***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 Blunt head trauma is a common cause of death and disability in children worldwide . Cranial computed tomography ( CT ) , the reference st and ard for the diagnosis of traumatic brain injury ( TBI ) , exposes children to ionizing radiation which has been linked to the development of brain tumors , leukemia , and other cancers . We describe the methods used to develop and test the effectiveness of a decision aid to facilitate shared decision-making with parents regarding whether to obtain a head CT scan or to further observe their child at home . Methods / Design This is a protocol for a multicenter clinician-level parallel r and omized trial to compare an intervention group receiving a decision aid , ‘ Head CT Choice ’ , to a control group receiving usual care . The trial will be conducted at five diverse emergency departments ( EDs ) in Minnesota and California . Clinicians will be r and omized to decision aid or usual care . Parents visiting the ED with children who are less than 18-years-old , have experienced blunt head trauma within 24 hours , and have one or two risk factors for clinical ly-important TBI ( ciTBI ) from the Pediatric Emergency Care Applied Research Network head injury clinical prediction rules will be eligible for enrollment . We will measure the effect of Head CT Choice on : ( 1 ) parent knowledge regarding their child ’s risk of ciTBI , the available diagnostic options , and the risks of radiation exposure associated with a cranial CT scan ( primary outcome ) ; ( 2 ) parent engagement in the decision-making process ; ( 3 ) the degree of conflict parents experience related to feeling uninformed ; ( 4 ) patient and clinician satisfaction with the decision made ; ( 5 ) the rate of ciTBI at seven days ; ( 6 ) the proportion of patients in whom a cranial CT scan is obtained ; and ( 7 ) seven-day healthcare utilization . To capture these outcomes , we will administer parent and clinician surveys immediately after each clinical encounter , obtain video recordings of parent-clinician discussion s , administer parent healthcare utilization diaries , analyze hospital billing records , review the electronic medical record , and conduct telephone follow-up . Discussion This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes , safety , and healthcare utilization in parents of children with minor head trauma in five diverse EDs . Trial registration Clinical Trials.gov registration number : NCT02063087 . Registration date February 13 , 2014 R and omised controlled trials ( RCTs ) can be hampered by poor patient accrual and retention . Decision aids ( DAs ) containing simple , evidence -based information , may assist patients with decision-making regarding trial participation . The current DA was of use for 95 % of participants . Further evaluation of the DA in a RCT is currently underway 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 Summary Use of the Chronic Pain Management Program was associated with significant decreases in pain‐related , functional , and mental health outcomes and an increase in pain knowledge . Abstract Internet‐based educational and therapeutic programs ( e‐health applications ) are becoming increasingly popular for a variety of psychological and physical disorders . We tested the efficacy of an online Chronic Pain Management Program , a comprehensive , fully self‐directed and self‐paced system that integrates social networking features and self‐management tools into an interactive learning environment . Of 305 adult participants ( 196 women , 109 men ) , a total of 162 individuals with chronic pain were r and omly assigned unsupervised access to the program  for approximately 6 weeks ; 143 were assigned to the wait‐listed control group with treatment as usual .  A comprehensive assessment was administered before the study and approximately 7 and 14 weeks thereafter . All recruitment , data collection , and participant involvement took place online . Participation was fully self‐paced , permitting the evaluation of program effectiveness under real‐world conditions . Intent‐to‐treat analysis that used linear growth models was used as the primary analytic tool . Results indicated that program utilization was associated with significant decreases in pain severity , pain‐related interference and emotional burden , perceived disability , catastrophizing , and pain‐induced fear . Further , program use led to significant declines in depression , anxiety , and stress . Finally , as compared to the wait‐listed control group , the experimental group displayed a significant increase in knowledge about the principles of chronic pain and its management . Study limitations are considered , including the recognition that not all persons with chronic pain are necessarily good c and i date s for self‐initiated , self‐paced , interactive learning Background — Cardiac stress testing in patients at low risk for acute coronary syndrome is associated with increased false-positive test results , unnecessary downstream procedures , and increased cost . We judged it unlikely that patient preferences were driving the decision to obtain stress testing . Methods and Results — The Chest Pain Choice trial was a prospect i ve r and omized evaluation involving 204 patients who were r and omized to a decision aid or usual care and were followed for 30 days . The decision aid included a 100-person pictograph depicting the pretest probability of acute coronary syndrome and available management options ( observation unit admission and stress testing or 24–72 hours outpatient follow-up ) . The primary outcome was patient knowledge measured by an immediate postvisit survey . Additional outcomes included patient engagement in decision making and the proportion of patients who decided to undergo observation unit admission and cardiac stress testing . Compared with usual care patients ( n=103 ) , decision aid patients ( n=101 ) had significantly greater knowledge ( 3.6 versus 3.0 questions correct ; mean difference , 0.67 ; 95 % CI , 0.34–1.0 ) , were more engaged in decision making as indicated by higher OPTION ( observing patient involvement ) scores ( 26.6 versus 7.0 ; mean difference , 19.6 ; 95 % CI , 1.6–21.6 ) , and decided less frequently to be admitted to the observation unit for stress testing ( 58 % versus 77 % ; absolute difference , 19 % ; 95 % CI , 6%–31 % ) . There were no major adverse cardiac events after discharge in either group . Conclusions — Use of a  decision aid  in patients with chest pain increased knowledge and engagement in decision making and decreased the rate of observation unit admission for stress testing . