***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 . 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 CONTEXT Decision aids are tools design ed to help patients participate in the clinical decision-making process . OBJECTIVE To determine whether use of an audiobooklet ( AB ) decision aid explaining the results of a clinical trial affected the decision-making process of study participants . DESIGN R and omized controlled trial conducted from May 1997 to April 1998 . SETTING Fourteen centers that participated in the Stroke Prevention in Atrial Fibrillation ( SPAF ) III trial . PARTICIPANTS A total of 287 patients from the SPAF III aspirin cohort study , in which patients with atrial fibrillation and a relatively low risk of stroke received 325 mg/d of aspirin and were followed up for a mean of 2 years . INTERVENTION At the end of SPAF III , participants were r and omized to be informed of the study results with usual care plus use of an AB ( AB group ) vs usual care alone ( control group ) . The AB included pertinent information to help patients decide whether to continue taking aspirin or switch to warfarin . MAIN OUTCOME MEASURES Patients ' ability to make choices regarding antithrombotic therapy , and 6-month adherence to these decisions . Their knowledge , expectations , decisional conflict ( the amount of uncertainty about the course of action to take ) , and satisfaction with the decision-making process were also measured . RESULTS More patients in the AB group made a choice about antithrombotic therapy than in the control group ( 99 % vs 94 % ; P = .02 ) . Patients in the AB group were more knowledgeable and had more realistic expectations about the risk of stroke and hemorrhage ( in the AB group , 53%-80 % correctly estimated different risks ; in the control group , 16%-28 % gave correct estimates ) . Decisional conflict and satisfaction were similar for the 2 groups . After 6 months , a similar percentage of patients were still taking their initial choice of antithrombotic therapy ( 95 % vs 93 % ; P = .44 ) . CONCLUSIONS For patients with atrial fibrillation who had participated in a major clinical trial , the use of an AB decision aid improved their underst and ing of the benefits and risks associated with different treatment options and helped them make definitive choices about which therapy to take . Further studies are necessary to evaluate the acceptability and impact of decision aids in other clinical setting Background Much of the research on decision-making in health care has focused on consultation outcomes . Less is known about the process by which clinicians and patients come to a treatment decision . This study aim ed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a r and omised controlled trial . Methods A video-based study set in an efficacy trial which compared the use of paper-based guidelines ( control ) with two forms of computer-based decision aids ( implicit and explicit versions of DARTS II ) . Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation . Twenty nine consultations were video-recorded .  A ten-minute ' slice ' of the consultation was sample d for detailed content analysis using existing interaction analysis protocol s for verbal behaviour and ethological techniques for non-verbal behaviour . Results Median consultation times ( quartiles ) differed significantly depending on the technology used . Paper-based guidelines took 21 ( 19–26 ) minutes to work through compared to 31 ( 16–41 ) minutes for the implicit tool ; and 44 ( 39–55 ) minutes for the explicit tool . In the ten minutes immediately preceding the decision point , GPs dominated the conversation , accounting for 64 % ( 58–66 % ) of all utterances and this trend was similar across all three arms of the trial . Information-giving was the most frequent activity for both GPs and patients , although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids . GPs ' language was highly technically focused and just 7 % of their conversation was socio-emotional in content ; this was half the socio-emotional content shown by patients ( 15 % ) . However , frequent head nodding and a close mirroring in the direction of eye-gaze suggested that both parties were active participants in the conversation Conclusion Irrespective of the arm of the trial , both patients ' and GPs ' behaviour showed that they were reciprocally engaged in these consultations . However , even in consultations aim ed at promoting shared decision-making , GPs ' were verbally dominant , and they worked primarily as information providers for patients . In addition , computer-based decision aids significantly prolonged the consultations , particularly the later phases . These data suggest that decision aids may not lead to more ' sharing ' in treatment decision-making and that , in their current form , they may take too long to negotiate for use in routine primary care OBJECTIVE To examine whether explanatory illustrations can improve older adults '  comprehension of written health information . METHODS Six short health-related texts were selected from websites and pamphlets . Young and older adults were r and omly assigned to read health-related texts alone or texts accompanied by explanatory illustrations .  Eye movements were recorded while reading . Word recognition , text comprehension , and comprehension of the illustrations were assessed after reading . RESULTS Older adults performed as well as or better than young adults on the word recognition and text comprehension measures . However , older adults performed less well than young adults on the illustration comprehension measures . Analysis of readers ' eye movements showed that older adults spent more time reading illustration-related phrases and fixating on the illustrations than did young adults , yet had poorer comprehension of the illustrations . CONCLUSION Older adults might not benefit from text illustrations because illustrations can be difficult to integrate with the text . PRACTICE IMPLICATION S Health practitioners should not assume that illustrations will increase older adults ' comprehension of health information Objective : To determine the efficacy of a computerised decision aid in patients with atrial fibrillation making decisions on whether to take warfarin or aspirin therapy .  