***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 Although a model for shared decision-making is important for patient-centered care , decisional conflict can emerge when patients participate in the decision-making . A decision aid is proposed to provide information and to involve patients more comfortably in the decision-making process . We aim ed to determine whether a decision aid helps patients with carpal tunnel syndrome ( CTS ) experience less decisional conflict regarding their decision-making for surgery . Methods Eighty patients with CTS were r and omized into two groups . The test group was given a decision aid in addition to regular information and the control group regular information only . The decision aid consisted of a 6-min videoclip that explains diagnosis and information regarding surgery for CTS with other treatment options . We evaluated patients ’ decisional conflict regarding surgery , knowledge about CTS , and symptom severity as measured by the Disabilities of Arm , Shoulder , and H and ( DASH ) Question naire . Results There was no difference in the decisional conflict scale ( DCS ) between both groups ( p = 0.76 ) . The test group had significantly better knowledge than the control group ( p = 0.04 ) . There was no correlation between the knowledge score and the DCS ( p = 0.76 ) . However , less severe symptoms were correlated with greater decisional conflict ( r = −0.29 , p = 0.02 ) . Conclusions We found that a decision aid does not reduce decisional conflict in patients with CTS , although it can help them be better informed . This study suggests that although a decision-aid is effective for patient education , doctor-patient communication should be more emphasized for patients with less severe symptoms , as they can have greater decisional conflict . Trial Registration SNUBH Registry 1510/317 - 003 Registered November 13 , OBJECTIVE We aim ed to evaluate the effect of a decision aid ( DA ) with patient narratives on decisional conflict in surgery choice for Japanese women with early-stage breast cancer . METHODS Two hundred ten women with early-stage breast cancer were r and omly assigned to an intervention or control group . Groups 1 and 2 received st and ard information and a DA , with or without patient narratives , and Group 3 received st and ard information ( control ) before surgery choice . At baseline , post-intervention ( Time 2 ) , and 1 month after surgery ( Time 3 ) , we evaluated decisional conflict as the primary outcome using a decisional conflict scale ( DCS ) . Sidak corrections for multiple comparisons in analysis of covariate were used to compare Time 2 and Time 3 DCS mean scores between each pair of groups . RESULTS At Time 3 , decisional conflict was significantly reduced for Group 1 vs control ( P=0.021 , Cohen 's d = 0.26 ) and Group 2 vs control ( P=0.008 , Cohen 's d=0.40 ) . CONCLUSION The DAs with and without patient narratives are equivalently effective at reducing postoperative decisional conflict in Japanese women with early-stage breast cancer . PRACTICE IMPLICATION S The DAs with and without patient narratives can be used in clinical practice for women with early-stage breast cancer Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more ABSTRACT In order to increase patient active engagement during patient – provider interactions , we developed and implemented patient training sessions in four antiretroviral therapy ( ART ) clinics in Namibia using a “ Patient Empowerment ” training curriculum . We examined the impact of these trainings on patient – provider interactions after the intervention . We tested the effectiveness of the intervention using a r and omized parallel group design , with half of the 589 enrolled patients r and omly assigned to receive the training immediately and the remaining r and omized to receive the training 6 months later . The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up . Each consultation was audiotaped and then coded using the Roter Interaction Analysis System ( RIAS ) . RIAS outcomes were compared between study groups at 6 months . Using intention-to-treat analysis , consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation ( adjusted difference in score 1.19 , p = .004 ) , doctor information gathering ( adjusted difference in score 2.96 , p = .000 ) , patient question asking ( adjusted difference in score .48 , p = .012 ) , and patient positive affect ( adjusted difference in score 2.08 , p = .002 ) . Other measures were higher in the intervention group but did not reach statistical significance . We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program , although outcome data were not available on all patients . The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided Background Chronic conditions are a major source of morbidity , mortality and cost worldwide . Shared decision making is one way to improve care for patients with chronic conditions . Although it has been widely studied , the effect of shared decision making in the context of chronic conditions is unknown . Methods / Design We will perform a systematic review with the objective of determining the effectiveness of  shared decision making interventions  for persons diagnosed with chronic conditions . We will search the following data bases for relevant articles : PubMed , Scopus , Ovid MEDLINE , Ovid EMBASE , Ovid EBM Review s CENTRAL , CINAHL , and Ovid PsycInfo . We will also search clinical trial registries and contact experts in the field to identify additional studies . We will include r and omized controlled trials study ing shared decision making interventions in patients with chronic conditions who are facing an actual decision . Shared decision making interventions will be defined as any intervention aim ing to facilitate or improve patient and /or clinician engagement in a decision making process . We will describe all studies and assess their quality . After adjusting for missing data , we will analyze the effect of shared decision making interventions  on outcomes in chronic conditions overall and stratified by condition . We will evaluate outcomes according to an importance ranking informed by a variety of stakeholders . We will perform several exploratory analyses including the effect of author contact on the estimates of effect . Discussion We anticipate that this systematic review may have some limitations such as heterogeneity and imprecision ; however , the results will contribute to improving the quality