***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: IMPORTANCE To make good decisions about prostate-specific antigen ( PSA ) screening , men must consider how they value the different potential outcomes . OBJECTIVE To determine the effects of different methods of helping men consider such values . DESIGN AND SETTING R and omized trial from October 12 to 27 , 2011 , in the general community . PARTICIPANTS A total of 911 men aged 50 to 70 years from the United States and Australia who had average risk . Participants were drawn from online panels from a survey research firm in each country and were r and omized by the survey firm to 1 of 3 values clarification methods : a balance sheet ( n = 302 ) , a rating and ranking task ( n = 307 ) , or a discrete choice experiment ( n = 302 ) . INTERVENTION Participants underwent a values clarification task and then chose the most important attribute . MAIN OUTCOME MEASURES The main outcome was the difference among groups in the most important attribute . Secondary outcomes were differences in unlabeled test preference and intent to undergo screening with PSA . RESULTS The mean age was 59.8 years ; most participants were white and more than one-third had graduated from college . More than 40 % reported a PSA test within 12 months . The participants who received the rating and ranking task were more likely to report reducing the chance of death from prostate cancer as being most important ( 54.4 % ) compared with those who received the balance sheet ( 35.1 % ) or the discrete choice experiment ( 32.5 % ) ( P < .001 ) . Those receiving the balance sheet were more likely ( 43.7 % ) to prefer the unlabeled PSA-like option ( as opposed to the " no screening"-like option ) compared with those who received rating and ranking ( 34.2 % ) or the discrete choice experiment ( 20.2 % ) . However , the proportion who intended to undergo PSA testing was high and did not differ between groups ( balance sheet , 77.1 % ; rating and ranking , 76.8 % ; and discrete choice experiment , 73.5 % ; P = .73 ) . CONCLUSIONS AND RELEVANCE Different values clarification methods produce different patterns of attribute importance and different preferences for screening when presented with an unlabeled choice . Further studies with more distal outcome measures are needed to determine the best method of values clarification , if any , for decisions such as whether to undergo screening with PSA Importance Prostate cancer screening remains controversial because potential mortality or quality -of-life benefits may be outweighed by harms from overdetection and overtreatment . Objective To evaluate the effect of a single prostate-specific antigen ( PSA ) screening intervention and st and ardized diagnostic pathway on prostate cancer – specific mortality . Design , Setting , and Participants The Cluster R and omized Trial of PSA Testing for Prostate Cancer ( CAP ) included 419 582 men aged 50 to 69 years and was conducted at 573 primary care practice s across the United Kingdom . R and omization and recruitment of the practice s occurred between 2001 and 2009 ; patient follow-up ended on March 31 , 2016 . Intervention An invitation to attend a PSA testing clinic and receive a single PSA test vs st and ard ( unscreened ) practice . Main Outcomes and Measures Primary outcome : prostate cancer – specific mortality at a median follow-up of 10 years . Prespecified secondary outcomes : diagnostic cancer stage and Gleason grade ( range , 2 - 10 ; higher scores indicate a poorer prognosis ) of prostate cancers identified , all-cause mortality , and an instrumental variable analysis estimating the causal effect of attending the PSA screening clinic . Results Among 415 357 r and omized men ( mean [ SD ] age , 59.0 [ 5.6 ] years ) , 189 386 in the intervention group and 219 439 in the control group were included in the analysis ( n = 408 825 ; 98 % ) . In the intervention group , 75 707 ( 40 % ) attended the PSA testing clinic and 67 313 ( 36 % ) underwent PSA testing . Of 64 436 with a valid PSA test result , 6857 ( 11 % ) had a PSA level between 3 ng/mL and 19.9 ng/mL , of whom 5850 ( 85 % ) had a prostate biopsy . After a median follow-up of 10 years , 549 ( 0.30 per 1000 person-years ) died of prostate cancer in the intervention group vs 647 ( 0.31 per 1000 person-years ) in the control group ( rate difference , −0.013 per 1000 person-years [ 95 % CI , −0.047 to 0.022 ] ; rate ratio [ RR ] , 0.96 [ 95 % CI , 0.85 to 1.08 ] ; P = .50 ) . The number diagnosed with prostate cancer was higher in the intervention group ( n = 8054 ; 4.3 % ) than in the control group ( n = 7853 ; 3.6 % ) ( RR , 1.19 [ 95 % CI , 1.14 to 1.25 ] ; P < .001 ) . More prostate cancer tumors with a Gleason grade of 6 or lower were identified in the intervention group ( n = 3263/189 386 [ 1.7 % ] ) than in the control group ( n = 2440/219 439 [ 1.1 % ] ) ( difference per 1000 men , 6.11 [ 95 % CI , 5.38 to 6.84 ] ; P < .001 ) . In the analysis of all-cause mortality , there were 25 459 deaths in the intervention group vs 28 306 deaths in the control group ( RR , 0.99 [ 95 % CI , 0.94 to 1.03 ] ; P = .49 ) . In the instrumental variable analysis for prostate cancer mortality , the adherence-adjusted causal RR was 0.93 ( 95 % CI , 0.67 to 1.29 ; P = .66 ) . Conclusions and