***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 
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    Input: 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 128 men across trials ) . Within each practice site , we r and omized men to either 1 ) a video-based decision aid and research er-led coaching session or 2 ) a highway safety video . Physicians at each site received a 1-hour educational session on prostate cancer and SDM . To assess intervention effects , we measured key components of SDM , intent to be screened , and actual screening . After finding that results did not vary by trial , we combined data across sites , adjusting for the r and om effects of both practice and physician . Results Compared to an attention control , our prostate cancer screening intervention increased men ’s perceptions that screening is a decision ( absolute difference + 41 % ; 95 % CI 25 to 57 % ) and men ’s knowledge about prostate cancer screening ( absolute difference + 34 % ; 95 % CI 19 % to 50 % ) , but had no effect on men ’s self-reported participation in shared decisions or their participation at their preferred level . Overall , the intervention decreased screening intent ( absolute difference −34 % ; 95 % CI −50 % to −18 % ) and actual screening rates ( absolute difference −22 % ; 95 % CI −38 to −7 % ) with no difference in effect by frame . Conclusions SDM interventions can increase men ’s knowledge , alter their perceptions of prostate cancer screening , and reduce actual screening . However , they may not guarantee an increase in shared decisions . Trial registration # ABSTRACT Despite increased interest among the public in breast cancer genetic risk and genetic testing , there are limited services to help women make informed decisions about genetic testing . This study , conducted with female callers ( N = 279 ) to the National Cancer Institute 's ( NCI 's ) Atlantic Region Cancer Information Service ( CIS ) , developed and evaluated a theory-based , educational intervention design ed to increase callers ' underst and ing of the following : ( a ) the kinds of information required to determine inherited risk ; ( b ) their own personal family history of cancer ; and ( c ) the benefits and limitations of genetic testing . Callers requesting information about breast/ovarian cancer risk , risk assessment services , and genetic testing were r and omized to either : ( 1 ) st and ard care or ( 2 ) an educational intervention . Results show that the educational intervention reduced intention to obtain genetic testing among women at average risk and increased intention among high-risk women at 6 months . In addition , high monitors , who typically attend to and seek information , demonstrated greater increases in knowledge and perceived risk over the 6-month interval than low monitors , who typically are distracted from information . These findings suggest that theoretically design ed interventions can be effective in helping women underst and their cancer risk and appropriate risk assessment options and can be implemented successfully within a service program like the CIS 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 There is an ever-growing trend toward more patient involvement in making health care decisions . This trend has been accompanied by the development of “ informed decision-making ” interventions to help patients become more engaged and comfortable with making these decisions . We describe the effects of a prostate cancer screening decision aid on knowledge , beliefs about screening , risk perception , control preferences , decisional conflict , and decisional anxiety . Data were collected from 200 males aged 50–70 years in the general population who r and omly were assigned to exposure to the decision aid or no exposure as a control condition .  A Solomon four-group design was used to test for possible pretest sensitization effects and to assess the effects of exposure to the decision aid . No significant pretest sensitization effects were found . Analysis of the exposure effects found that knowledge increased significantly for those exposed to the decision aid compared with those unexposed . Exposure to the decision aid also had some influence on decreasing both decisional conflict and decisional anxiety . Decision aids can play an important role in increasing patients ' knowledge and decreasing anxiety when asked to make health care decisions Background Whether early detection and treatment of prostate cancer ( PCa ) will reduce disease-related mortality remains uncertain . As a result , tools are needed to facilitate informed decision making . While there have been several decision aids ( DAs ) developed and tested , very few have included an exercise to help men clarify their values and preferences about PCa screening . Further , only one DA has utilized an interactive web-based format , which allows for an expansion and customization of the material . We describe the development of two DAs , a booklet and an interactive website , each with a values clarification component and design ed for use in diverse setting s. Methods We conducted two feasibility studies to assess men 's ( 45 - 70 years ) Internet access and their willingness to use a web- vs. a print-based tool .  The booklet was adapted from two previous versions evaluated in r and omized controlled trials ( RCTs ) and the website was created to closely match the content of the revised booklet . Usability testing was conducted to obtain feedback regarding draft versions of the material s. The tools were also review ed by a plain language expert and the interdisciplinary research team . Feedback on the content and presentation led to iterative modifications of the tools . Results The feasibility studies confirmed that the Internet was a viable medium , as the majority of men used a computer , had access to the Internet , and Internet use increased over time . Feedback from the usability testing on the length , presentation , and content of the material s was incorporated into the final versions of the booklet and website . Both the feasibility studies and the usability testing highlighted the need to address men 's informed  decision making regarding screening . Conclusions Informed decision making for PCa screening is crucial at present and may be important for some time , particularly if a definitive recommendation either for or against screening does not emerge from ongoing prostate cancer screening trials . We have detailed our efforts at developing print- and web-based DAs to assist men in determining how to best meet their PCa screening preferences . Following completion of our ongoing RCT design ed to test these material s , our goal will be to develop a dissemination project for the more effective tool . Trial Registration OBJECTIVE Screening asymptomatic men for prostate cancer is controversial and informed decision making is recommended . Within two prostate cancer screening programs , we evaluated the impact of a print-based decision aid ( DA ) on decision-making outcomes . METHODS Men ( N=543 ) were 54.9 ( SD=8.1 ) years old and 61 % were African-American . The 2(booklet type : DA vs. usual care (UC)) × 2(delivery mode : Home vs. Clinic ) r and omized controlled trial assessed decisional and screening outcomes at baseline , 2-months , and 13-months . RESULTS Intention-to-treat linear regression analyses using generalized estimating equations revealed that DA participants reported improved knowledge relative to UC ( B=.41 , p<.05 ) . For decisional conflict , per- protocol analyses revealed a group by time interaction ( B=-.69 , p<.05 ) , indicating that DA participants were less likely to report decisional conflict at 2-months compared to UC participants ( OR=.49 , 95 % CI : .26-.91 , p<.05 ) . CONCLUSION This is the first r and omized trial to evaluate a DA in the context of free mass screening , a challenging setting in which to make an informed decision . The DA was highly utilized by participants , improved knowledge and reduced decisional conflict . PRACTICE IMPLICATION S These results are valuable in underst and ing ways to improve the decisions of men who seek screening and can be easily implemented within many setting OBJECTIVE Genetic testing is increasingly part of routine clinical care for women with a family history of breast cancer . Given their substantially elevated risk for breast cancer , BRCA1/BRCA2 mutation carriers must make the difficult decision whether or not to opt for risk reducing mastectomy . To help BRCA1/2 carriers make this decision , the authors developed a computer-based interactive decision aid that was tested against usual care in a r and omized controlled trial . DESIGN After the completion of genetic counseling , 214 female ( aged 21 - 75 ) BRCA1/BRCA2 mutation carriers were r and omized to Usual Care  ( UC ; N = 114 ) or Usual Care plus Decision Aid ( DA ; N = 100 ) arms . UC participants received no additional intervention . DA participants were sent the CD-ROM DA to view at home . MAIN OUTCOME MEASURES The authors measured final management decision , decisional conflict , decisional satisfaction , and receipt of risk reducing mastectomy at 1- , 6- , and 12-months postr and omization . RESULTS Longitudinal analyses revealed that the DA was effective among carriers who were initially undecided about how to manage their breast cancer risk . Within this group , the DA led to an increased likelihood of reaching a management decision ( OR = 3.09 , 95 % CI = 1.62 , 5.90 ; p < .001 ) , decreased decisional conflict ( B = -.46 , z = -3.1 , p < 002 ) , and increased satisfaction ( B = .27 , z = 3.1 , p = .002 ) compared to UC . Among carriers who had already made a management decision by the time of r and omization , the DA had no benefit relative to UC . CONCLUSION These results demonstrate that BRCA1/BRCA2 mutation carriers who are having difficulty making a breast cancer risk management decision can benefit from adjunct decision support Background Patients are being encouraged to go online to obtain health information and interact with their health care systems . However , a 2014 survey found that less than 60 % of American adults aged 65 and older use the Internet , with much lower usage among black and Latino seniors compared with non-Hispanic white seniors , and among older versus younger seniors . Objective Our aims were to ( 1 ) identify race/ethnic and age cohort disparities among seniors in use of the health plan ’s patient portal , ( 2 ) determine whether race/ethnic and age cohort disparities exist in access to digital devices and preferences for using email- and Web-based modalities to interact with the health care system , ( 3 ) assess whether observed disparities in preferences and patient portal use are due simply to barriers to access and inability to use the Internet , and ( 4 ) learn whether older adults not currently using the health plan ’s patient portal or website have a potential interest in doing so in the future and what kind of support might be best suited to help them . Methods We conducted two studies of seniors aged 65 - 79 years . First , we used administrative data about  patient portal account status and utilization in 2013 for a large cohort of English-speaking non-Hispanic white ( n=183,565 ) , black ( n=16,898 ) , Latino ( n=12,409 ) , Filipino ( n=11,896 ) , and Chinese ( n=6314 ) members of the Kaiser Permanente Northern California health plan . Second , we used data from a mailed survey conducted in 2013 - 2014 with a stratified r and om sample of this population ( final sample : 849 non-Hispanic white , 567 black , 653 Latino , 219 Filipino , and 314 Chinese ) . These data were used to examine race/ethnic and age disparities in patient portal use and readiness and preferences for using digital communication for health-related purpose s. Results Adults aged 70 - 74 and 75 - 79 were significantly less likely than 65 - 69 year olds to be registered to use the patient portal , and among those registered , to have used the portal to send messages , view lab test results , or order prescription refills . Across all age groups , non-Hispanic whites and Chinese seniors were significantly more likely than black , Latino , and Filipino seniors to be registered and to have performed these actions . The survey found that black , Latino , and Filipino seniors and those 75 years old and older were significantly less likely to own digital devices ( eg , computers , smartphones ) , use the Internet and email , and be able and willing to use digital technology to perform health care-related tasks , including obtaining health information , than non-Hispanic whites , Chinese , and younger seniors ( aged 65 - 69 ) , respectively . The preference for using non-digital modalities persisted even among Internet users . Conclusions Health plans , government agencies , and other organizations that serve diverse groups of seniors should include social determinants such as race/ethnicity and age when monitoring tr 
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Conclusions The diversity of the US population is represented in a majority of cancer-related PtDA RCTs , but fewer studies have tailored PtDAs to address the multiple social disadvantages that may impact patients ’ participation in SDM .