***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 evaluate the effect of a video decision support tool on the preferences for future medical care in older people if they develop advanced dementia , and the stability of those preferences after six weeks . Design R and omised controlled trial conducted between 1 September 2007 and 30 May 2008 . Setting Four primary care clinics ( two geriatric and two adult medicine ) affiliated with three academic medical centres in Boston . Participants Convenience sample of 200 older people ( ≥65 years ) living in the community with previously scheduled appointments at one of the clinics . Mean age was 75 and 58 % were women . Intervention Verbal narrative alone ( n=106 ) or with a video decision support tool ( n=94 ) . Main outcome measures Preferred goal of care : life prolonging care ( cardiopulmonary resuscitation , mechanical ventilation ) , limited care ( admission to hospital , antibiotics , but not cardiopulmonary resuscitation ) , or comfort care ( treatment only to relieve symptoms ) . Preferences after six weeks . The principal category for analysis was the difference in proportions of participants in each group who preferred comfort care . Results Among participants receiving the verbal narrative alone , 68 ( 64 % ) chose comfort care , 20 ( 19 % ) chose limited care , 15 ( 14 % ) chose life prolonging care , and three ( 3 % ) were uncertain . In the video group , 81 ( 86 % ) chose comfort care , eight ( 9 % ) chose limited care , four ( 4 % ) chose life prolonging care , and one ( 1 % ) was uncertain ( χ2=13.0 , df=3 , P=0.003 ) . Among all participants the factors associated with a greater likelihood of opting for comfort care were being a college graduate or higher , good or better health status , greater health literacy , white race , and r and omisation to the video arm . In multivariable analysis , participants in the video group were more likely to prefer comfort care than those in the verbal group ( adjusted odds ratio 3.9 , 95 % confidence interval 1.8 to 8.6 ) . Participants were re-interviewed after six weeks . Among the 94/106 ( 89 % ) participants re-interviewed in the verbal group , 27 ( 29 % ) changed their preferences ( κ=0.35 ) . Among the 84/94 ( 89 % ) participants re-interviewed in the video group , five ( 6 % ) changed their preferences ( κ=0.79 ) ( P<0.001 for difference ) . Conclusion Older people who view a video depiction of a patient with advanced dementia after hearing a verbal description of the condition are more likely to opt for comfort as their goal of care compared with those who solely listen to a verbal description . They also have more stable preferences over time . Trial registration Clinical trials.gov NCT00704886 Background Men considering the prostate specific antigen ( PSA ) test for prostate cancer , an increasingly common male cancer , are encouraged to make informed decisions , as the test is limited in its accuracy and the natural history of the condition is poorly understood . The Web-based PSA decision aid , Prosdex , was developed as part of the UK Prostate Cancer Risk Management Programme in order to help men make such informed decisions . Objectives The aim of this study was to evaluate the effect of the Web-based PSA decision aid , Prosdex , on informed decision making . Methods A Web-based r and omized controlled trial was conducted in South Wales , United Kingdom . Men aged 50 to 75 who had not previously had a PSA test were r and omly allocated to two intervention and two control groups . Participants in the intervention groups either viewed Prosdex or were given a paper version of the text . The main outcome measures were the three components of informed decision making : ( 1 ) knowledge of prostate cancer and PSA , ( 2 ) attitude toward PSA testing , ( 3 ) behavior using a proxy measure , intention to undergo PSA testing . Decisional conflict and anxiety were also measured as was uptake of the PSA test . Outcomes were measured by means of an online question naire for the Prosdex group , the paper version group , and one of two control groups . Six months later , PSA test uptake was ascertained from general practitioners ’ records , and the online question naire was repeated . Results are reported in terms of the Mann-Whitney U-statistic divided by the product of the two sample sizes ( U/mm ) , line of no effect 0.50 . Results Participants were 514 men . Compared with the control group that completed the initial online question naire , men in the Prosdex group had increased knowledge about the PSA test and prostate cancer ( U/mn 0.70 ; 95 % CI 0.62 - 0.76 ) ; less favourable attitudes to PSA testing ( U/mn 0.39 , 95 % CI 0.31 - 0.47 ) ; were less likely to undergo PSA testing ( U/mn 0.40 , 95 % CI 0.32 - 0.48 ) ; and had less decisional conflict ( U/mn 0.32 , 95 % CI 0.25 - 0.40 ) ; while anxiety level did not differ ( U/mn 0.50 , 95 % CI 0.42 - 0.58 ) . For these outcomes there were no significant differences between men in the Prosdex group and the paper version group . However , in the Prosdex group , increased knowledge was associated with a less favourable attitude toward testing ( Spearman rank correlation [ ρ ] = -0.49 , P < .001 ) and lower intention to undergo testing ( ρ = -0.27 , P = .02 ) . After six months , PSA test uptake was lower in the Prosdex group than in the paper version and the question naire control group ( P = .014 ) . Test uptake was also lower in the control group that did not complete a question naire than in the control group that did , suggesting a possible Hawthorne effect of the question naire in favour of PSA testing . Conclusions Exposure to Prosdex was associated with improved knowledge about the PSA test and prostate cancer . Men who had a high level of knowledge had a less favourable attitude toward and were less likely to undergo PSA testing  . Prosdex appears to promote informed decision making regarding the PSA test . Trial Registration IS RCT N48473735 ; http://www.controlled-trials.com/IS RCT N48473735 ( Archived by WebCite at http://www.webcitation.org/5r1TLQ5nK 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 . There is limited evidence about how to ensure that patients are helped to make informed medical care decisions . Objective . To test a decision support intervention for uterine fibroid treatments . Design and Setting . Practical clinical trial to test informed choice assistance in 4 r and omly assigned gynecology clinics compared to 5 others providing a pamphlet . Patients . Three hundred women facing a treatment decision for fibroids over a 13-month period . Intervention . Mailed DVD and brochure about fibroid treatments plus the Ottawa decision guide and an offer of counseling soon after an index visit . Measurements . Mailed survey 6 to 8 weeks later asking about knowledge , preferences , and satisfaction with decision support . Results . In total , 244 surveys were completed for an adjusted response rate of 85.4 % . On a 5-point scale , intervention subjects reported more treatment options being mentioned ( 3.0 v. 2.4 ) , had a higher knowledge score ( 3.3 v. 2.8 ) , and were more likely to report being adequately informed ( 4.4 v. 4.0 ) , and their decision was both more satisfactory ( 4.3 v. 4.0 ) and more consistent with their personal values ( 4.5 v. 4.2 ) . Neither knowledge nor use of the intervention was associated with greater concordance between preferences and decisions . Limitations . Implementation of intervention may not have been well timed to the decision for some patients , limiting their use of the material s and counseling . Conclusion . It is difficult to integrate structured decision support consistently into practice . Decision support for benign uterine conditions showed effects on knowledge and satisfaction but not on concordance 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 PURPOSE Low health literacy is a significant problem in the United States . At the same time written screening tools such as the American Urological Association symptom score are used more frequently at hospitals and clinics . We previously reported that many patients do not fully underst and this tool and often provide inaccurate information . To combat this problem we developed a novel multimedia version of the American Urological Association symptom score . MATERIAL S AND METHODS In this r and omized , controlled trial we divided 232 patients into a control arm that self-administered the traditional written version of the symptom score and an experimental arm that self-administered the new multimedia version .  Patients in each arm were later administered the tool a second time by an interviewer for comparison . Using multivariate analysis we measured disagreement between the self-administered and interviewer administered scores , and compared the 2 arms . RESULTS Patients assigned the written and the multimedia version showed an average error of 3.48 and 1.97 , respectively ( p < 0.001 ) , for a 43 % decrease . Improvement was noted regardless of patient literacy . Errors by patients with low and high literacy decreased from 4.55 to 2.24 and 3.10 to 1.86 ( p = 0.03 and < 0.001 , respectively ) . CONCLUSIONS As a model , the American Urological Association symptom score multimedia version represents an exciting opportunity to improve many other written screening tools since it increased underst and ing and decreased scoring errors across all literacy levels , possibly allowing physicians to treat patients more effectively RATIONALE We developed an evidence -based decision aid for patients with advanced cystic fibrosis considering referral for lung transplantation . OBJECTIVES To prospect ively evaluate whether use of the decision aid increased knowledge about the options , improved realistic expectations , and decreased decisional conflict in adult patients . METHODS We performed a single-blind r and omized controlled trial involving 149 adult patients with cystic fibrosis with an FEV(1 ) < or= 40 % predicted from 14 Canadian and Australian centers . All participants received an education and counseling session from their cystic fibrosis team and were then r and omized to receive the decision aid or usual care . The decision aid is available online at http://decisionaid.ohri.ca/decaids.html . MEASUREMENTS AND MAIN RESULTS The primary end points measured were participants ' knowledge , realistic expectations , and decisional conflict evaluated 3 weeks after r and omization . Patients r and omized to the decision aid had greater knowledge about their options ( P < 0.0001 ) 
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Conclusion Lower health literacy affects key decision-making outcomes , but few existing PtDAs have addressed the needs of lower health literacy users .