***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 concerns that facilitating informed choice would decrease diabetes screening uptake , ' informed choice ' invitations that increased knowledge did not affect attendance ( the DICISION trial ) . We explored possible reasons using data from an experimental analogue study undertaken to develop the invitations . We tested a model of the impact on knowledge , attitude and intentions of a diabetes screening invitation design ed to facilitate informed choices . Methods 417 men and women aged 40 - 69 recruited from town centres in the UK were r and omised to receive either an invitation for diabetes screening design ed to facilitate informed choice or a st and ard type of invitation .  Knowledge of the invitation , attitude towards diabetes screening , and intention to attend for diabetes screening were assessed two weeks later . Results Attitude was a strong predictor of screening intentions ( β = .64 , p = .001 ) . Knowledge added to the model but was a weak predictor of intentions ( β = .13 , p = .005 ) . However , invitation type did not predict attitudes towards screening but did predict knowledge ( β = -.45 , p = .001 ) , which mediated a small effect of invitation type on intention ( indirect β = -.06 , p = .017 ) . Conclusions These findings may explain why information about the benefits and harms of screening did not reduce diabetes screening attendance in the DICISION trial Background : Few interventions have proven effective in reducing the overuse of antibiotics for acute respiratory infections . We evaluated the effect of DECISION+2 , a shared decision-making training program , on the percentage of patients who decided to take  antibiotics  after consultation with a physician or resident . Methods : We performed a r and omized trial , clustered at the level of family practice teaching unit , with 2 study arms : DECISION+2 and control . The DECISION+2 training program included a 2-hour online tutorial followed by a 2-hour interactive seminar about shared decision-making . The primary outcome was the proportion of patients who decided to use antibiotics immediately after consultation . We also recorded patients ’ perception that shared decision-making had occurred . Two weeks after the initial consultation , we assessed patients ’ adherence to the decision , repeat consultation , decisional regret and quality of life . Results : We compared outcomes among 181 patients who consulted 77 physicians in 5 family practice teaching units in the DECISION+2 group , and 178 patients who consulted 72 physicians in 4 family practice teaching units in the control group . The percentage of patients who decided to use antibiotics after consultation was 52.2 % in the control group and 27.2 % in the DECISION+2 group ( absolute difference 25.0 % , adjusted relative risk 0.48 , 95 % confidence interval 0.34–0.68 ) . DECISION+2 was associated with patients taking a more active role in decision-making ( Z = 3.9 , p < 0.001 ) . Patient outcomes 2 weeks after consultation were similar in both groups . Interpretation : The shared decision-making program DECISION+2 enhanced patient participation in decision-making and led to fewer patients deciding to use antibiotics for acute respiratory infections . This reduction did not have a negative effect on patient outcomes 2 weeks after consultation . Clinical Trials.gov trial register no. NCT01116076 OBJECTIVE The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate , vs. usual education alone , on conflict associated with decision making , plus explore time-to-treatment , and treatment choice . METHODS A r and omized , multi-center clinical trial was conducted with measures at baseline , 1- , and 6 months . Men with newly diagnosed localized prostate cancer ( CaP ) who sought consultation at urology , radiation oncology , or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited . Intervention group participants used the Personal Patient Profile-Prostate , a decision support system comprised of customized text and video coaching regarding potential outcomes , influential factors , and communication with care providers . The primary outcome , patient-reported decisional conflict , was evaluated over time using generalized estimating equations to fit generalized linear models . Additional outcomes , time-to-treatment , treatment choice , and program acceptability/usefulness , were explored . RESULTS A total of 494 eligible men were r and omized ( 266 intervention ; 228 control ) . The intervention reduced adjusted decisional conflict over time compared with the control group , for the uncertainty score ( estimate -3.61 ; ( confidence interval , -7.01 , 0.22 ) , and values clarity ( estimate -3.57 ; confidence interval ( -5.85,-1.30 ) . Borderline effect was seen for the total decisional conflict score ( estimate -1.75 ; confidence interval ( -3.61,0.11 ) . Time-to-treatment was comparable between groups , while undecided men in the intervention group chose brachytherapy more often than in the control group . Acceptability and usefulness were highly rated . CONCLUSION The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences Background