***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 improve medication appropriateness and adherence in elderly patients with multimorbidity , we developed a complex intervention involving general practitioners ( GPs ) and their healthcare assistants ( HCA ) . In accordance with the Medical Research Council guidance on developing and evaluating complex interventions , we prepared for the main study by testing the feasibility of the intervention and study design in a cluster r and omised pilot study . Setting 20 general practice s in Hesse , Germany . Participants 100 cognitively intact patients ≥65 years with ≥3 chronic conditions , ≥5 chronic prescriptions and capable of participating in telephone interviews ; 94 patients completed the study . Intervention The HCA conducted a checklist-based interview with patients on medication-related problems and reconciled their medications . Assisted by a computerised decision-support system ( CDSS ) , the GPs discussed medication intake with patients and adjusted their medication regimens . The control group continued with usual care . Outcome measures Feasibility of the intervention and required time were assessed for GPs , HCAs and patients using mixed methods ( question naires , interviews and case vignettes after completion of the study ) . The feasibility of the study was assessed concerning success of achieving recruitment targets , balancing cluster sizes and minimising drop-out rates . Exploratory outcomes included the medication appropriateness index ( MAI ) , quality of life , functional status and adherence-related measures . MAI was evaluated blinded to group assignment , and intra-rater/inter-rater reliability was assessed for a sub sample of prescriptions . Results 10 practice s were r and omised and analysed per group . GPs/HCAs were satisfied with the interventions despite the time required ( 35/45 min/patient ) . In case vignettes , GPs/HCAs needed help using the CDSS . The study made no patients feel uneasy . Intra-rater/inter-rater reliability for MAI was excellent . Inclusion criteria were challenging and potentially inadequate , and should therefore be adjusted . Outcome measures on pain , functionality and self-reported adherence were unfeasible due to frequent missing values , an incorrect manual or potentially invalid results . Conclusions Intervention and trial design were feasible . The pilot study revealed important limitations that influenced the design and conduct of the main study , thus highlighting the value of piloting complex interventions . Trial registration number IS RCT N99691973 ; Results BACKGROUND Beliefs concerning the causes of mental illness may help to explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their white counterparts . This study applies the cultural influences on mental health framework to identify the relationship between race/ethnicity and differences in 1 ) beliefs on the cause of mental illness , 2 ) preferences for type of treatment , and 3 ) provider characteristics . METHOD Analyses were conducted using baseline data collected from participants who completed the cultural attitudes toward healthcare and mental illness question naire , developed for the Primary Care Research in Substance Abuse and Mental Health for the Elderly study , a multisite r and omized trial for older adults ( 65 + ) with depression , anxiety , or at-risk alcohol consumption . The final sample consisted of 1,257 non-Latino whites , 536 African Americans , 112 Asian Americans , and 303 Latinos . RESULTS African Americans , Asian Americans , and Latinos had differing beliefs regarding the causes of mental illness when compared with non-Latino whites . Race/ethnicity was also associated with determining who makes healthcare decisions , treatment preferences , and preferred characteristics of healthcare providers . CONCLUSIONS This study highlights the association between race/ethnicity and health beliefs , treatment preferences , healthcare decisions , and consumers ' preferred characteristics of healthcare providers . Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services BACKGROUND General Practitioners ( GPs ) often have to simultaneously tackle multiple health problems of older patients . A patient-centred process that engages the patient in setting health priorities for treatment is needed . We investigated whether a structured priority- setting consultation reconciles the often-differing doctor-patient views on the importance of problems . DESIGN Cluster r and omised controlled trial with 40 GPs and their 317 consecutively recruited older patients . PROCEDURE Following a geriatric assessment , patients and doctors independently rated the importance of each uncovered problem . GPs then selected priorities with their patients in a consultation . Trained intervention GPs held a structured