***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 — 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 Background Many patients at high risk of cardiovascular diseases are managed and monitored in general practice . Recommendations for cardiovascular risk management , including lifestyle change , are clearly described in the Dutch national guideline . Although lifestyle interventions , such as advice on diet , physical exercise , smoking and alcohol , have moderate , but potentially relevant effects in these patients , adherence to lifestyle advice in general practice is not optimal . The IMPALA study intends to improve adherence to lifestyle advice by involving patients in decision making on cardiovascular prevention by nurse-led clinics . The aim of this paper is to describe the design and methods of a study to evaluate an intervention aim ed at involving patients in cardiovascular risk management . Methods A cluster-r and omised controlled trial in 20 general practice s , 10 practice s in the intervention arm and 10 in the control arm , starting on October 2005 . A total of 720 patients without existing cardiovascular diseases but eligible for cardiovascular risk assessment will be recruited . In both arms , the general practitioners and nurses will be trained to apply the national guideline for cardiovascular risk management . Nurses in the intervention arm will receive an extended training in risk assessment , risk communication , the use of a decision aid and adapted motivational interviewing . This communication technique will be used to support the shared decision-making process about risk reduction . The intervention comprises 2 consultations and 1 follow-up telephone call . The nurses in the control arm will give usual care after the risk estimation , according to the national guideline . Primary outcome measures are self-reported adherence to lifestyle advice and drug treatment . Secondary outcome measures are the patients ' perception of risk and their motivation to change their behaviour . The measurements will take place at baseline and after 12 and 52 weeks . Clinical endpoints will not be measured , but the absolute 10-year risk of cardiovascular events will be estimated for each patient from medical records at baseline and after 1 year . Discussion The combined use of risk communication , a decision aid and motivational interviewing to enhance patient involvement in decision making is an innovative aspect of the intervention . Trial registration Current Controlled Trials IS RCT OBJECTIVE To test the effect of three questions ( what are my options ? what are the benefits and harms ? and how likely are these ? ) , on information provided by physicians about treatment options . METHODS We used a cross-over trial using two unannounced st and ardized patients ( SPs ) simulating a presentation of mild-moderate depression . One SP was assigned the intervention role ( asking the questions ) , the other the control role . An intervention and control SP visited each physician , order allocated r and omly . The study was conducted in family practice s in Sydney , Australia , during 2008 - 09 . Data were obtained from consultation audio-recordings . Information about treatment options and patient involvement were analyzed using the Assessing Communication about Evidence and Patient Preferences ( ACEPP ) tool and the OPTION tool . RESULTS Thirty-six SP visits were completed ( 18 intervention , 18 control ) . Scores were higher in intervention consultations than controls : ACEPP scores 21.4 vs. 16.6 , p<0.001 , difference 4.7 ( 95 % CI 2.3 - 7.0 ) and OPTION scores 36 vs. 25 , p=0.001 , difference 11.5 ( 95 % CI 5.1 - 17.8 ) , indicating greater information provision and behavior supporting patient involvement . CONCLUSION Asking these three questions improved information given by  family physicians  and increased physician facilitation of patient involvement . Practice implication s. These questions can drive evidence -based practice , strengthen patient-physician communication , and improve safety and quality Purpose . To conduct a pilot test of a decision aid design ed to help patients choose among currently recommended colorectal cancer screening programs . Methods . R and omized controlled trial comparing a patient decision aid based on multi criteria decision-making theory with a simple educational intervention . Patient population . 96 patients at average risk for colorectal cancer seen in an Internal Medicine practice in Rochester , New York . Outcome measures . The two primary outcome measures were patient decision process and the decision outcome . Patient decision process was assessed using the decisional conflict scale . Decision outcome was defined as the proportion of colorectal cancer screening plans carried out . Results . After controlling for the effects of the physicians in a factorial analysis of variance , patients who used the decision aid had lower decisional conflict regarding colorectal cancer screening decisions ( F ratio6.47 , P = 0.01 ) due to increased knowledge , better clarity of values , and higher ratings of the quality of the decisions they made . There was no difference between the groups in decision