Men diagnosed with localized prostate cancer ( LPC ) can choose from multiple treatment regimens and are faced with a decision in which medical factors and personal preferences are important . The Personal Patient Profile-Prostate ( P3P ) is a computerized decision aid for men with LPC that focuses on personal preferences . We determined whether the P3P intervention improved the concordance of treatment choice with self-reported influential side-effects compared with a control group . Methods English/Spanish-speaking men diagnosed with LPC ( 2007–2009 ) from four US cities were enrolled into a r and omized trial and followed through 6-months via mailed or online question naire . Men were r and omized to receive the P3P intervention or st and ard education plus links to reputable websites . We classified choice as concordant if men were concerned with ( a ) sexual function and chose external beam radiotherapy or brachytherapy , ( b ) bowel function and chose prostatectomy , ( c ) sex , bowel , and /or bladder function and chose active surveillance , or ( d ) not concerned with any side effect and chose any treatment . Using logistic regression , we calculated odds ratios ( OR ) and 95 % confidence intervals ( CI ) for the association between the P3P intervention and concordance . Results Of 448 men , most were < 65 years , non-Hispanic white , had multiple physician consultations prior to enrollment , and chose a treatment discordant with concerns about potential side effects . There was no significant difference in concordance between the intervention ( 45 % ) and control ( 50 % ) group ( OR = 0.82 ; 95%CI = 0.56 , 1.2 ) . Conclusions The P3P intervention did not improve concordance between potential side effects and treatment choice . Information and /or physician consultation immediately after diagnosis was likely to influence decisions despite concerns about side effects . The intervention may be more effective before the first treatment options consultation . Trial registration NCT00692653 http:// clinical OBJECTIVE To test whether information about benefits and harms of screening for type 2 diabetes increases intentions to make lifestyle changes amongst attenders , predominantly among the socially advantaged and those with a strong future time orientation . STUDY DESIGN Planned subgroup analysis of attenders for screening participating in a r and omized controlled trial of an informed choice invitation vs a st and ard invitation to attend for type 2 diabetes screening . METHODS Potentially eligible participants were identified from practice registers using routine data which were used to calculate risk scores for diabetes for all aged 40 - 69 years without known type 2 diabetes and area deprivation based on post code . In total , 1272 individuals in the top 25 % risk category were r and omized to receive one of two  invitations to attend their practice s for screening : an informed choice invitation or a st and ard invitation . The subsequent attenders completed self-report measures of future time orientation and deprivation immediately before undergoing a screening test . RESULTS Individual-level deprivation demonstrated a significant moderator effect [ F ( 4,635 ) = 4.32 , P = 0.002 ] : individuals who were high in deprivation had lower intentions to engage in lifestyle change following receipt of the informed choice invitation . However , intentions were not patterned by deprivation when it was assessed at the area-level using the Index of Multiple Deprivation 2007 . The hypothesized moderating effect of future time orientation on invitation type was also supported [ F(14,613 ) = 2.46 , P = 0.002 ) : individuals low in future time orientation had markedly lower intentions to engage in lifestyle change following receipt of an informed choice invitation compared with a st and ard invitation for screening . CONCLUSION Efforts to enhance informed choice where the implication s of diagnosis are a requirement for lifestyle change may require that the immediate benefits are communicated , and efforts to address the apparent barriers to diabetes self-care are made , if the potential for inequity is to be avoided The concept of shared decision making ( SDM ) is an important emerging trend in clinical medicine but has received little or no attention in the dental literature . Decision aids can play a useful role in SDM by helping patients and clinicians choose among reasonable alternative treatment options . The purpose of this study was to develop and test an Endodontic Decision Board ( EndoDB ) for chairside use to help clarify treatment alternatives , benefits , risks , prognosis , and costs when root canal therapy or extraction of a tooth was indicated . The hypothesis was that the use of the EndoDB would lead to improved patient knowledge , greater satisfaction with the decision-making process , and no difference in anxiety when compared to the st and ard discussion and informed consent process ( usual care ) . The EndoDB was tested in a r and omized controlled trial in a postgraduate endodontics clinic . After treatment discussion , a brief question naire was completed by the patient to measure knowledge , satisfaction , and anxiety .  