Relevance Among practice s r and omized to a single PSA screening intervention vs st and ard practice without screening , there was no significant difference in prostate cancer mortality after a median follow-up of 10 years but the detection of low-risk prostate cancer cases increased . Although longer-term follow-up is under way , the findings do not support single PSA testing for population -based screening . Trial Registration IS RCT N Identifier : IS RCT 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 : Screening for prostate cancer ( PC ) may save lives , but overdiagnosis and overtreatment are serious drawbacks . We aim ed to determine men ’s preferences for PC screening  , and to elicit the trade-offs they make . Methods : A discrete choice experiment ( DCE ) was conducted among a population -based r and om sample of 1000 elderly men ( 55–75-years-old ) . Trade-offs were quantified with a panel latent class model between five PC screening aspects : risk reduction of PC-related death , screening interval , risk of unnecessary biopsies , risk of unnecessary treatments , and out-of-pocket costs . Results : The response rate was 46 % ( 459/1000 ) . Men were willing to trade-off 2.0 % ( CI : 1.6%–2.4 % ) or 1.8 % ( CI : 1.3%–2.3 % ) risk reduction of PC-related death to decrease their risk of unnecessary treatment or biopsy with 10 % , respectively . They were willing to pay [ euro ] 188 per year ( CI : [ euro ] 141–[euro ] 258 ) to reduce their relative risk of PC-related death with 10 % . Preference heterogeneity was substantial , with men with higher educational levels having a lower probability to opt for PC screening than men with lower educational levels . Conclusion : Men were willing to trade-off some risk reduction of PC-related death to be relieved of the burden of biopsies or unnecessary treatments . Increasing knowledge on overdiagnosis and overtreatment , especially for men with lower educational levels , is warranted to prevent unrealistic expectations from PC screening IMPORTANCE Healthcare overuse , the delivery of low-value services , is increasingly recognized as a critical problem . However , little is known about the comparative effectiveness of alternate formats for presenting benefits and harms information to patients as a strategy to reduce overuse . OBJECTIVE To examine the effect of different benefits and harms presentations on patients ' intentions to accept low-value or potentially low-value screening services ( prostate cancer screening in men ages 50 - 69 years ; osteoporosis screening in low-risk women ages 50 - 64 years ; or colorectal cancer screening in men and women ages 76 - 85 years ) . DESIGN , SETTING , AND PARTICIPANTS R and omized clinical trial of 775 individuals eligible to receive information about any 1 of the 3 screening services and scheduled for a visit with their clinician .  Participants were r and omized to 1 of 4 intervention arms that differed in terms of presentation format : words , numbers , numbers plus narrative , and numbers plus framed presentation . The trial was conducted from September 2012 to June 2014 at 2 family medicine and 2 internal medicine practice s affiliated with the Duke Primary Care Research Consortium . The data were analyzed between May and September of 2015 . INTERVENTIONS One-page evidence -based decision support sheets on each of the 3 screening services , with benefits and harms information presented in 1 of 4 formats : words , numbers , numbers plus narratives , or numbers plus a framed presentation . MAIN OUTCOMES AND MEASURES The primary outcome was change in intention to accept screening ( on a response scale from 1 to 5 ) . Our secondary outcomes included general and disease-specific knowledge , perceived risk and consequences of disease , screening attitudes , perceived net benefit of screening , values clarity , and self-efficacy for screening . RESULTS We enrolled and r and omly allocated 775 individuals , aged 50 to 85 years , to 1 of 4 intervention arms : 195 to words , 192 to numbers , 196 to narrative , and 192 to framed formats . Intentions to accept screening were high before the intervention and change in intentions did not differ across intervention arms ( words , -0.07 ; numbers , -0.05 ; numbers plus narrative , -0.12 ; numbers plus framed presentation , -0.02 ; P = .57 for all comparisons ) . Change in other outcomes also showed no difference across intervention arms . Results were similar when stratified by screening service . CONCLUSIONS AND RELEVANCE Single , brief , written decision support interventions , such as the ones in this study , are unlikely to be sufficient to change intentions for screening . Alternate and additional interventions are needed to reduce overused screening services . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01694784 BACKGROUND Little is known about what information affects men 's decisions about prostate cancer screening . METHODS We developed a four-part decision aid about  prostate cancer screening and tested it in men , ages 45 - 85 , to determine how the information in each part--(1 ) the epidemiology of prostate cancer ; ( 2 ) the PSA test ; ( 3 ) prostate biopsy 
    Output:
    
The variability of men 's values and preferences reflect that the decision to screen is highly preference sensitive .