***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: PURPOSE Impairment of fertility is a common sequela of successful cancer treatment . Therefore , fertility preservation ( FP ) should be discussed with all young cancer patients . Decisions about FP are challenging . Patients wish more specific support and the first results concerning the helpfulness of decision aids ( DA ) were promising . Aside from describing the process of development and the content of an online DA in German , the objective of this study was to pilot test users ' satisfaction with the DA and its effect on knowledge about FP and decisional conflict ( DC ) . METHODS In this prospect i ve consecutive study , a control group ( n = 20 , fertility counseling ) was followed by and compared with an  intervention group ( n = 20 ,  counseling and additional use of the DA , developed by an interdisciplinary team ) of recently diagnosed female cancer patients between 18 and 40 years . RESULTS Nearly all participants who applied the DA considered it helpful for decision-making and recommendable . Knowledge about FP was high with regard to FP techniques women went for . DC was moderate according to the mean score ( M = 27.92 , st and ard deviation = 13.27 ) and only in 20 % , the score was above the threshold for high DC . There was no difference between the control and intervention group for knowledge and DC . CONCLUSION The DA seems to serve as additional and well-accepted support tool in decision-making for patients and professionals . Referral to a reproductive specialist is crucial to warrant comprehensive information . These results need to be confirmed with the current ongoing r and omized controlled study Abstract This paper reports on the feasibility and preliminary effects of a decision aid ( DA ) about female fertility preservation ( FP ) . We conducted a pilot multicentre r and omized controlled trial of women with breast cancer aged 18–40 who were r and omized to brochures or the DA .  Over 18 months , 62 women were eligible , of which 42 were invited by their healthcare provider ( 74 % ) to participate in the study . A total of 36 women signed up for participation and 26 ( 72 % ) were r and omized to brochures ( n = 13 ) or the DA  ( n = 13 ) . In both groups , many women ( 87 % ) read the brochures and eight women used all available brochures . In the intervention group , 7/13 women logged in to the DA . Women who received brochures had slightly less decisional conflict , whereas knowledge improved in both groups . Our results indicate that both brochures about FP and a detailed DA have beneficial effects with regard to knowledge , but the DA seemed to introduce slightly more decisional conflict ( DC ) than the brochures . Although we encountered challenges with recruitment , our design and measurements seem feasible and the effects of the information material s seem promising , hence justifying conducting a larger study Background We aim ed to evaluate the effect of a decision aid ( DA ) with information only compared to a DA with values clarification exercise ( VCE ) , and to study the role of personality and information seeking style in DA-use , decisional conflict ( DC ) and knowledge . Methods Two scenario-based experiments were conducted with two different groups of healthy female participants . Dependent measures were : DC , knowledge , and DA-use ( time spent , pages viewed , VCE used ) . Respondents were r and omized between a DA with information only ( VCE- ) and a DA with information plus a VCE(VCE+ ) ( experiment 1 ) , or between information only ( VCE- ) , information plus VCE without referral to VCE(VCE+ ) , and information plus a VCE with specific referral to the VCE , requesting participants to use the VCE(VCE++ ) ( experiment 2 ) . In experiment 2 we additionally measured personality ( neuroticism/conscientiousness ) and information seeking style ( monitoring/blunting ) . Results Experiment 1 . There were no differences in DC , knowledge or DA-use between VCE- ( n=70 ) and VCE+ ( n=70 ) . Both DAs lead to a mean gain in knowledge from 39 % at baseline to 73 % after viewing the DA . Within VCE+ , VCE-users ( n=32 , 46 % ) reported less DC compared to non-users . Since there was no difference in DC between VCE- and VCE+ , this is likely an effect of VCE-use in a self-selected group , and not of the VCE per se . Experiment 2 . There were no differences in DC or knowledge between  VCE- ( n=65 ) , VCE+ ( n=66 ) , VCE++ ( n=66 ) . In all groups , knowledge increased on average from 42 % at baseline to 72 % after viewing the DA . Blunters viewed fewer DA-pages ( R=0.38 , p<.001 ) . More neurotic women were less certain ( R=0.18 , p<.01 ) and felt less supported in decision making ( R=0.15 , p<.05 ) ; conscientious women felt more certain ( R=-0.15 , p<.05 ) and had more knowledge after viewing the DA ( R=0.15 , p<.05 ) . Conclusions Both DAs lead to increased knowledge in healthy population s making hypothetical decisions , and use of the VCE did not improve knowledge or DC . Personality characteristics were associated to some extent with DA-use , information seeking styles with aspects of DC . More research is needed to make clear recommendations regarding the need for tailoring of information provision to personality characteristics , and to assess the effect of VCE use in actual patients Background : Fertility is a priority for many young women with breast cancer . Women need to be informed about interventions to retain fertility before chemotherapy so as to make good quality decisions . This study aim ed to prospect ively evaluate the efficacy of a fertility-related decision aid ( DA ) . Methods : A total of 120 newly diagnosed early-stage breast cancer patients from 19 Australian oncology clinics , aged 18–40 years and desired future fertility , were assessed on  decisional conflict , knowledge , decision regret , and satisfaction about fertility-related treatment decisions .  These were measured at baseline , 1 and 12 months , and were examined using linear mixed effects models . Results : Compared with usual care , women who received the DA had reduced decisional conflict ( β=−1.51 ; 95%CI : −2.54 to 0.48 ; P=0.004 ) and improved knowledge ( β=0.09 ; 95%CI : 0.01–0.16 ; P=0.02 ) , after adjusting for education , desire for children and baseline uncertainty . The DA was associated with reduced decisional regret at 1 year ( β=−3.73 ; 95%CI : −7.12 to −0.35 ; P=0.031 ) , after adjusting for education . Women who received the DA were more satisfied with the information received on the impact of cancer treatment on fertility ( P<0.001 ) , fertility options ( P=0.005 ) , and rated it more helpful ( P=0.002 ) , than those who received st and ard care . Conclusion : These findings support widespread use of this DA shortly after diagnosis ( before chemotherapy ) among younger breast cancer patients who have not completed their families PURPOSE This study was undertaken to determine the effect , if any , of treatment for cancer diagnosed during childhood or adolescence on fertility . PATIENTS AND METHODS We review ed the fertility of female participants in the Childhood Cancer Survivor Study ( CCSS ) , which consisted of 5-year survivors , and a cohort of r and omly selected siblings who responded to a question naire . Medical records of all members of the cohort were abstract ed to obtain chemotherapeutic agents administered ; the cumulative dose of drug administered for several drugs of interest ; and the doses , volumes , and date s of administration of all radiation therapy . RESULTS There were 5,149 female CCSS participants , and there were 1,441 female siblings of CCSS participants who were age 15 to 44 years . The relative risk ( RR ) for survivors of ever being pregnant was 0.81 ( 95 % CI , 0.73 to 0.90 ; P < .001 ) compared with female siblings . In multivariate models among survivors only , those who received a hypothalamic/pituitary radiation dose > or = 30 Gy ( RR , 0.61 ; 95 % CI , 0.44 to 0.83 ) or an ovarian/uterine radiation dose greater than 5 Gy were less likely to have ever been pregnant ( RR , 0.56 for 5 to 10 Gy ; 95 % CI , 0.37 to 0.85 ; RR , 0.18 for > 10 Gy ; 95 % CI , 0.13 to 0.26 ) . Those with a summed alkylating agent dose ( AAD ) score of three or four or who were treated with lomustine or cyclophosphamide were less likely to have ever been pregnant . CONCLUSION This large study demonstrated that fertility is decreased among female CCSS participants . The risk factors identified may be utilized for pretreatment counseling of patients and their parents Introduction Women diagnosed with cancer and facing potentially sterilising cancer treatment have to make time-pressured decisions regarding fertility preservation with specialist fertility services while undergoing treatment of their cancer with oncology services . Oncologists identify a need for re sources enabling them to support women 's fertility preservation decisions more effectively ; women report wanting more specialist information to make these decisions . The overall aim of the ‘ Cancer , Fertility and Me ’ study is to develop and evaluate a new evidence -based patient decision aid ( PtDA ) for women with any cancer considering fertility preservation to address this unmet need . Methods and analysis This is a prospect i ve mixed- method observational study including women of reproductive age ( 16 years + ) with a new diagnosis of any cancer across two regional cancer and fertility centres in Yorkshire , UK . The research involves three stages . In stage 1 , the aim is to develop the PtDA using a systematic method of evidence synthesis and multidisciplinary expert review of current clinical practice and patient information . In stage 2 , the aim is to assess the face validity of the PtDA . Feedback on its content and format will be ascertained using question naires and interviews with patients , user groups and key stakeholders . Finally , in stage 3 the acceptability of using this re source when integrated into usual cancer care pathways at the point of cancer diagnosis and treatment planning will be evaluated . This will involve a quantitative and qualitative evaluation of the PtDA in clinical practice . Measures chosen include using count data of the PtDAs administered in clinics and accessed online , decisional and patient-reported outcome measures and qualitative feedback . Quantitative data will be analysed using descriptive statistics , paired sample t-tests and CIs ; interviews will be analysed using thematic analysis . Ethics and dissemination Research Ethics Committee approval ( Ref : 16/EM/0122 ) and Health Research Authority approval ( Ref : 194751 ) has been granted . Findings will be published in open access peer- review ed journals , presented at conferences for academic and health professional audiences , with feedback to health professionals and program managers . The Cancer , Fertility and Me patient decision aid ( PtDA ) will be disseminated via a diverse range of open-access media , study and charity websites , professional organisations and academic sources . External endorsement will be sought from the International Patient Decision Aid St and ards ( IPDAS ) Collaboration inventory of PtDAs and other relevant professional organisations , for example , the British Fertility Society . Trial registration number NCT02753296 ; pre- results The aim of this prospect i ve study is to assess the reliability and validity of a multi-dimensional measure of informed choice ( MMIC ) . Participants were 225 pregnant women in two general hospitals in the UK , women receiving low-risk results following serum screening for Down syndrome . The MMIC was administered before testing and the Ottawa Decisional Conflict Scale  was administered 6 weeks later . The component scales of the MMIC , knowledge and attitude , were internally consistent ( alpha values of 0.68 and 0.78 , respectively ) . Those who made a choice categorised as informed using the MMIC rated their decision 6 weeks later as being more informed , better supported and of higher quality than women whose choice was categorised as uninformed . This provides evidence of predictive validity , whilst the lack of association between the MMIC and anxiety shows construct ( discriminant ) validity . Thus , the MMIC has been shown to be psychometrically robust in pregnant women offered the choice to undergo prenatal screening for Down syndrome and receiving a low-risk result . Replication of this finding in other groups , facing other decisions , with other outcomes , should be assessed in future research OBJECTIVES We conducted pilot studies of the feasibility and efficacy of an interactive , computerized educational tool , Banking on Fatherhood ( BOF ) . METHODS Two small r and omized trials were conducted , with 20 male cancer patients eligible to bank sperm in Study 1 and 19 oncology fellows or residents in Study 2 . In each trial , half of the subjects viewed BOF before completing question naires , and half viewed it afterward . Outcome measures included a knowledge test in both trials and a Decisional Conflict scale in the patient trial . All participants , plus a panel of 10 experts , ultimately viewed BOF and completed a form evaluating its usability and value . RESULTS Patients who completed question naires after viewing BOF had significantly less decisional conflict about banking sperm than those who had not viewed it ( P=0.0065 ) , but knowledge scores were not significantly different between groups . Physicians who filled out question naires after viewing BOF scored significantly higher on the knowledge test ( P<0.006 ) . Patients , physicians and experts rated BOF as easy to use , informative and addressing important psychosocial concerns , with videos and animations adding to the value of the educational tool . CONCLUSION Pilot studies suggest that BOF is a feasible intervention that could enhance decisions about sperm banking . Research with larger groups is needed to vali date its effectiveness 
    Output:
    
PtDAs were shown to significantly increase fertility preservation knowledge and decrease decisional conflict .
Overall satisfaction with decision aids was high .
PtDAs can serve as effective complements to current fertility counselling practice s by increasing information satisfaction and decision-making outcomes .