***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: Study objective : To determine the efficacy of a comprehensive , one-month psychosocial training program for first-year medical residents . Design : Nonr and omized , controlled study with immediate pre/post evaluation . Limited evaluation of some residents was also conducted an average of 15 months after teaching . Setting : Community-based , primary care-oriented residency program at Michigan State University (MSU).Subjects : All 28 interns from the single-track MSU residency program during 1986/87–88/89 participated in this required rotation ; there was no dropout or instance of noncompliance with the study . In the follow-up study in 1989 , all 13 available trainees participated . Of 20 untrained , volunteer controls , ten were second/third-year residents in the same program during 1986/87 and ten were interns from a similar MSU program in Kalamazoo , MI , during 1988/89.Teaching  intervention : An experiential , skill-oriented , and learner-centered rotation with competency-based objects focused on communication and relationship-building skills and on the diagnosis and management of psychologically disturbed medical patients . Measurements and main results : The two subsets of the control group were combined because residents and training programs were similar and because means and st and ard deviations for the subsets were similar on all measures . By two-way analyses of variance ( group × gender ) , the trainee group showed significantly greater gains ( p<0.001 ) on question naires addressing knowledge , self- assessment , and attitudes ; a mean of 15 months following training , there was no significant deterioration of attitude scores . All trainees were also able to identify previously unrecognized , potentially deleterious personal responses using a systematic rating procedure . Residents ’ acceptance of the program was high . Conclusions : Intensive , comprehensive psychosocial training was well accepted by residents . It improved their knowledge , self-awareness , self- assessment , and attitudes , the latter improvement persisting well beyond training Background Although previous studies have reported the efficacy of communication skills training ( CST ) programs , specific training addressing communication about uncertainty and hope in oncology has not yet been studied . This paper describes the study protocol of a r and omized controlled trial assessing the efficacy of a CST program aim ed at improving  physician ability to communicate about uncertainty and hope in encounters with cancer patients . Methods / design Physician participants will be r and omly assigned in groups ( n = 3/group ) to a  30-h CST program ( experimental group ) or to a waiting list ( control group ) .  The training program will include learner-centered , skills-focused , practice -oriented techniques . Training efficacy is assessed in the context of an encounter with a simulated advanced stage cancer patient at baseline and after the CST for the experimental group , and after four months for the waiting-list group . Efficacy assessment s will include communicational , psychological and physiological measures . Group-by-time effects will be analyzed using a generalized estimating equation ( GEE ) . A power analysis indicated that a sample size of 60 ( 30 experimental and 30 control ) participants will be sufficient to detect effects . Discussion The current study will aid in the development of effective  CST programs to improve  physician ability to communicate about uncertainty and hope in encounters with cancer patients .Trial registration US Clinical Trials Register NCT02836197 Background Shared decision-making ( SDM ) has become increasingly important in health care . However , despite scientific evidence , effective implementation strategies , and a prominent position on the health policy agenda , SDM is not widely implemented in routine practice so far . Therefore , we developed a program for routine implementation of SDM in oncology by conducting an analysis of the current state and a needs assessment in a pilot study based on the Consoli date d Framework for Implementation Research ( CFIR ) . Based on these results , the main aim of our current study is to evaluate the process and outcome of this theoretically and empirically grounded multicomponent implementation program design ed to foster SDM in routine cancer care . Methods We use a stepped wedge design , a variant of the cluster r and omized controlled trial . The intervention to be implemented is SDM .  Three participating clinics of one comprehensive cancer center will be r and omized and receive the multicomponent SDM implementation program in a time-delayed sequence . The program consists of the following strategies : ( a ) SDM training for health care professionals , ( b ) individual coaching for physicians , ( c ) patient activation strategy , ( d ) provision of patient information material and decision aids , ( e ) revision of the clinics ’ quality management documents , and ( f ) critical reflection of current organization of multidisciplinary team meetings . We will conduct a mixed methods outcome and process evaluation . The outcome evaluation will consist of four measurement points . The primary outcome is adoption of SDM , measured by the 9-item Shared Decision Making Question naire . A range of other implementation outcomes will be assessed ( i.e. , acceptability , readiness for implementing change , appropriateness , penetration ) . The implementation process will be evaluated using stakeholder interviews and field notes . This will allow adapting interventions if necessary . Discussion This study is the first large study on routine implementation of SDM conducted in German cancer care . We expect to foster implementation of SDM at the enrolled clinics . Insights gained from this study , using a theoretically and empirically grounded approach , can inform other SDM implementation studies and health policy developments , both nationally and internationally . Trial registration clinical trials.gov , NCT03393351 . Registered 8 January 2018 A literature search for articles concerning  communication skills teaching and learning in medicine was done . The search yielded 180 pertinent articles , which were quality grade d into the three categories of high , medium and low quality , using established criteria . Only those of high and medium quality were used for the review , which thus is based on 31 r and omized studies , 38 open effect studies and 14 descriptive studies . Communication skills can be taught in courses , are learnt , but are easily forgotten if not maintained by practice .The most effective point in time to learn these at medical school is probably during the clinical clerkships , but there is no study that has specifically addressed this question .After a short period of training , doctors can be effective as teachers . The teaching method should be experiential as it has been shown conclusively that instructional methods do not give the desired results .The contents of communication skills courses should primarily be problem defining . All students should have communication skills training since those with the lowest pre-course scores gain the most from such courses . Men are slower learners of communication skills than women , which should be taken into account by course organizers . As there is only one really long-term follow up into the residency phase of communication skills training at medical school , those who have done r and omized studies in the field should if possible carry out further follow-up studies Background Systemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high . Hence , treatment decisions require Shared Decision Making ( SDM ) . The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment . Methods A RCT design with four parallel arms will be adopted . Patients with metastatic or irresectable cancer with a median life expectancy < 12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible . A total of 24 oncologists ( in training ) and 192 patients will be recruited . The oncologist training consists of a reader , two group sessions ( 3.5 h ; including modelling videos and role play ) , a booster feedback session ( 1 h ) and a consultation room tool . The patient communication aid consists of a home-sent question prompt list and a value clarification exercise to prepare patients for SDM in the consultation . The control condition consists of care as usual . The primary outcome is observed SDM in audio-recorded consultations . Secondary outcomes include patient and oncologist evaluation of communication and decision-making , the decision made , quality of life , potential adverse outcomes such as anxiety and hopelessness , and consultation duration . Patients fill out question naires at baseline ( T0 ) , before ( T1 ) and after the consultation ( T2 ) and at 3 and 6 months ( T3 and T4 ) . All oncologists participate in two st and ardized patient assessment s ( before-after training ) prior to the start of patient inclusion . They will fill out a question naire before and after these assessment s , as well as after each of the recorded consultations in clinical practice . Discussion The CHOICE trial will enable evidence -based choices regarding the investment in SDM interventions targeting either oncologists , patients or both in the advanced cancer setting . The trial takes into account the immediate effect of the interventions on observed communication , but also on more distal and potential adverse patient outcomes . Also , the trial provides evidence regarding the assumption that SDM about palliative cancer treatment results in less aggressive treatment and more quality of life in the final period of life . Trial registration Netherl and s Trial Registry number NTR5489 ( prospect i ve ; 15 Sep 2015 ) The potential benefits of health-related quality of life ( HRQL ) assessment in oncology clinical practice include better detection of problems , enhanced disease and treatment monitoring and improved care . However , few empirical studies have investigated the effects of incorporating such assessment s into routine clinical care . Recent r and omized studies have reported improved detection of and communication about patients ' concerns , but few have found effects on patient HRQL or satisfaction . This study examined whether offering interpretive assistance of HRQL results would improve these patient outcomes . Two hundred and thirteen participants with metastatic breast , lung or colorectal cancer were r and omly assigned to one of three conditions : usual care ; HRQL assessment or HRQL assessment followed by a structured interview and discussion . Interviews about patients ' assessment responses were conducted by a research nurse , who then presented HRQL information to the treating nurse . HRQL and treatment satisfaction outcomes were assessed at 3 and 6 months . No significant differences were found between study conditions in HRQL or satisfaction . Results suggest that routine HRQL assessment , even with description of results , is insufficient to improve patient HRQL and satisfaction . It is suggested that positive effects may require supplementing assessment results with specific suggestions for clinical management changes OBJECTIVES --To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon 's opinion or the patient 's choice . To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery  was associated with their participation in a r and omised clinical trial . DESIGN -- Prospect i ve , multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer . SETTING --12 District general hospitals , three London teaching hospitals , and four private hospitals . PATIENTS --269 Women under 75 with a probable diagnosis of stage I or II breast cancer who were referred to 22 different surgeons . INTERVENTIONS --Surgery and radiotherapy or adjuvant chemotherapy , or both , depending on the individual surgeon 's stated preferences for managing early breast cancer . MAIN OUTCOME MEASURES --Anxiety and depression as assessed by st and ard methods two weeks , three months , and 12 months after surgery . RESULTS --Of the 269 women , 31 were treated by surgeons who favoured mastectomy , 120 by surgeons who favoured breast conservation , and 118 by surgeons who offered a choice of treatment . Sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery , and 43 of these chose  breast conserving surgery . The incidences of anxiety , depression , and sexual dysfunction were high in all treatment groups . There were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy . A significant effect of surgeon type on the incidence of depression was observed , with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons ( p = 0.06 ) . There was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose . Most of the women ( 159/244 ) gave fear of cancer as their primary fear rather than fear of losing a breast . The overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the Cancer Research Campaign breast conservation study . At 12 months 28 % of women who underwent mastectomy in the present study were anxious compared with 26 % in the earlier study , and 27 % of women in the present study who underwent lumpectomy were anxious compared with 31 % in the earlier study . In both the present and earlier study 21 % of women who underwent mastectomy were depressed , and 19 % of women who underwent lumpectomy in the present study were depressed compared with 27 % in the earlier study . ) CONCLUSIONS --There is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy . Women who surrender autonomy for decision making by agreeing to participate in r and omised clinical trials do not experience any different psychological , sexual , or social problems from those women who are treated for breast cancer outside a clinical trial Background The grading of recommendation , assessment , development and evaluation ( GRADE ) approach is widely implemented in health technology assessment and guideline development organisations throughout the world . GRADE provides a transparent approach to reaching judgements about the quality of evidence on the effects of a health care intervention , but is complex and therefore challenging to apply in a consistent manner . Methods We developed a checklist to guide the research er to extract the data required to make a GRADE assessment . We applied the checklist to 29 meta-analyses of r and omised controlled trials on the effectiveness of health care interventions . Two review ers used the checklist for each paper and used these data to rate the quality of evidence for a particular outcome . Results For most ( 70 % ) checklist items , there was good agreement between review ers . The main problems were for items relating to indirectness where considerable judgement is required . Conclus 
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Evidence suggesting no difference between  CST and no CST  on eliciting patient concerns and providing appropriate information was of a moderate-certainty .
There was no evidence of differences in the other HCP communication skills , including clarifying and /or summarising information , and negotiation .
Doctors and nurses did not perform differently for any HCP outcomes .There were no differences between the groups with regard to HCP ' burnout ' ( low-certainty evidence ) nor with regard to patient satisfaction or patient perception of the HCPs communication skills ( very low-certainty evidence ) .
Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient 's emotions or offering support .
We were unable to determine whether the effects of CST are sustained over time , whether consolidation sessions are necessary , and which types of CST programs are most likely to work .
We found no evidence to support a beneficial effect  of CST on HCP ' burnout ' , the mental or physical health and satisfaction of people with cancer