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01077037 Decision aids in North American breast cancer out patients have been shown to assist with treatment decision making and reduce decisional conflict . To date , appropriate delivery formats to effectively increase patient participation in newly diagnosed breast cancer in patients have not been investigated in the context of German health care provision . The impact of a decision aid intervention was studied in patients ( n=111 ) with a strong suspicion of breast cancer in a r and omised controlled trial . The primary outcome variable was decisional conflict . Participants were followed up 1 week post-intervention with a retention rate of 92 % . Analyses revealed that the intervention group felt better informed ( ηp2=0.06 ) but did not experience an overall reduction in decisional conflict as compared with the control group . The intervention had no effect on uptake rates of treatment options , length of consultation with the surgeon , time point of treatment decision making , perceived involvement in decision making , neither decision related nor general patient satisfaction . Patients who received the decision aid intervention experienced a small benefit with regards to how informed they felt about advantages and disadvantages of relevant treatment options . Results are discussed in terms of context ual factors and individual differences as moderators of treatment decision aid effectiveness Purpose . Women with localized breast cancer face difficult decisions about adjuvant therapy . Several decision aids are available to help women choose between treatment options . Decision aids are known to affect treatment choices and may therefore affect patient survival . The authors aim ed to model the effects of the Adjuvant ! decision aid on expected survival in women with early stage breast cancer . Patients and Methods . Data were obtained from a r and omized trial of Adjuvant ! ( n = 395 ) . To calculate the effects of the decision aid on survival , the authors used the Adjuvant ! survival predictions as a surrogate endpoint . Data from each arm were entered separately into statistical models to estimate change in survival associated with receiving the Adjuvant ! decision aid . Results . Most women ( ∼ 85 % ) chose a treatment option that maximized predicted survival . The effects of the decision aid on outcome could not be modeled because a small number of women ( n = 12 , 3 % ) chose treatment options associated with a large ( 5%—14 % ) loss in survival . These women — most typically estrogen receptor positive but refusing hormonal therapy — were equally divided between Adjuvant ! and control groups and were not distinguished by medical or demographic factors . Conclusions . Expected benefit from treatment is a key variable in underst and ing patient behavior . A small number of women refuse adjuvant treatment associated with large increases in predicted survival , even when they are explicitly informed about the degree of benefit they would forgo . Investigation of the effects of decision aids on cancer survival is unlikely to be fruitful due to power considerations OBJECTIVE Although African American ( AA ) men are at elevated risk for prostate cancer , medical guidelines do not present consistent screening recommendations for this group . However , all guidelines stress the need for screening decision making with a provider . This study evaluated the effectiveness of a brochure for the female partners of AA men , design ed to help promote such discussion on the part of their mates . We also explored the effect of the partner 's monitoring style ( i.e. , the extent to which the partner typically attends to health threats ) on promoting discussion . METHODS Female partners of AA men ( N = 231 ) were r and omized to receive either a  prostate cancer screening Centers for Disease Control brochure for AA men , combined with a ' partner ' brochure containing strategies to promote men 's initiation of a provider visit to discuss screening , or the Centers for Disease Control brochure only and completed preintervention and post-intervention surveys online . RESULTS The message groups did not differ on taking active steps to engage in provider discussion : relative risk ratio ( RRR ) = 0.99 , p = .98 ; thinking about it : RRR = 1.13 , p = .74 . However , among partners who received the partner brochure , monitoring style was associated with ' thinking about initiating a provider visit ' on the part of the mate ( RRR = 1.74 , p < .01 ) . Across conditions , monitoring style was also associated with ' taking active steps to initiate a provider visit ' on the part of the mate ( RRR = 1.38 , p < .05 ) . CONCLUSIONS High monitoring partners may be effective in influencing their AA mates to initiate provider discussion , particularly when tailored messaging is provided Background Professional societies recommend shared decision making ( SDM ) for prostate cancer screening , however , most efforts have promoted informed rather than shared decision making . The objective of this study is to 1 ) examine the effects of a prostate cancer screening intervention to promote SDM and 2 ) determine whether framing prostate information in the context of other clearly beneficial men ’s health services affects decisions . Methods We conducted two separate r and omized controlled trials of the same prostate cancer intervention ( with or without additional information on more clearly beneficial men ’s health services ) . For each trial , we enrolled a convenience sample of 2 internal medicine practice s , and their interested physicians and male patients with no prior history of prostate cancer ( for a total of 4 practice s , 28 physicians , and 12 
    Output:
    
Moreover , those exposed to a decision aid were either equally or more satisfied with their decision , the decision-making process , and /or the preparation for decision making compared to usual care .
People receiving  decision aids  do not appear to differ from those receiving usual care in terms of anxiety , general health outcomes , and condition-specific health outcomes .
Studies did not report adverse events associated with the use of decision aids .
Compared to usual care across a wide variety of decision context s , people exposed to decision aids feel more knowledgeable , better informed , and clearer about their values , and they probably have a more active role in decision making and more accurate risk perceptions .
There is growing evidence that decision aids may improve values-congruent choices .
There are no adverse effects on health outcomes or satisfaction .
New for this up date d is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation .