***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 Despite increasing recognition of the importance of involving patients in decisions on preventive healthcare interventions , little is known about how well patients underst and and utilise information provided on the relative benefits from these interventions . The aim of this study was to explore whether lay people can discriminate between preventive interventions when effectiveness is presented in terms of relative risk reduction ( RRR ) , and whether such discrimination is influenced by presentation of baseline risk . Methods The study was a r and omised cross-sectional interview survey of a representative sample ( n = 1,519 ) of lay people with mean age 59 ( range 40–98 ) years in Denmark . In addition to demographic information , respondents were asked to consider a hypothetical drug treatment to prevent heart attack . Its effectiveness was r and omly presented as RRR of 10 , 20 , 30 , 40 , 50 or 60 percent , and half of the respondents were presented with quantitative information on the baseline risk of heart attack . The respondents had also been asked whether they were diagnosed with hypercholesterolemia or had experienced a heart attack . Results In total , 873 ( 58 % ) of the respondents consented to the hypothetical treatment . While 49 % accepted the treatment when RRR = 10 % , the acceptance rate was 58–60 % for RRR>10 . There was no significant difference in acceptance rates across respondents irrespective of whether they had been presented with quantitative information on baseline risk or not . Conclusion In this study , lay people 's decisions about therapy were only slightly influenced by the magnitude of the effect when it was presented in terms of RRR . The results may indicate that lay people have difficulties in discriminating between levels of effectiveness when they are presented in terms of RRR BACKGROUND It is important that patients are well-informed about risks and benefits of therapies to help them decide whether to accept medical therapy . Different numerical formats can be used in risk communication but It remains unclear how the different formats affect decisions made by real-life patients . AIM To compare the impact of using Prolongation Of Life ( POL ) and Absolute Risk Reduction ( ARR ) information formats to express effectiveness of cholesterol-lowering therapy on patients ' redemptions of statin prescriptions , and on patients ' confidence in their decision and satisfaction with the risk communication . DESIGN AND SETTING Cluster-r and omised clinical trial in general practice s. Thirty-four Danish GPs from 23 practice s participated in a primary care-based clinical trial concerning use of quantitative effectiveness formats for risk communication in health prevention consultations . METHOD GPs were cluster-r and omised ( treating practice s as clusters ) to inform patients about cardiovascular mortality risk and the effectiveness of statin treatment using either POL or ARR formats . Patients ' redemptions of statin prescriptions were obtained from a regional prescription data base . The COMRADE question naire was used to measure patients ' confidence in their decision and satisfaction with the risk communication . RESULTS Of the 240 patients included for analyses , 112 were allocated to POL information and 128 to ARR . Patients redeeming a statin prescription totalled six ( 5.4 % ) when informed using POL , and 32 ( 25.0 % ) when using ARR . The level of confidence in decision and satisfaction with risk communication did not differ between the risk formats . CONCLUSION Patients redeemed statin prescriptions less often when their GP communicated treatment effectiveness using POL compared with ARR Background Different presentations of treatment effects can affect decisions . However , previous studies have not evaluated which presentations best help people make decisions that are consistent with their own values . We undertook a pilot study to compare different methods for doing this . Methods and Findings We conducted an Internet-based r and omized trial comparing summary statistics for communicating the effects of statins on the risk of coronary heart disease ( CHD ) . Participants rated the relative importance of treatment consequences using  visual analogue scales ( VAS ) and category rating scales ( CRS ) with five response options . We r and omized participants to either VAS or CRS first and to one of six summary statistics : relative risk reduction ( RRR ) and five absolute measures of effect : absolute risk reduction , number needed to treat , event rates , tablets needed to take , and natural frequencies ( whole numbers ) . We used logistic regression to determine the association between participants ' elicited values and treatment choices . 