Design : Two-armed open exploratory r and omised controlled trial . Setting : Two research clinics deriving participants from general practice s in Northeast Engl and . Participants : 109 patients with atrial fibrillation aged over 60 . Interventions : Computerised decision aid applied in shared decision-making clinic compared to evidence -based paper guidelines applied as direct advice . Main outcome measures : Primary outcome measure was the decision conflict scale . Secondary outcome measures included anxiety , knowledge , decision-making preference , treatment decision , use of primary and secondary care services and health outcomes . Results : Decision conflict was lower in the computerised decision aid group immediately after the clinic ; mean difference −0.18 ( 95 % CI −0.34 to −0.01 ) . Participants in this group not already on warfarin were much less likely to start warfarin  than those in the guidelines arm ( 4/16 , 25 % compared to the guidelines group 15/16 , 93.8 % , RR 0.27 , 95 % CI 0.11 to 0.63 ) . Conclusions : Decision conflict was lower immediately following the use of a computerised decision aid in a shared decision-making consultation than immediately following direct doctor-led advice based on paper guidelines . Furthermore , participants in the computerised decision aid group were significantly much less likely to start warfarin  than those in the guidelines arm . The results show that such an approach has a positive impact on decision conflict comparable to other studies of decision aids , but also reduces the uptake of a clinical ly effective treatment that may have important implication s for health outcomes OBJECTIVE Poor adherence to therapy , perhaps related to unaddressed patient preferences , limits the effectiveness of osteoporosis treatment in at-risk women . A parallel patient-level r and omized trial in primary care practice s was performed . METHODS Eligible postmenopausal women with bone mineral density T-scores less than -1.0 and not receiving bisphosphonate therapy were included . In addition to usual primary care , intervention patients received a decision aid ( a tailored pictographic 10-year fracture risk estimate , absolute risk reduction with bisphosphonates , side effects , and out-of-pocket cost ) , and control patients received a st and ard brochure .  Knowledge transfer , patient involvement in decision-making , and rates of bisphosphonate start and adherence were studied . Data came from medical records , post-visit written and 6-month phone surveys , video recordings of clinical encounters , and pharmacy prescription profiles . RESULTS A total of 100 patients ( range of 10-year fracture risk , 6%-60 % ) were allocated r and omly to receive the decision aid ( n=52 ) or usual care ( n=48 ) . Patients receiving the decision aid were 1.8 times more likely to correctly identify their 10-year fracture risk ( 49 % vs 28 % ; 95 % confidence interval [ CI ] , 1.03 - 3.2 ) and 2.7 times more likely to identify their estimated risk reduction with bisphosphonates ( 43 % vs 16 % ; 95 % CI , 1.3 - 5.7 ) . Patient involvement improved with the decision aid by 23 % ( 95 % CI , 13.6 - 31.4 ) .  Bisphosphonates  were started by 44 % of patients receiving the decision aid and 40 % of patients receiving usual care . Adherence at 6 months was similarly high across both groups , but the proportion with more than 80 % adherence was higher with the decision aid ( n=23 [ 100 % ] vs n=14 [ 74 % ] ; P = .009 ) . CONCLUSION A decision aid improved the quality of clinical decisions about bisphosphonate therapy in at-risk postmenopausal women , did not affect start rates , and may have improved adherence Objective To determine the effectiveness of a patient decision aid ( PDA ) to improve decision quality and glycaemic control in people with diabetes making treatment choices using a cluster r and omised controlled trial ( RCT ) . Design A cluster RCT . Setting 49 general practice s in UK r and omised into intervention ( n=25 ) and control ( n=24 ) . Participants General practice s Inclusion criteria : > 4 medical partners ; list size > 7000 ; and a diabetes register with > 1 % of practice population . 191 practice s assessed for eligibility , and 49 practice s r and omised and completed the study . Patients People with type 2 diabetes mellitus ( T2DM ) taking at least two oral glucose-lowering drugs with maximum tolerated dose with a glycosolated haemoglobin ( HbA1c ) greater than 7.4 % ( IFCC HbA1c > 57 mmol/mol ) or advised in the preceeding 6 months to add or consider changing to insulin therapy . Exclusion criteria : currently using insulin therapy ; difficulty reading or underst and ing English ; difficulty in underst and  ing the purpose of the study ; visual or cognitive impairment or mentally ill . A total of 182 assessed for eligibility , 175 r and omised to 95 intervention and 80 controls , and 167 completion and analysis .  Intervention Brief training of clinicians and use of PDA with patients in single consultation . Primary outcomes Decision quality ( Decisional Conflict Scores , knowledge , realistic expectations and autonomy ) and glycaemic control ( glycosolated haemoglobin , HbA1c ) . Secondary outcomes Knowledge and realistic expectations of the risks and benefits of insulin therapy and diabetic complications . Results Intervention group : lower total Decisional Conflict Scores ( 17.4 vs 25.2 , p<0.001 ) ; better knowledge ( 51.6 % vs 28.8 % , p<0.001 ) ; realistic expectations ( risk of ‘ hypo ’ , ‘ weight gain ’ , ‘ complications ’ ; 81.0 % vs 5.2 % , 70.5 % vs 5.3 % , 26.3 % vs 5.0 % respectively , p<0.001 ) ; and were more autonomous in decision-making ( 64.1 % vs 42.9 % , p=0.012 ) . No significant difference in the glycaemic control between the two groups . Conclusions Use of the P AND As decision aid reduces decisional conflict , improves knowledge , promotes realistic expectations and autonomy in people with diabetes making treatment choices in general practice . IS RCT N Trials Register Number 14842077 Background . Statin Choice is a decision aid about taking statins . The optimal mode of delivering Statin Choice ( or any other decision aid ) in clinical practice is unknown . Methods . To investigate the effect of mode of delivery on decision aid efficacy , the authors further explored the results of a concealed 2 × 
    Output:
    
Decision aids performed better than control resp .
usual care interventions by increasing knowledge and accurate risk perception in older people ( decision attributes ) .
With regard to decision process attributes , decision aids result ed in lower decisional conflict and more patient participation .
Conclusions This review shows promising results on the effectiveness of decision aids for older adults .
Decision aids improve older  adults ’ knowledge , increase their risk perception , decrease decisional conflict and seem to enhance participation in SDM .