outcomes : 52 % of patients in the control group and 49 % in the experimental group completed planned screening tests ( P = 1.0 ) . Conclusions . In a pilot study , a multi criteria -based patient decision aid for colorectal cancer screening improved patients ’ decision-making processes but had no effect on the implementation of screening plans OBJECTIVE To evaluate the effects of a programme to enhance the involvement of older patients in their consultations in general practice . DESIGN Cluster r and omized trial , in which data was collected from different cohorts . SETTING AND PARTICIPANTS Twenty-five general practice s in the south-east part of the Netherl and s and their patients aged 70 years and over . INTERVENTION Patients in the intervention group received a leaflet to help them prepare for the consultation . General practitioners ( GPs ) received an outreach visit to optimize older patients ' involvement when visiting their GP . Patients in the control group received usual care . MAIN OUTCOME MEASURES Question naires measuring involvement ( COMRADE ) , enablement ( Patient Enablement Index ) and satisfaction with their care ( EUROPEP ) . RESULTS Pre-intervention 315 patients and post-intervention 263 patients were included . Subjects were satisfied with their involvement and the GP 's behaviour during the consultation . No differences in effect as a result of the leaflet on involvement , enablement or satisfaction were found between the intervention and the control group . Of 318 patients who received the leaflet and visited their GP in the intervention period , 47 patients used the leaflet . These users were more accustomed to prepare themselves for consultations . Users reported more psychological problems than non-users . CONCLUSIONS No relevant effects of the implementation programme on involvement , enablement or satisfaction were found . Other strategies are needed to enhance involvement of older patients in their care . Alternatively , older patients may perceive themselves sufficiently involved 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 Background Most women use some method of pain relief during labour . There is extensive research evidence available of pharmacological pain relief during labour ; however this evidence is not readily available to pregnant women . Decision aids are tools that present evidence based information and allow preference elicitation . Methods We developed a labour analgesia decision aid . Using a RCT design women either received a decision aid or a pamphlet .  Eligible women were primiparous , ≥ 37 weeks , planning a vaginal birth of a single infant and had sufficient English to complete the trial material s. We used a combination of affective ( anxiety , satisfaction and participation in decision-making ) and behavioural outcomes ( intention and analgesia use ) to assess the impact of the decision aid , which were assessed before labour . Results 596 women were r and omised ( 395 decision aid group , 201 pamphlet group ) . There were significant differences in knowledge scores between the decision aid group and the pamphlet group ( mean difference 8.6 , 95 % CI 3.70 , 13.40 ) . There were no differences between decisional conflict scores ( mean difference -0.99 ( 95 % CI -3.07 , 1.07 ) , or anxiety ( mean difference 0.3 , 95 % CI -2.15 , 1.50 ) . The decision aid group were significantly more likely to consider their care providers opinion ( RR 1.28 95%CI 0.64 , 0.95 ) . There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use . Conclusions This decision aid improves women 's labour analgesia knowledge without increasing anxiety . Significantly , the decision aid group were more informed of labour analgesia options , and considered the opinion of their care providers more often when making their analgesia decisions , thus improving informed decision making . Trial Registration Trial registration no : IS RCT BACKGROUND Poor quality of information transfer about the benefits and risks of statin drug use may result in patients not making informed decisions that they can act on in a timely fashion . METHODS The effect of a decision aid about statin drugs on treatment decision making in 98 patients with diabetes was determined in a cluster r and omized trial of decision aid vs control pamphlet , with concealed allocation , blinding of participants to study goals , and adherence to the intention-to-treat principle . Twenty-one endocrinologists conducted specialty outpatient metabolic consultations . Patients in the intervention group received Statin Choice , a tailored decision aid that presents the estimated 10-year cardiovascular risk , the absolute risk reduction with use of statin drugs , and the 
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Categorical measures did not show any effect for any of the interventions .
It is uncertain whether interventions to improve adoption of SDM are effective given the low quality of the evidence .
However , any intervention that actively targets patients , healthcare professionals , or both , is better than none .
Also , interventions targeting patients and healthcare professionals together show more promise than those targeting only one or the other