***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: OBJECTIVE To develop and vali date the  Readiness for Implementation Model  ( RIM ) . This model predicts a healthcare organization 's potential for success in implementing an interactive health communication system ( IHCS ) . The model consists of seven weighted factors , with each factor containing five to seven elements . DESIGN Two decision-analytic approaches , self-explicated and conjoint analysis , were used to measure the weights of the  RIM  with a sample of 410 experts . The RIM model with weights was then vali date d in a prospect i ve study of 25 IHCS implementation cases . MEASUREMENTS Orthogonal main effects design was used to develop 700 conjoint- analysis profiles , which varied on seven factors . Each of the 410 experts rated the importance and desirability of the factors and their levels , as well as a set of 10 different profiles . For the prospect i ve 25-case validation , three time-repeated measures of the RIM scores were collected for comparison with the implementation outcomes . RESULTS Two of the seven factors , ' organizational motivation ' and ' meeting user needs , ' were found to be most important in predicting implementation readiness . No statistically significant difference was found in the predictive validity of the two approaches ( self-explicated and conjoint analysis ) . The RIM was a better predictor for the 1-year implementation outcome than the half-year outcome . LIMITATIONS The expert sample , the order of the survey tasks , the additive model , and basing the RIM cut-off score on experience are possible limitations of the study . CONCLUSION The RIM needs to be empirically evaluated in institutions adopting IHCS and sustaining the system in the long term Abstract Objective : To examine the use of evidence based leaflets on informed choice in maternity services . Design : Non-participant observation of 886 antenatal consultations . 383 in depth interviews with women using maternity services and health professionals providing antenatal care . Setting : Women 's homes ; antenatal and ultrasound clinics in 13 maternity units in Wales . Participants : Childbearing women and health professionals who provide antenatal care . Intervention : Provision of 10 pairs of Informed Choice leaflets for service users and staff and a training session in their use . Main outcome measures : Participants ' views and commonly observed responses during consultations and interviews . Results : Health professionals were positive about the leaflets and their potential to assist women in making informed choices , but competing dem and s within the clinical environment undermined their effective use . Time pressures limited discussion , and choice was often not available in practice . A widespread belief that technological intervention would be viewed positively in the event of litigation reinforced notions of “ right ” and “ wrong ” choices rather than “ informed ” choices . Hierarchical power structures result ed in obstetricians defining the norms of clinical practice and hence which choices were possible . Women 's trust in health professionals ensured their compliance with professionally defined choices , and only rarely were they observed asking questions or making alternative requests . Midwives rarely discussed the contents of the leaflets or distinguished them from other literature related to pregnancy . The visibility and potential of the leaflets as evidence based decision aids was thus greatly reduced . Conclusions : The way in which the leaflets were disseminated affected promotion of informed choice in maternity care . The culture into which the leaflets were introduced supported existing normative patterns of care and this ensured informed compliance rather than informed choice . What is already known on this topic Informed Choice leaflets are widely used in maternity care but little is known about their ability to influence informed choice and decision making High quality information is essential for promoting informed choice but is insufficient by itself What this study adds Time constraints and other pressures on health professionals result ed in a lack of discussion of the content of the leaflets Fear of litigation , power hierarchies , and the technological imperative in maternity care limited the choices available Health professionals promoted normative practice s rather than choice , and as women valued their opinions this led to the promotion of informed compliance rather than informed Objectives To describe the development , validation and inter-rater reliability of an instrument to measure the  quality of patient decision support technologies ( decision aids ) . Design Scale development study , involving construct , item and scale development , validation and reliability testing . Setting There has been increasing use of decision support technologies – adjuncts to the discussion s clinicians have with patients about difficult decisions . A global interest in developing these interventions exists among both for-profit and not-for-profit organisations . It is therefore essential to have internationally accepted st and ards to assess the quality of their development , process , content , potential bias and method of field testing and evaluation . Methods Scale development study , involving construct , item and scale development , validation and reliability testing . Participants Twenty-five research er-members of the