Patients in the EndoDB group ( n=32 ) demonstrated a small , but statistically significant , increase in knowledge ( t-test ; difference=+0.37 ; p=0.03 ) compared to the  usual care group ( n=35 ) . There was no difference between groups in the measures of satisfaction or anxiety ( Mann-Whitney U-test ; p>0.05 ) . Decision aids may emerge as a useful tool to facilitate SDM and evidence -based clinical practice Objective : To evaluate a decision aid ( DA ) design ed to promote informed decision making for prostate cancer screening . Methods : Twelve work sites were r and omly assigned to an intervention or nonintervention comparison condition . Intervention sites received access to a computer-tailored DA at the workplace . Male employees age 45 years and above ( n = 625 ) completed surveys at baseline and at 3-month follow-up , documenting aspects of informed decision making . Results : Using an intention-to-treat analysis , men in the intervention group were significantly more likely to have made a screening decision and to have improved knowledge without increased decisional conflict , relative to men in the comparison group . These changes were observed despite the fact that only 30 % of men in intervention sites used the DA . Among DA users , similar improvements were observed , although the magnitudes of changes were substantially greater , and significant improvements in decision self-efficacy were observed . Conclusions : A DA offered in the workplace promoted decision making , improved knowledge , and increased decision self-efficacy among users , without increasing decisional conflict . However , participation was suboptimal , suggesting that better methods for engaging men in workplace interventions are needed . Impact Statement : This trial shows the efficacy of a computer-tailored DA in promoting informed decisions about prostate cancer screening . The DA was delivered through work sites , thereby providing access to re sources required to participate in informed decision making without requiring a medical appointment . However , participation rates were suboptimal , and additional strategies for engaging men are needed . Cancer Epidemiol Biomarkers Prev ; 19(9 ) ; 2172–86 . © 2010 AACR Purpose Evaluate baseline factors that may explain the influence of study site on decisional conflict ( DC ) in men from the Personal Patient Profile : Prostate ( P3P ) r and omized trial . Material s and methods 476 cases from 5 P3P sites were included . Participants completed baseline demographic assessment s , 4 subscales of the DC scale at baseline ( uncertainty , informed , values clarity , and support ) , the Exp and ed Prostate Cancer Index Composite ( short form ) and the State-Trait Anxiety Inventory . Site data regarding typical practice s were collected . Linear regressions were used to model the relation between baseline DC scores and study site adjusting for the list of variables . Results Baseline decisional uncertainly ( p?=?0.001 ) and informed ( p?=?0.03 ) subscales were significantly different across sites . Participant demographic and baseline measures were significantly different ( p?<?0.05 ) between sites except for trait anxiety . We identified participant level factors that explained study site differences at baseline for the decisional uncertainty and values clarity subscales : a preferred treatment choice at study entry , whether the study program was accessed at home vs. in clinic , number of doctors consulted pre- study , working status , state anxiety , information from the media or a health care provider , and perceived knowledge level . State anxiety was associated with higher DC across all subscales . Conclusions Individual characteristics of men seeking consultation for LPC were associated with DC at baseline , not the site alone ; anxiety contributed to higher conflict . These findings will inform future development and implementation of the P3P and other decision support interventions .Trial registration NCT00692653 OBJECTIVE To evaluate effects of an informational film on making an informed choice regarding second trim 
    Output:
    
There is high- quality evidence that decision aids compared to usual care improve people 's knowledge regarding options , and reduce their decisional conflict related to feeling uninformed and unclear about their personal values .
There is moderate- quality evidence that decision aids compared to usual care stimulate people to take a more active role in decision making , and improve accurate risk perceptions when probabilities are included in decision aids , compared to not being included .
There is low- quality evidence that decision aids improve congruence between the chosen option and the patient 's values .
New for this up date d review is further evidence indicating more informed , values-based choices , and improved patient-practitioner communication .
There is a variable effect of decision aids on length of consultation .
Consistent with findings from the previous review , decision aids have a variable effect on choices .
They reduce the number of people choosing discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction .