***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: Abstrac Objective : To test the effect of extra non-directive information about prenatal testing , given individually or in a class . Setting : Antenatal clinics in a district general hospital and a university hospital . Design : R and omised controlled trial ; participants allocated to control group or offer of extra information individually or in class . Subjects : 1691 women booking antenatal care before 15 weeks ' gestation . Interventions : All participants received the usual information about prenatal tests from hospital staff . Individual participants were offered a separate session with a research midwife in which prenatal screening was described in detail . Class participants were offered the same extra information in an early prenatal class . Main outcome measures : Attendance at extra information sessions ; uptake rates of prenatal tests ; levels of anxiety , underst and ing , and satisfaction with decisions . Results : Attendance at classes was lower than at individual sessions ( adjusted odds ratio 0.45 ; 95 % confidence interval 0.35 to 0.58 ) .  Ultrasonography  was almost universally accepted ( 99 % ) and was not affected by either intervention . Uptake of cystic fibrosis testing , high in controls ( 79 % ) , was lowered in the individual group ( 0.44 ; 0.20 to 0.97 ) and classes ( 0.39 ; 0.18 to 0.86 ) . Uptake of screening for Down 's syndrome , already low ( 34 % ) in controls , was not further depressed by extra information in classes ( 0.99 ; 0.70 to 1.39 ) and was slightly higher in the individual group ( 1.45 ; 1.04 to 2.02 ) . Women offered extra information had improved underst and ing and were more satisfied with information received ; satisfaction with decisions about prenatal testing was unchanged . The offer of individual information reduced anxiety later in pregnancy . Conclusions : Ultrasonography is valued for non-medical reasons and chosen even by fully informed people who eschew prenatal diagnosis . The offer of extra information has no overall adverse effects on anxiety and reduces uptake of blood tests when background uptake rate is high ( but not when it is already low ) . High uptake of prenatal blood tests suggests compliant behaviour and need for more information The purpose of this study was to determine if providing men with information about screening for prostate cancer would enable them to assume a more active role in decision making with their family physician , and lower levels of anxiety and decisional conflict .  Men were recruited from one family medical clinic in Winnipeg , Manitoba . One hundred men scheduled for a periodic health examination ( PHE ) were r and omly assigned to receive verbal and written information either prior to the PHE , or following the second interview . Men completed measures of preferred decisional role and anxiety prior to the PHE ; and assumed decisional role , decisional conflict , and anxiety post PHE . Results demonstrated that men who received the information prior to the PHE assumed a significantly more active role in making a screening decision , and had lower levels of decisional conflict post PHE . The two groups did not differ with regard to levels of state anxiety . Providing men with information enables them to make informed screening decisions with their family physicians The purpose of this study was to develop and test a decision support intervention ( DSI ) to assist women to make and act on informed decisions that are consistent with their values in the area of menopause and hormone replacement therapy ( HRT ) . Mode and intensity of intervention were tested in midlife women ( N = 248 ) , r and omly assigned to one of three intervention formats : written information only , guided discussion , or personalized decision exercise . Data were collected over 12 months . Knowledge , decisional conflict , satisfaction with health care provider , and self-efficacy improved following intervention and were maintained for 12 months for all groups . Women 's adherence to their own plans over 12 months was 59 % ( exercise ) , 76 % ( calcium intake ) , and 89 % ( HRT ) . Carefully written information is effective in promoting knowledge , adherence , and satisfaction among well-educated , interested women . It was concluded that women can underst and complex information , including tradeoffs regarding treatment options . Women will adhere to their own plans , suggesting that consumer rather than provider plans may be the more appropriate gold st and ard for measuring adherence OBJECTIVE : To assess the impact of providing an educational videotape , ' Treatment Choices for Ischaemic Heart Disease : a Shared Decision-Making Program Videotape , ' to patients referred for coronary angiography compared with st and ard patient-physician decision making ( usual care ) .  