International Patient Decision Aid St and ards Collaboration worked together to develop the instrument ( IPDASi ) . In the fourth Stage ( reliability study ) , eight raters assessed thirty r and omly selected decision support technologies . Results IPDASi measures quality in 10 dimensions , using 47 items , and provides an overall quality score ( scaled from 0 to 100 ) for each intervention . Overall IPDASi scores ranged from 33 to 82 across the decision support technologies sample d ( n = 30 ) , enabling discrimination . The inter-rater intraclass correlation for the overall quality score was 0.80 . Correlations of dimension scores with the overall score were all positive ( 0.31 to 0.68 ) . Cronbach 's alpha values for the 8 raters ranged from 0.72 to 0.93 . Cronbach 's alphas based on the dimension means ranged from 0.50 to 0.81 , indicating that the dimensions , although well correlated , measure different aspects of decision support technology quality . A short version ( 19 items ) was also developed that had very similar mean scores to IPDASi and high correlation between short score and overall score 0.87 ( CI 0.79 to 0.92 ) . Conclusions This work demonstrates that IPDASi has the ability to assess the quality of decision support technologies . The existing IPDASi provides an assessment of the quality of a DST 's components and will be used as a tool to provide formative advice to DSTs developers and summative assessment s for those who want to compare their tools against an existing benchmark Background Decision aids are evidence based tools that assist patients in making informed values-based choices and supplement the patient-clinician interaction . While there is evidence to show that decision aids improve key indicators of patients ' decision quality , relatively little is known about physicians ' acceptance of decision aids or factors that influence their decision to use them . The purpose of this study was to describe physicians ' perceptions of three decision aids , their expressed intent to use them , and their subsequent use of them . Methods We conducted a cross-sectional survey of r and om sample s of Canadian respirologists , family physicians , and geriatricians .  Three decision aids representing a range of health decisions were evaluated . The survey elicited physicians ' opinions on the characteristics of the decision aid and their willingness to use it . Physicians who indicated a strong likelihood of using the decision aid were contacted three months later regarding their actual use of the decision aid . Results Of the 580 eligible physicians , 47 % ( n = 270 ) returned completed question naires . More than 85 % of the respondents felt the decision aid was well developed and that it presented the essential information for decision making in an underst and able , balanced , and unbiased manner . A majority of respondents ( > 80 % ) also felt that the decision aid would guide patients in a logical way , preparing them to participate in decision making and to reach a decision . Fewer physicians ( < 60 % ) felt the decision aid would improve the quality of patient visits or be easily implemented into practice and very few ( 27 % ) felt that the decision aid would save time . Physicians ' intentions to use the decision aid were related to their comfort with offering it to patients , the decision aid topic , and the perceived ease of implementing it into practice . While 54 % of the surveyed physicians indicated they would use the decision aid , less than a third followed through with this intention . Conclusion Despite strong support for the format , content , and quality of patient decision aids , and physicians ' stated intentions to adopt them into clinical practice , most did not use them within three months of completing the survey . There is a wide gap between intention and behaviour . Further research is required to study the determinants of this intention-behaviour gap and to develop interventions aim ed at barriers to physicians ' use of decision aids We evaluated the effect of an intervention on call centre nurses '  knowledge of decision support and skills in coaching callers facing value-sensitive health decisions . Forty-one registered nurses at a health call centre were r and omly assigned to an intervention or control group . The intervention was a coaching protocol , online tutorial , skills building workshop and performance feedback . The main outcome measures were : knowledge test ; blinded quality assessment of coaching skills during simulated calls and call duration . Compared with controls , nurses in the intervention group had better knowledge ( 74 versus 60 % , P = 0.007 ) and decision coaching skills ( 81 versus 44 % , P < 0.001 ) , particularly in assessing decisional needs ( information , values clarity , support , stage and timing of decision ) and addressing support issues . Call duration did not differ ( 18.5 versus 16.7 min , P = 0.73 ) . The coaching protocol was rated as compatible with nurses ' views on decision-making and more advantageous compared with their usual practice s. The intervention improved the quality of nurses ' decision coaching without affecting call duration OBJECTIVE To assess the impact of a decision aid on perceived risk of heart attacks and medication adherence among urban primary care patients with diabetes . METHODS We r and omly allocated 150 patients with diabetes to participate in a usual primary care visit either with or without the Statin Choice tool . Participants completed a question naire at baseline and telephone follow-up at 3 and 6 months . RESULTS Intervention patients were more likely to accurately perceive their underlying risk for a heart attack without taking a statin ( OR : 1.9 , CI : 1.0 - 3.8 ) and with taking a statin ( OR : 1.4 , CI : 0.7 - 2.8 ) ; a decline in risk overestimation among patients receiving the decision aid accounts for this finding . There was no difference in statin adherence at 3 or 6 months . CONCLUSION A decision aid about using statins to reduce coronary risk among patients with diabetes  improved risk communication , beliefs , and decisional conflict , but did not improve adherence to statins . PRACTICE IMPLICATION S Decision aid enhanced communication about the risks and benefits of statins improved patient risk perceptions but did not alter adherence among patients with diabetes OBJECTIVE Compliance with antipsychotic medication is a major issue in schizophrenia treatment , and noncompliance with antipsychotic treatment is closely related to relapse and rehospitalization . An enhanced involvement of patients with schizophrenia in treatment decisions ( " shared decision making " ) is expected to improve long-term compliance and reduce rehospitalizations . The aim of the present analysis was to study whether shared decision making ( SDM ) in antipsychotic drug choice would influence long-term outcome . METHOD From February 2003 to January 2004 , psychiatric state hospital in patients with a diagnosis of schizophrenia ( ICD-10 ; N = 107 ) were recruited for the trial using a cluster-r and omized controlled design . An SDM program on antipsychotic drug choice consisting of a decision aid and a planning talk between patient and physician was compared with routine care with respect to long-term compliance and rehospitalizations ( 6-month and 18-month follow-up ) . RESULTS On the whole , we found high rates of noncompliance and rehospitalization . There were no differences between intervention and control groups in the univariate analyses . However , when controlling for confounding factors in a multivariate analysis , there was a positive trend ( p = .08 ) that patients in the SDM intervention had fewer rehospitalizations . Additionally , a higher desire of the patient for autonomy and better knowledge at discharge were associated with higher hospitalization rates . CONCLUSION The intervention studied showed a positive trend but no clear beneficial effect on long-term outcomes . A more thorough implementation of SDM ( e.g. , iterative administration of decision aid ) might yield larger effects . Those patients with higher participation preferences are at higher risk for poor treatment outcomes and therefore require special attention . Strategies to match these patients ' needs might improve compliance and long-term outcomes Background . R and omized controlled trials show that patient decision aids ( DAs ) can promote shared decision making and improve decision quality . Despite this evidence , integration of DAs into routine clinical practice has proceeded slowly . Objective . To identify factors that promote or impede integrating DAs into clinical practice in a large health care delivery system . Design . Mixed- methods case study . Setting and Patients . Group Health , an integrated health plan and care delivery system in Washington state . Intervention . The project was carried out in 6 specialty service lines using 12 video-based DAs for preference-sensitive conditions related to elective surgical procedures . Measurements . Process data , site visits , meeting observations , and in-depth interviews conducted with clinical staff , project staff , and health plan leaders in 2009 and 2010 . Results . The project established systemwide and clinic-specific processes that facilitated the distribution of approximately 10,000 DAs over 2 years . Several factors were identified as important for success in this implementation , including strong support from senior leaders , establishing a system for previsit ordering and providing timely feedback to teams about distribution rates , engaging providers and staff in development of the implementation process , and finding ways to address concerns about conditions that were perceived as life-threatening and /or time sensitive . Limitations . Limitations included lack of data on patient perspectives , an implementation setting with salaried providers , and frontline provider interviews conducted in only selected service lines . Conclusions . With strong leadership , financial support , and a well-defined implementation strategy , 12 video-based DAs in 6 specialty service lines were integrated into routine practice over 2 years . Findings from this demonstration may advance the ability of other organizations to use DAs effectively and promote widespread adoption of shared decision making in routine patient care Decision aids ( DAs ) are tools to support patients make informed health decisions with their practition 
    Output:
    
The results point to significant challenges to the implementation of  patient decision support  using this model , including indifference on the part of health care professionals .
This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows , ultimately contributing to organizational inertia regarding their adoption .
Conclusions It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a ‘ referral model ’ consistently report difficulties .