770 participants age 18 or over and literate in English completed the study . In all , 13 % in the VAS-first group failed to complete their VAS rating , while 9 % of the CRS-first group failed to complete their scoring ( p = 0.03 ) . Different ways of weighting the elicited values had little impact on the analyses comparing the different presentations . Most ( 51 % ) preferred the RRR compared to the other five summary statistics ( 1 % to 25 % , p = 0.074 ) . However , decisions in the group presented the RRR deviated substantially from those made in the other five groups . The odds of participants in the RRR group deciding to take statins were 3.1 to 5.8 times that of those in the other groups across a wide range of values ( p = 0.0007 ) . Participants with a scientific background , who were more numerate or had more years of education were more likely to decide not to take statins . Conclusions Internet-based trials comparing different presentations of treatment effects are feasible , but recruiting participants is a major challenge . Despite a slightly higher response rate for CRS , VAS is preferable to avoid approximation of a continuous variable . Although most participants preferred the RRR , participants shown the RRR were more likely to decide to take statins regardless of their values compared with participants who were shown any of the five other summary statistics . Trial Registration Controlled-Trials.com IS RCT # # # # Summary box Measurement of  blood pressure  is an iconic part of modern medicine . Over the past century , life insurers , public health organisations , and prospect i ve studies , including the Framingham Heart Study , have established the relation between increased blood pressure and long term morbidity and mortality.1 About Graphic representation was used to explore to what extent the number needed to treat ( NNT ) conveys the appropriate notion of benefit for the individual patient in interventions aim ed at delaying adverse events . A sample of the Danish population ( n = 675 ) was interviewed face to face , and asked whether they would consent to a hypothetical drug that reduces the risk of heart attack . The benefit of the drug was expressed in terms of NNT and was r and omly set at 10 , 25 , 50 , 100 , 200 , and 400 . NNT does not convey information on the proportion of patients being helped by an intervention or the size of the delay of the adverse event intended to be prevented . The proportion of people consenting to the hypothetical drug was about 80 % , irrespective of NNT , and some of those who rejected the drug misinterpreted the meaning of NNT . Lay people may have difficulties in underst and ing the meaning of NNT , and clinicians may do well to use the NNT with caution until more is known about how patients comprehend it Background Shared decision-making and patients ’ choice of interventions are areas of increasing importance , not least seen in the light of the fact that chronic conditions are increasing , interventions considered important for public health , and still non-acceptance of especially risk-reducing treatments of cardiovascular diseases ( CVD ) is prevalent . A better underst and ing of patients ’ medication-taking behavior is needed and may be reached by study ing the reasons why people accept or decline medication recommendations . The aim of this paper was to identify factors that may influence people ’s decisions and reasoning for accepting or declining a cardiovascular preventive medication offer . Methods From a r and om sample of 4,000 people aged 40–59 years in a Danish population , 1,169 participants were asked to imagine being at increased risk of cardiovascular disease and being offered a preventive medication . After receiving ‘ complete ’ information about effectiveness of the medication they were asked whether they would accept medication . Finally , they were asked about reasons for the decision . Results A total of 725 ( 67 % ) of 1,082 participants accepted the medication offer . Even quite large effects of medication ( up to 8 percentage points absolute risk reduction ) had a smaller impact on acceptance to medication than personal experience with cardiovascular disease . Furthermore , increasing age of the participant and living with a partner were significantly associated with acceptance . Some 45 % of the respondents accepting justified their choice as being for health reasons , and they were more likely to be women , live alone , have higher income and higher education levels . Among those who did not accept the medication offer , 56 % indicated that they would rather prefer to change lifestyle . Conclusions Medication effectiveness seems to have a moderate influence on people ’s decisions to accept preventive medication , while factors such as personal experience with cardiovascular disease may have an equally strong or stronger influence , indicating that practitioners could do well to carefully identify the reasons for their patients ’ treatment decisions Background For shared decision making doctors need to communicate the effectiveness of therapies such that patients can underst and it and discriminate between small and large effects . Previous research indicates that patients have difficulties in underst and ing risk measures . This study aim ed to test the hypothesis that lay people may be able to discriminate between therapies when their effectiveness is expressed in terms of postponement of an adverse disease event . Methods In 2004 a r and om sample of 1,367 non-institutionalized Danes aged 40 + was interviewed in person . The participants were asked for demographic information and asked to consider a hypothetical preventive drug treatment . The respondents were r and omized to the magnitude of treatment effectiveness ( heart attack postponement of 1 month , 6 months , 12 months , 2 years , 4 years and 8 years ) and subsequently asked whether they would take such a therapy . They were also asked whether they had hypercholesterolemia or had experienced a heart attack . Results In total 58 % of the respondents consented to the hypothetical treatment . The proportions accepting treatment were 39 % , 52 % , 56 % , 64 % , 67 % and 73 % when postponement was 1 month , 6 months , 12 months , 2 years , 4 years and 8 years respectively . Participants who thought that the effectiveness information was difficult to underst and , were less likely to consent to therapy ( p = 0.004 ) . Conclusion Lay people can discriminate between levels of treatment effectiveness when they are presented in terms of postponement of an adverse event . The results indicate that such postponement is a comprehensible measure of effectiveness Background There is uncertainty about how GPs should convey information about treatment effectiveness to their patients in the context of cardiovascular disease . Hence we study the concordance of decisions based on one of four single information formats for treatment effectiveness with subsequent decisions based on all four formats combined with a pictorial representation . Methods A r and omized study comprising 1,169 subjects aged 40–59 in Odense , Denmark . Subjects were r and omized to receive information in terms of absolute risk reduction ( ARR ) , relative risk reduction ( RRR ) , number needed to treat ( NNT ) , or prolongation of life ( POL ) without heart attack , and were asked whether they would consent to treatment . Subsequently the same information was conveyed with all four formats jointly accompanied by a pictorial presentation of treatment effectiveness . Again , subjects should consider consent to treatment . Results After being informed about all four formats , 52%–79 % of the respondents consented to treatment , depending on level of effectiveness and initial information format . Overall , ARR gave highest concordance , 94 % ( 95 % confidence interval ( 91 % ; 97 % ) ) between initial and final decision , but ARR was not statistically superior to the other formats . Conclusion Decisions based on ARR had the best concordance with decisions based on all four formats and pictorial representation , but the difference in concordance between the four formats was small , and it is unclear whether respondents fully understood the information they received BACKGROUND The number needed to treat ( NNT ) has been promoted as the preferred effect measure when patients and physicians share decision making . Our aim was to explore the impact of the NNT on laypeople 's decisions about preventive drug therapies . METHODS Two thous and subjects were selected for the survey ; 1201 ( 60 % ) responded for a representative sample of the Norwegian population . Respondents were allocated to scenarios with r and om combinations of a disease to be prevented , drug treatment costs , and effect size in terms of NNT . They were interviewed about their hypothetical consent to the therapy , then r and omized to different interpretations of NNT and asked to reconsider their initial responses . RESULTS The proportions consenting varied from 76 % when the NNT was 50 to 67 % when the NNT was 1600 ( P for trend = .06 ) . When faced with the prospect of avoiding lethal disease , stroke , myocardial infa rct ion , or hip fracture , the proportions consenting were 84 % , 76 % , 68 % , and 53 % , respectively ( P<.01 ) . Across different treatment costs ( $ 37 , $ 68 , $ 162 , and $ 589 ) the proportions consenting varied from 78 % to 61 % ( P for trend < .01 ) . Twenty-four percent of the respondents changed their decision when informed about how to interpret the NNT , and 93 % of those switched from positive to negative decisions , regardless of the magnitude of NNT . CONCLUSIONS Respondents ' decisions were influenced by the type of disease to be prevented and the cost of the intervention , but not by the effect size in terms of NNT . This suggests that NNT is difficult to underst and and that other effect formats should be considered for shared decision making Background We conducted an Internet-based r and omized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease ( CVD ) for people with newly diagnosed hypertension to determine which framing presentation result ed in choices most consistent with participants ' values . Methods and Findings In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company , adult volunteers rated the relative importance of the consequences of taking antihypert 
    Output:
    
Conclusions Many patients require a substantial risk reduction before they consider taking a daily medication worthwhile , even when the medication is described as being side effect free and costless