consultation and utilised the list of uncovered patient problems with their importance ratings to agree priorities . Untrained control GPs only used the patient 's problem list without importance ratings . MAIN OUTCOME Doctor-patient agreement on independent importance ratings two weeks after the priority- setting consultation . ANALYSIS Weighted kappa ( κw ) and multilevel logistic regression model . RESULTS Intervention GPs and their patients determined mutual priorities for 20 % of individual problems . In this process , GPs often succeeded in convincing their patients of the importance of vaccinations , lifestyle and cognitive issues . Likewise , patients convinced their GPs to prioritise their social and functional problems . Further treatment plans ensued in 84 % of these priority areas . The regression model adjusting for clusters and baseline characteristics did not demonstrate significant differences in doctor-patient agreement on problems between groups a two weeks later . CONCLUSION Differing views on the importance of health problems between GPs and older patients were not sustainably reconciled . The special consultation facilitated identification of priority problems for treatment despite differences in perceived importance of problems between patients and GPs . German clinical trials register drks 00000792 BACKGROUND It is unknown what minimal benefit in disease-free survival  older patients with breast cancer require from adjuvant systemic therapy , and if this differs from that required by younger patients . We prospect ively examined patients ' preferences for adjuvant chemotherapy ( aCT ) and adjuvant hormonal therapy ( aHT ) , factors related to minimally-required benefit , and patients ' self-reported motivations . PATIENTS AND METHODS Fifty-two younger ( 40 - 64 years ) and 29 older ( ≥ 65 years ) women with a first primary , invasive tumor were interviewed post-surgery , prior to receiving aCT/aHT recommendation . RESULTS The proportions of younger versus older participants who would accept , refuse , or were undecided about therapy were 92 % versus 62 % , 4 % versus 24 % , and 4 % versus 14 % for aCT , and 92 % versus 59 % , 8 % versus 17 % , and 0 % versus 24 % for aHT . The proportion of older participants who would refuse rather than accept aCT was larger than that of younger participants ( P = .005 ) . No significant difference was found for aHT ( P = .12 ) . Younger and older participants ' minimally-required benefit , in terms of additional 10-year disease-free survival , to accept aCT ( median , 5 % vs. 4 % ; P = .13 ) or aHT ( median , 10 % vs. 8 % ; P = .15 ) did not differ . Being single/divorced/widowed ( odds ratio [ OR ] , 0.16 ; P = .005 ) , presence of geriatric condition ( inability to perform daily activities , incontinence , severe sensory impairment , depression , polypharmacy , difficulties with walking ; OR , 0.27 ; P = .047 ) , and having a preference to make the treatment decision either alone or after considering the clinician 's opinion ( active role ; OR , 0.15 ; P = .012 ) were independently related to requiring larger benefits from aCT . The most frequent motivations for/against therapy included the wish to survive/avoid recurrence , clinician 's recommendation , side effects , and treatment duration ( only aHT ) . CONCLUSION Whereas older participants were less willing to accept aCT than younger participants , no significant difference was found for aHT . However , a majority of older participants would still accept both therapies . Adjuvant systemic therapy should be discussed with eligible patients regardless of age Background : Decision aids have been shown to be useful in selected situations to assist patients in making treatment decisions . Important features such as the format of decision aids and their graphic presentation of data on benefits and harms of treatment options have not been well studied . Methods : In a r and omized trial with a 3 × 2 factorial design , we investigated the effects of decision aid format ( decision board , decision booklet with audiotape , or interactive computer program ) and graphic presentation of data ( pie graph or pictogram ) on patients ' comprehension and choices of 3 treatments for anticoagulation , identified initially as “ treatment A ” ( warfarin ) , “ treatment B ” ( acetylsalicylic acid ) and “ treatment C ” ( no treatment ) .  