STUDY DESIGN : R and omized controlled clinical trial . SETTING : University Hospital and Veterans Affairs Hospital . PATIENTS : A consecutive sample of 217 patients referred for coronary angiography were r and omized to receive ' usual care ' or to receive the videotape in addition to st and ard patient physician decision making ( videotape ) : 109 completed the study ( 50 % completion rate ) . MAIN OUTCOME MEASURES : Knowledge of coronary artery disease , satisfaction , self-reported physical and mental health functioning , and the proportion of patients who were referred for coronary revascularization . RESULTS : Compared with patients who received ' usual care , ' those who received the videotape were more knowledgeable ( mean score 83 vs. 58 % ; P < 0.0001 ) but less satisfied with their treatment ( 79 vs. 88 % ; P = 0.038 ) . There were no significant differences between the videotape and ' usual care ' groups with respect to satisfaction with the decision making process ( mean score 73 vs. 77 % ; P = 0.37 ) , satisfaction with the decision made ( mean score 73 vs. 78 % ; P = 0.28 ) , physical functioning ( 38 vs. 38 % ; P = 0.76 ) , mental health functioning ( 49 vs. 49 % ; P = 0.94 ) , or in referral for coronary revascularization ( OR 0.60 ; 95 % CI 0.22 - 1.65 ; P = 0.33 ) . CONCLUSION : Although the educational videotape increased patients ' knowledge level , it was associated with a decrease in their level of satisfaction with treatment . Before there is wide-spread dissemination of this technology , advocates should demonstrate its effectiveness in everyday practice In early 1983 , all 1,280 faculty and resident physicians at one hospital who were eligible to be vaccinated against hepatitis B  were divided r and omly into three groups : Group 1 physicians received general information about the risks and benefits of alternative vaccine decisions ; Group 2 physicians were additionally invited to provide personal information for an individualized decision analysis ( 12.6 percent responded ) ; and Group 3  physicians  , who served as controls , were not contacted . In one year 's follow-up , 20 percent of physicians were screened for hepatitis B antibody or vaccinated . More Group 2 physicians whose decision analyses recommended screening or vaccination took these actions ( 39 percent ) than any other group . Group assignment remained significantly associated with vaccine decisions after analyzing results by the " intention to treat " principle , and after adjusting for training status , exposure to blood and blood products , and pre- study intentions about the vaccine . Despite the low overall vaccine acceptance rate , it is concluded that individualized decision analysis can influence the clinical decisions taken by knowledgeable and interested patients 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 response to the isolation of the BRCA1 gene , a breast-ovarian cancer-susceptibility gene , biotechnology companies are already marketing genetic tests to health care providers and to the public . Initial studies indicate interest in BRCA1 testing in the general public and in population s at high risk . However , the optimal strategies for educating and counseling individuals have yet to be determined . PURPOSE Our goal was to evaluate the impact of alternate strategies for pretest education and counseling on decision-making regarding BRCA1 testing among women at low to moderate risk who have a family history of breast and /or ovarian cancer . METHODS A r and omized trial design was used to evaluate the effects of education only ( educational approach ) and education plus counseling ( counseling approach ) , as compared with a waiting-list ( control ) condition ( n = 400 for all groups combined ) . The educational approach review ed information about personal risk factors , inheritance of cancer susceptibility , the benefits , limitations , and risks of BRCA1 testing , and cancer screening and prevention options . The counseling approach included this information , as well as a personalized discussion of experiences with cancer in the family and the potential psychological and social impact of testing . Data on knowledge of inherited cancer and BRCA1 test characteristics , perceived risk , perceived benefits , limitations and risks of BRCA1 testing , and testing intentions were collected by use of structured telephone interviews at baseline and at 1-month follow-up . Provision of a blood sample for future testing served as a proxy measure of intention to be tested ( in the education and counseling arms of the study ) . The effects of intervention group on study outcomes were evaluated by use of hierarchical linear regression modeling and logistic regression modeling ( for the blood sample outcome ) . All P values are for two-sided tests . RESULTS The educational and counseling approaches both led to significant increases in knowledge , relative to the control condition ( P < .001 for both ) . The counseling approach , but not the educational approach , was superior to the control condition in producing significant increases in perceived limitations and risks of BRCA1 testing ( P < .01 ) and decreases in perceived benefits ( P < .05 ) . However , neither approach produced changes in intentions to have BRCA1 testing . Prior to and following both education only and education plus counseling , approximately one half of the participants stated that they intended to be tested ; after the session , 52 % provided a blood sample . CONCLUSIONS St and ard educational approaches may be equally effective as exp and ed counseling approaches in enhancing knowledge . Since knowledge is a key aspect of medical decision-making , st and ard education may be adequate in situations where genetic testing must be streamlined . On the other h and , it has been argued that optimal decision-making requires not only knowledge , but also a reasoned evaluation of the positive and negative consequences of alternate decisions . Although the counseling approach is more likely to achieve this goal , it may not diminish interest in testing , even among women at low to moderate risk . Future research should focus on the merits of these alternate approaches for subgroups of individuals with different background s who are being counseled in the variety of setting s where BRCA1 testing is likely to be offered Seventy-four patients , ranging in age from 15 to 50 and presenting with a moderate to severe dentofacial deformity requiring orthognathic surgery , were r and omly assigned to a  video imaging or a st and ard case presentation ( CP ) group . Motives for treatment did not differ significantly between the video image and st and ard CP groups . Two weeks after the case presentation , 60 % of the st and ard CP group and 74 % of the video image group ranked the anticipated change in facial appearance as an important factor in making a treatment decision . Seventy percent of the st and ard CP group and 83 % of the video image group agreed with the statement that surgery would be necessary to correct their problem . In the st and ard CP group , 47 % of the patients ranked dental casts as the most helpful physical record in making a treatment decision , and 46 % said the acetate profile tracing was the most helpful tool for underst and ing what to expect from treatment . In the video imaging group , 42 % of the patients said the  video imaging presentation  was the most helpful tool in making a treatment decision , and 39 % of the patients said it was the most helpful tool for underst and ing treatment expectations . The proportion of patients in the video image case presentation group with elevated self-image expectations following treatment was significantly higher ( P = .045 ) than in the st and ard case presentation group . The presentation of video images appears to be a valuable information source for conveying treatment options to patients , but caution may be needed to prevent elevated or possibly unrealistic treatment expectations Abstract OBJECTIVE : Routine screening for prostate cancer is controversial because of frequent false-positive results , the potential for slow , non-life-threatening growth of untreated cancer , the uncertainty regarding whether treatment can extend life , and the potential for treatment complications . This study examines how information about prostate-specific antigen ( PSA ) testing and the uncertain benefits of treating prostate cancer affects patients ’ desire for PSA testing . DESIGN : An educational videotape design ed to inform men about the uncertainty surrounding PSA screening and the treatment of early-stage prostate cancer was presented to two groups of male patients 50 years of age or older . SETTING : Dartmouth-Hitchcock Medical Center . PATIENTS / PARTICIPANTS : For study 1 , men seeking a free prostate cancer screening were preassigned to view the educational videotape ( N=184 ) or another videotape ( N=188 ) . For study 2 , men scheduled to visit a general internal medicine clinic viewed either the educational videotape ( N=103 ) or no videotape ( N=93 ) . MEASUREMENTS AND MAIN RESULTS : The men ’s information and preferences about prostate cancer screening and treatment and actual choice of PSA test at the next test opportunity were measured . Men who viewed the educational videotape were : better informed about PSA tests , prostate cancer , and its treatment ; preferred no active treatment if cancer were found ; and preferred not to be screened ( all significant atp≤.002 in both studies ) . Men viewing the educational video were less likely to have a PSA test ( p=.041 , study 2 ) . This tendency was not significant at the free-PSA clinic ( p=.079 ) . CONCLUSIONS : Preference regarding cancer screening and treatment is greatly affected by information about medical uncertainties . Because informed patient choices vary , PSA screening decisions should incorporate individual preferences No abstract available . Although practice guidelines suggest that postmenopausal women learn about the benefits and nsks and consider their values when deciding about hormone therapy , the optimal decision-support 
    Output:
    
Decision aids had a variable effect on decisions .
When complex decision aids were compared with simpler versions , they were better at reducing decisional conflict , improved knowledge marginally , but did not affect satisfaction .
CONCLUSIONS Decision aids improve knowledge , reduce decisional conflict , and stimulate patients to be more active in decision making without increasing their anxiety .
Decision aids have little effect on satisfaction and a variable effect on decisions .
The effects on outcomes of decisions ( persistence with choice , quality of life ) remain uncertain