***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 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 # RATIONALE Continuous positive airway pressure ( CPAP ) and m and ibular advancement device ( MAD ) therapy are commonly used to treat obstructive sleep apnea ( OSA ) . Differences in efficacy and compliance of these treatments are likely to influence improvements in health outcomes . OBJECTIVES To compare health effects after 1 month of optimal CPAP and MAD therapy in OSA . METHODS In this r and omized crossover trial , we compared the effects of 1 month each of CPAP and MAD treatment on cardiovascular and neurobehavioral outcomes . MEASUREMENTS AND MAIN RESULTS Cardiovascular ( 24-h blood pressure , arterial stiffness ) , neurobehavioral ( subjective sleepiness , driving simulator performance ) , and quality of life ( Functional Outcomes of Sleep Question naire , Short Form-36 ) were compared between treatments . Our primary outcome was 24-hour mean arterial pressure .  A total of 126 patients with moderate-severe OSA ( apnea hypopnea index [ AHI ] , 25.6 [ SD 12.3 ] ) were r and omly assigned to a treatment order and 108 completed the trial with both devices . CPAP was more efficacious than MAD in reducing AHI ( CPAP AHI , 4.5 ± 6.6/h ; MAD AHI , 11.1 ± 12.1/h ; P < 0.01 ) but reported compliance was higher on MAD ( MAD , 6.50 ± 1.3 h per night vs. CPAP , 5.20 ± 2 h per night ; P < 0.00001 ) . The 24-hour mean arterial pressure was not inferior on treatment with MAD compared with CPAP ( CPAP-MAD difference , 0.2 mm Hg [ 95 % confidence interval , -0.7 to 1.1 ] ) ; however , overall , neither treatment improved blood pressure . In contrast , sleepiness , driving simulator performance , and disease-specific quality of life improved on both treatments by similar amounts , although MAD was superior to CPAP for improving four general quality -of-life domains . CONCLUSIONS Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA . The results may be explained by greater efficacy of CPAP being offset by inferior compliance relative to MAD , result ing in similar effectiveness . Clinical trial registered with https://www.anzctr.org.au ( ACTRN 12607000289415 ) BACKGROUND Poor quality of information transfer about the benefits and risks of statin drug use may result in patients not making informed decisions that they can act on in a timely fashion . METHODS The effect of a decision aid about statin drugs on treatment decision making in 98 patients with diabetes was determined in a cluster r and omized trial of decision aid vs control pamphlet , with concealed allocation , blinding of participants to study goals , and adherence to the intention-to-treat principle . Twenty-one endocrinologists conducted specialty outpatient metabolic consultations . Patients in the intervention group received Statin Choice , a tailored decision aid that presents the estimated 10-year cardiovascular risk , the absolute risk reduction with use of statin drugs , and the disadvantages of using statin drugs . Patients in the control group received the institution 's pamphlet about cholesterol management . We measured acceptability , knowledge about options and cardiovascular risk , and decisional conflict immediately after the visit , and adherence to pill taking was measured 3 months later . RESULTS Patients favored using the decision aid ( odds ratio [ OR ] , 2.8 ; 95 % confidence interval [ CI ] , 1.2 - 6.9 ) ; patients who received the decision aid ( n = 52 ) knew more ( difference , 2.4 of 9 points ; 95 % CI , 1.5 - 3.3 ) , had better estimated cardiovascular risk ( OR , 22.4 ; 95 % CI , 5.9 - 85.6 ) and potential absolute risk reduction with statin drugs ( OR , 6.7 ; 95 % CI , 2.2 - 19.7 ) , and had less decisional conflict ( difference , -10.6 ; 95 % CI , -15.4 to -5.9 on a 100-point scale ) than did patients in the control group ( n = 46 ) . Of 33 patients in the intervention group taking statin drugs at 3 months , 2 reported missing 1 dose or more in the last week compared with 6 of 29 patients in the control group taking statin drugs ( OR , 3.4 ; 95 % CI , 1.5 - 7.5 ) . CONCLUSIONS A decision aid enhanced decision making about statin drugs and may have favorably affected drug adherence The purpose of this study was to develop and test a decision support intervention ( DSI ) to assist women to make and act on informed decisions that are consistent with their values in the area of menopause and hormone replacement therapy ( HRT ) . Mode and intensity of intervention were tested in midlife women ( N = 248 ) , r and omly assigned to one of three intervention formats : written information only , guided discussion , or personalized decision exercise . Data were collected over 12 months . Knowledge , decisional conflict , satisfaction with health care provider , and self-efficacy improved following intervention and were maintained for 12 months for all groups . Women 's adherence to their own plans over 12 months was 59 % ( exercise ) , 76 % ( calcium intake ) , and 89 % ( HRT ) . Carefully written information is effective in promoting knowledge , adherence , and satisfaction among well-educated , interested women . It was concluded that women can underst and complex information , including tradeoffs regarding treatment options . Women will adhere to their own plans , suggesting that consumer rather than provider plans may be the more appropriate gold st and ard for measuring adherence Objective To assess which of three triage strategies for women with borderline abnormal cervical smear results in the best psychosocial outcomes . Design Pragmatic , non-blinded , multicentre , r and omised controlled trial . Setting 18 family planning clinics across Australia , covering both urban and rural areas , between January 2004 and October 2006 . Participants Women aged 16 - 70 years ( n=314 ) who attended routine cervical screening and received a borderline cervical smear . Interventions Patients were r and omly assigned to human papillomavirus ( HPV ) DNA testing ( n=104 ) , a repeat smear test at six months ( n=106 ) , or the patient ’s informed choice of either test supported by a decision aid ( n=104 ) . Psychosocial outcomes were assessed at multiple time points over 12 months by postal question naire . Main outcome measures We assessed health related quality of life ( SF36 mental health subscale ) , cognitive effects ( such as perceived risk of cervical cancer , intrusive thoughts ) , affective outcomes ( general anxiety [ state-trait anxiety inventory ] ) , specific anxiety about an abnormal smear ( cervical screening question naire ) , and behavioural outcomes ( sexual health behaviour and visits to the doctor ) over 12 months of follow-up . Results At two weeks , some psychosocial outcomes were worse for women allocated to HPV testing compared with those in the smear testing group ( SF36 vitality subscale : t=−1.63 , df=131 , P=0.10 ; intrusive thoughts χ2=8.14 , df=1 , P<0.01 ) . Over 12 months , distress about the abnormal smear was lowest in women allocated to HPV testing and highest in the repeat smear testing group ( t=−2.89 , df=135 , P<0.01 ) . Intrusive thoughts were highest in patients allocated to HPV testing ( 25 % , compared with 13 % in the informed choice group ; difference=12 % , 95 % CI −1.1 % to 25.1 % ) . Women in the HPV DNA group and the informed choice group were more satisfied with their care than women allocated to repeat smear testing . Conclusions Although the psychosocial effect was initially worse for women allocated to HPV triage , over the full year of follow-up this intervention was better for women ’s psychosocial health than repeat smear testing . Offering informed choice could have a small advantage for cognitive outcomes , but in view of the additional effort and logistical complexity that this intervention requires , HPV testing alone can be justified for most women . Trial Registration actr.org.au Identifier : 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 CONTEXT Decision aids can increase patient involvement in treatment decision making . However , questions remain regarding their effects and cost implication s. OBJECTIVE To evaluate the effects of information , with and without a structured preference elicitation interview , on treatment choices , health outcomes , and costs . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial with 2 years of follow-up . Between October 1996 and February 1998 , 894 women with uncomplicated menorrhagia were recruited from 6 hospitals in southwest Engl and . Women were r and omized to the control group , information alone group ( information ) , or information plus interview group ( interview ) . INTERVENTIONS Women in both intervention groups were sent an information pack ( a booklet and complementary videotape ) 6 weeks before their specialist consultation . Immediately before their consultation , women in the interview group underwent structured interview , to clarify and elicit their preferences . MAIN OUTCOME MEASURES Self-reported health status was the 
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Other studies included in the review indicated that PtDAs will likely increase up-front costs , but in some context s may reduce short-term costs by reducing the uptake of invasive treatments , such as elective surgery .
Our review suggests that policy makers currently have insufficient economic evidence to appropriately consider their investments in PtDAs