Patients aged 65 years or older without known atrial fibrillation and not currently taking warfarin were included . The effect of blinding to the treatment name was tested in a before – after comparison . The primary outcome was change in comprehension score , as assessed by the Atrial Fibrillation Information Question naire . Secondary outcomes were treatment choice , level of satisfaction with the decision aid , and decisional conflict . Results : Of 102 eligible patients , 98 completed the study . Comprehension scores ( maximum score 10 ) increased by an absolute mean of 3.1 ( p < 0.01 ) after exposure to the decision aid regardless of the format or graphic presentation . Overall , 96 % of the participants felt that the decision aid helped them make their treatment choice . Unblinding of the treatment name result ed in 36 % of the participants changing their initial choice ( p < 0.001 ) . Interpretation : The decision aid led to significant improvement in patients ' knowledge regardless of the format or graphic representation of data . Revealing the name of the treatment options led to significant shifts in declared treatment preferences Objectives Deprescribing has been proposed as a way to reduce polypharmacy in frail older people . We aim ed to reduce the number of medicines consumed by people living in residential aged care facilities ( RACF ) . Secondary objectives were to explore the effect of deprescribing on survival , falls , fractures , hospital admissions , cognitive , physical , and bowel function , quality of life , and sleep . Methods Ninety-five people aged over 65 years living in four RACF in rural mid-west Western Australia were r and omised in an open study . The intervention group ( n = 47 ) received a deprescribing intervention , the planned cessation of non-beneficial medicines . The control group ( n = 48 ) received usual care . Participants were monitored for twelve months from r and omisation . Primary outcome was change in the mean number of unique regular medicines . All outcomes were assessed at baseline , six , and twelve months . Results Study participants had a mean age of 84.3±6.9 years and 52 % were female . Intervention group participants consumed 9.6±5.0 and control group participants consumed 9.5±3.6 unique regular medicines at baseline . Of the 348 medicines targeted for deprescribing ( 7.4±3.8 per person , 78 % of regular medicines ) , 207 medicines ( 4.4±3.4 per person , 59 % of targeted medicines ) were successfully discontinued . The mean change in number of regular medicines at 12 months was -1.9±4.1 in intervention group participants and + 0.1±3.5 in control group participants ( estimated difference 2.0±0.9 , 95%CI 0.08 , 3.8 , p = 0.04 ) . Twelve intervention participants and 19 control participants died within 12 months of r and omisation ( 26 % versus 40 % mortality , p = 0.16 , HR 0.60 , 95%CI 0.30 to 1.22 ) There were no significant differences between groups in other secondary outcomes . The main limitations of this study were the open design and small participant numbers . Conclusions Deprescribing reduced the number of regular medicines consumed by frail older people living in residential care with no significant adverse effects on survival or other clinical outcomes . Trial Registration Australian New Zeal and Clinical Trials Registry Purpose Lung cancer chemotherapy decisions in patients ≥70 years old are complex because of toxicity , comorbidity and the limited data on patient preferences . We examined the relationships between preferences and chemotherapy use in this group of patients . Methods and patients We used a question naire describing four hypothetical lung cancer treatment options .  Eighty-three elderly ( ≥70 years old ) lung cancer patients were informed about their diagnosis and therapeutic choices and then asked to choose one of the four options . Patients had previously been included in a prospect i ve study to explore geriatric evaluation in an oncology unit and all had given written informed consent . Results Older patients ( n=83 ) diagnosed with lung cancer ( non-small- and small-cell lung cancer ) from January 2006 to February 2008 were recruited from a single centre . The mean patient age was 77 years ( range : 70–91 ) . Eighty-one patients ( 97.6 % ) were men . Non-small-cell lung cancer ( NSCLC ) was the diagnosis in 63 patients ( 76 % ) . Most patients selected active treatment ( 38.6 % most survival benefit , 18 % less survival benefit ) and 31.3 % selected no active treatment . Elderly lung cancer patients were significantly more likely to accept aggressive treatments despite high reported toxicities . Although most of the patients were symptomatic at diagnosis , the “ symptom relief ” option was chosen less frequently than the options that could prolong survival . Factors significantly related to patients ’ attitude toward chemotherapy were age ( p<0.001 ) , frailty ( p=0.0039 ) , depression and poor performance status ( PS ) . Conclusion Elderly lung cancer patients want to be involved in the decision-making process . Survival was the main treatment objective for more than half of the patients in this study . We have not found other published studies about elderly lung cancer patients ’ 
    Output:
    
Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy .