation alone . METHODS Between October 1995 and March 2000 , 176 women with lymph node-negative breast cancer who were c and i date s for adjuvant chemotherapy were r and omly assigned to receive the Decision Board plus the medical consultation ( 83 patients ) or the medical consultation alone ( 93 patients ) . One week after the consultation , patients completed a question naire assessing their knowledge about breast cancer and chemotherapy .  Satisfaction with decision making was assessed 1 week and 3 , 6 , and 12 months after r and omization , and differences between groups were analyzed by a repeated measures analysis of variance . All statistical tests were two-sided . RESULTS Patients in the Decision Board arm were better informed about breast cancer and adjuvant chemotherapy than patients in the control arm ( mean knowledge score = 80.2 [ on a scale of 0 - 100 ] , 95 % confidence interval [ CI ] = 77.1 to 83.3 , and 71.7 , 95 % CI = 69.0 to 74.4 , respectively ; P<.001 ) . Over the entire study period , satisfaction with decision making was higher for patients in the Decision Board arm than for patients in the control arm ( P = .032 ) . There was no statistically significant difference between the two groups in the number of patients who chose adjuvant chemotherapy ( 77 % and 70 % for patients in the Decision Board arm and those in the control arm , respectively ; P = .303 ) . CONCLUSION When making decisions regarding adjuvant chemotherapy , patients with early breast cancer who had been exposed to the Decision Board had better knowledge of the disease and treatment options and greater satisfaction with their decision making than those who received the st and ard consultation BACKGROUND A consulting method known as ' shared decision making ' ( SDM ) has been described and operationalized in terms of several ' competences ' . One of these competences concerns the discussion of the risks and benefits of treatment or care options-'risk communication ' . Few data exist on clinicians ' ability to acquire skills and implement the competences of SDM or risk communication in consultations with patients . OBJECTIVE The aims of this study were to evaluate the effects of skill development workshops for SDM and the use of risk communication aids on the process of consultations . METHODS A cluster r and omized trial with crossover was carried out with the participation of 20 recently qualified GPs in urban and rural general practice s in Gwent , South Wales . A total of 747 patients with known atrial fibrillation , prostatism , menorrhagia or menopausal symptoms were invited to a consultation to review their condition or treatments . Half the consultations were r and omly selected for audio-taping , of which 352 patients attended and were audio-taped successfully . After baseline , participating doctors were r and omized to receive training in ( i ) SDM skills or ( ii ) the use of simple risk communication aids , using simulated patients . The alternative training was then provided for the final study phase . Patients were allocated r and omly to a consultation during baseline or intervention 1 ( SDM or risk communication aids ) or intervention 2 phases . A r and omly selected half of the consultations were audio-taped from each phase . Raters ( independent , trained and blinded to study phase ) assessed the audio-tapes using a vali date d scale to assess levels of patient involvement ( OPTION : observing patient involvement ) , and to analyse the nature of risk information discussed . Clinicians completed question naires after each consultation , assessing perceived clinician-patient agreement and level of patient involvement in decisions . Multilevel modelling was carried out with the OPTION score as the dependent variable , and rater , consultation and clinician levels of data , st and ardized by rater within clinician . RESULTS Following each of the interventions , the clinicians significantly increased their involvement of patients in decision making ( OPTION score increased by 10.6 following risk communication training [ 95 % confidence interval ( CI ) 7.9 -13.3 ; P < 0.001 ] and by 12.9 after SDM skill development ( 95 % CI 10 -15.8 , P < 0.001 ) , a moderate effect size . The level of involvement achieved by the risk communication aids was significantly increased by the subsequent introduction of the skill development workshops ( 7.7 increase in OPTION score , 95 % CI 3.4 - 12 ; P < 0.001 ) . The alternative sequence ( skills followed by risk communication aids ) did not achieve this effect . The use of most risk information formats increased after the provision of specific risk communication aids ( P < 0.001 ) . Clinicians using the risk communication tools perceived significantly higher patient and clinician agreement on treatment ( P < 0.001 ) , patient satisfaction with information ( P < 0.01 ) , clinician satisfaction with decision ( P < 0.01 ) and general overall satisfaction with the consultation ( P < 0.001 ) than those who were exposed to SDM skill development workshops . CONCLUSIONS These clinicians were able to acquire the skills to implement SDM competences and to use risk communication aids . Each intervention provided independent effects . Further progress towards greater patient involvement in health care decision making is possible , and skill development in this area should be incorporated into postgraduate professional development programmes Abstract Objective : To assess the effect of leaflets on promoting informed choice in women using maternity services . Design : Cluster trial , with maternity units r and omised to use  leaflets  ( intervention units ) or offer usual care ( control units ) . Data collected through postal question naires . Setting : 13 maternity units in Wales . Participants : Four separate sample s of women using maternity services . Antenatal sample s : women reaching 28 weeks ' gestation before ( n=1386 ) and after ( n=1778 ) the intervention . Postnatal sample s : women at eight weeks after delivery before ( n=1741 ) and after ( n=1547 ) the intervention . Intervention : Provision of 10 pairs of Informed Choice leaflets for service users and midwives and a training session for staff in their use . Main outcome measures : Change in the proportion of 
    Output:
    
Conclusions : Multifaceted interventions that include educating health professionals about sharing decisions with patients and patient-mediated interventions , such as patient decision aids , appear promising for improving health professionals ’ adoption of shared decision making in routine clinical practice as seen by patients