of care for individuals with chronic conditions and facilitate a process that allows decision making that is most consistent with their own values and preferences . Trial registration PROSPERO Registration Number : PURPOSE Breast cancer ( BC ) decision aid ( DA ) r and omized studies are limited to DA use in consultations among Western population s and for primary surgery . Their effectiveness beyond consultations , for reconstructive surgery and in other population s , has not been evaluated . We developed a DA administered after consultation for Chinese women deciding on BC surgery and , where relevant , immediate breast reconstruction , which was evaluated in this r and omized controlled trial ( RCT ) . PATIENTS AND METHODS Overall , 276 women considering BC surgery for early-stage BC were r and omly assigned to receive a DA ( take-home booklet ) or the st and ard information booklet ( control condition ) after the initial consultation , wherein surgeons disclosed the diagnosis and discussed treatment options with patients . Using block r and om assignment by week , 138 women were assigned to the DA arm and 138 to the control arm . Participants completed interview-based question naires 1 week after consultation and then 1 , 4 , and 10 months after surgery . Primary outcome measures were decisional conflict , decision-making difficulties , BC knowledge 1 week after consultation , and decision regret 1 month after surgery . Secondary outcome measures were treatment decision , decision regret 4 and 10 months after surgery , and postsurgical anxiety and depression . RESULTS The DA group reported significantly lower decisional conflict scores 1 week after consultation ( P = .016 ) compared with women in the control arm . Women receiving the DA had significantly lower decision regret scores 4 ( P = .026 ) and 10 months ( P = .014 ) after surgery and lower depression scores 10 months after surgery ( P = .001 ) . CONCLUSION This RCT demonstrated DAs may benefit Chinese patients in Hong Kong by reducing decisional conflict and subsequent regret and enhance clinical services for this population OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE The objective of this study was to evaluate the patients ' perception of the usefulness of a question prompt sheet ( QPS ) in facilitating the involvement of advanced cancer patients during consultation . METHODS Advanced cancer patients attending their first consultation after diagnosis were r and omly assigned to the intervention group ( received QPS and a hospital introduction sheet ( HIS ) ) or the control group ( received HIS only ) . Analysis was conducted on an intention-to-treat basis . The primary outcome measure was patient rating of the usefulness of the material ( s ) ( numerical rating scale of 0 - 10 ) . RESULTS Sixty-three advanced cancer patients ( 72.4 % response rate ) were enrolled and analyzed . Nearly three-quarters of patients in both groups read the material ( s ) before consultation . The rated usefulness of the material ( s ) for asking questions of physicians was significantly higher in the intervention group than in controls ( 4.4 ± 3.6 and 2.7 ± 2.8 , respectively ; p = 0.033 ) . The mean score of the usefulness of the material ( s ) for underst and ing the treatment plan tended to be higher in the intervention group than in the controls ( 4.9 ± 3.6 and 3.3 ± 2.8 ; p = 0.051 ) . The mean score of willingness to use the material ( s ) in the future was significantly higher in the intervention group than in the controls ( 5.3 ± 3.8 and 2.8 ± 2.8 ; p = 0.006 ) . There were no significant differences between the groups in the average total number of questions asked by patients ( median , 1.0 ; interquartile range in both groups , 2.0 ) . CONCLUSIONS QPS provided before oncology consultation may be useful for advanced cancer patients , on the other h and , it did not directly promote patient confidence to ask questions Paternalistic models of health care , social distance between patients and providers , and cultural norms discourage patients from playing an active role in health consultations . This study tested whether individual coaching can give family planning patients the confidence and communication skills to talk more openly and more vigorously with providers . Educators met with 384 Indonesian women in clinic waiting rooms and coached them on asking questions , expressing concerns , and seeking clarification . An analysis of audiotaped consultations found that patients who received coaching articulated significantly more questions and concerns than others . Coaching narrowed differentials in active communication by patient type , age , and assertiveness , but it widened differentials by patient education and socioeconomic class . The discontinuation rate at 8 months was lower in the intervention than the control condition , but the difference was only marginally significant Background A patient decision aid ( PDA ) is a tool for shared decision making ( SDM ) , which emphasises patient empowerment . It is useful in chronic diseases and when there are multiple , no best single treatment option . Although SDM is prevalent in Western countries , its use is limited in Chinese societies , where the adoption of a paternalistic approach is strong . Here , we report the development , acceptance and pilot test results of a PDA targeted at Chinese patients with primary open-angle glaucoma ( POAG ) . Methods We developed a PDA design ed for use in Chinese patients with POAG . Recruited subjects were given our PDA . Baseline evaluation included decision conflict scale ( DCS ) , vali date d glaucoma adherence question naires and glaucoma knowledge question naire . Subjects were briefed through the PDA and instructed to read it that day . Three to four weeks later , follow-up question naire as described above were conducted with the addition of acceptance question naires . Results Data from 65 subjects were available . The PDA was well received among subjects . DCS improved from 48.9±20.4 at baseline to 34.3±2 
    Output:
    
Whilst most of the studies reported increased patient participation , those interventions which had provider or patient training in communication skills were found to be more effective .
CONCLUSION Interventions to improve patient participation , within the context of dyadic decision making , in non-Western countries can be feasible and effective if communication skills training is provided for health-care providers and /or patients