***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: OBJECTIVE This study examined the long-term effects on women 's  health related quality of life ( HRQOL ) of involvement in decision-making about their treatment for breast cancer and about follow-up care after treatment . METHODS Using a cross-sectional survey design , a sample of breast cancer survivors from Western Washington who were 2 , 5 , and 10 years postdiagnosis were recruited via a cancer registry and interviewed about their HRQOL and their involvement in decision-making about their cancer treatment and follow-up care . MAIN OUTCOME MEASURES HRQOL was assessed using the SF-36 . RESULTS Multiple regression analyses examining demographic and disease characteristics revealed age , and education , but not stage of cancer at diagnosis , to be significant predictors of perceived involvement in decision-making about cancer treatment and follow-up . Controlling for demographic and disease characteristics , perceived involvement in decision-making about treatment overall , surgery , chemotherapeutic treatment , and follow-up care were each associated with improved HRQOL , including the general health and vitality subscales of the SF-36 ( p < .05 ) . Involvement in decision-making about surgery was also associated with better mental health among survivors of breast cancer . Congruence of involvement in decision-making with a patient 's preferred level of involvement was also associated with improved survivor HRQOL on several subscales . CONCLUSIONS Perceived involvement in decision-making about breast cancer treatment , and about follow-up care is associated with better HRQOL for survivors 2 , 5 , and 10 years postdiagnosis . Prospect i ve studies may be warranted to determine the possible mechanisms by which perceived involvement in decision-making about aspects of treatment other than surgery type might influence survivor HRQOL OBJECTIVES /HYPOTHESIS To describe patterns of patient involvement in head and neck cancer decision making . STUDY DESIGN Prospect i ve longitudinal ethnography of otolaryngology patients making treatment decisions . METHODS Grounded theory analysis of verbatim transcripts and original voice recordings from : 1 )  participant-driven diaries , 2 )  participants ' office visits with their physicians , and 3 ) semistructured interviews completed after a treatment decision had been made . RESULTS Patients with serious illness and experiencing considerable pain , discomfort , or alteration in the ability to perform activities of daily living , and who fear for their life , do not make decisions in a way that adheres to the conventional model of decision making , which presumes a sequential , office-based interaction with clear patient autonomy . These patients have the ability to interpret information they receive during office visits , but they describe making a treatment decision as " deciding to do something " not choosing a specific treatment . This group also describes " trust " or " confidence " in the physician as the most important factor in making a decision , not the type or amount of information received . They move through providers toward treatment in a linear fashion , from one physician specialty to the next , usually without doubling back to revisit previous decisions or discussion s. CONCLUSIONS Decision making in serious illness unfolds differently than in less serious problems . The conventional model does not fit this patient population , and reliance on trust of the physician figures prominently . Decision support should be aim ed at physician decision making , promoting explicit incorporation of patient-specific data into the process Objective To assess US physicians ’ attitudes towards using shared decision-making ( SDM ) to achieve cost containment . Design Cross-sectional mailed survey . Setting US medical practice . Participants 3897 physicians were r and omly selected from the AMA Physician Masterfile . Of these , 2556 completed the survey . Main outcome measures Level of enthusiasm for “ Promoting better conversations with patients as a means of lowering healthcare costs ” ; degree of agreement with “ Decision support tools that show costs would be helpful in my practice ” and agreement with “ should promoting SDM  be legislated to control overall healthcare costs ” . Results Of 2556 respondents ( response rate ( RR ) 65 % ) , two-thirds ( 67 % ) were ‘ very enthusiastic ’ about promoting SDM as a means of reducing healthcare costs . Most ( 70 % ) agreed decision support tools that show costs would be helpful in their practice , but only 24 % agreed with legislating SDM to control costs . Compared with physicians with billing-only compensation , respondents with salary compensation were more likely to strongly agree that decision support tools showing costs would be helpful ( OR 1.4 ; 95 % CI 1.1 to 1.7 ) . Primary care physicians ( vs surgeons , OR 1.4 ; 95 % CI 1.0 to 1.6 ) expressed more enthusiasm for SDM being legislated as a means to address healthcare costs . Conclusions Most US physicians express enthusiasm about using SDM to help contain costs . They believe decision support tools that show costs would be useful . Few agree that SDM should be legislated as a means to control healthcare costs BACKGROUND Adjuvant therapy improves breast cancer survival but is underutilized by Black women . Few interventions have addressed this problem . This preliminary report describes the process we used to develop a decision-support intervention for Black women eligible for adjuvant therapy .  Aims were to use qualitative methods to describe factors that influence Black women 's  adjuvant therapy decisions , use these formative data to develop messages for a treatment decision-support intervention , and pilot test the acceptability and utility of the intervention with community members and newly diagnosed women . METHODS Thirty-four in-depth interviews were conducted with breast cancer patients in active treatment , survivors and cancer providers to gather qualitative data . Participant ages ranged from 38 to 69 years . A cultural framework was used to analyze the data and to inform intervention messages . Most women relied on their providers for treatment recommendations . Several women reported problems communicating with providers and felt unprepared to ask questions and discuss adjuvant treatment options . Other factors related to treatment experiences were : spiritual coping , collectivism and sharing breast cancer experiences with other Black survivors . RESULTS Using these formative data , we developed an intervention that is survivor-based and includes an in-person session which incorporates sharing personal stories , communication skills training and decision support . Intervention material s were review ed by community members , research ers/clinicians and patients newly diagnosed with breast cancer . CONCLUSION Patients reported satisfaction with the intervention and felt better prepared to talk with providers . The intervention will be tested in a r and omized trial to enhance decision support and increase use of indicated adjuvant treatment OBJECTIVE Examine how patient-clinician information engagement ( PCIE ) may operate through feeling informed to influence patients ' treatment decision satisfaction ( TDS ) . METHODS R and omly drawn sample ( N=2013 ) from Pennsylvania Cancer Registry , comprised of breast , prostate and colon cancer patients completed mail surveys in the Fall of 2006 ( response rate=64 % ) and Fall of 2007 . Of 2013 baseline respondents , 85 % agreed to participate in follow-up survey ( N=1703 ) . Of those who agreed , 76 % ( N=1293 ) completed follow-up surveys . The sample was split between males and females . The majority of participants were White , over the age of 50 , married , and with a high school degree . Most reported having been diagnosed with in situ and local cancer . RESULTS PCIE was related to concurrent TDS ( beta=.06 ) and feeling informed ( beta=.15 ) , after confounder adjustments . A mediation analysis was consistent with PCIE affecting TDS through feeling informed . Baseline PCIE predicted feeling informed ( beta=.04 ) measured 1 year later , after adjustments for baseline feeling informed and other confounders . Feeling informed was related to concurrent TDS ( beta=.35 ) after confounder adjustment and follow-up TDS ( beta=.13 ) after baseline TDS and confounder adjustment . CONCLUSION Results suggest PCIE affects TDS in part through patients ' feeling informed . PRACTICE IMPLICATION S PCIE may be important in determining patients ' level of feeling informed and TDS Background : Among breast cancer patients , tamoxifen use is associated with reduced risk of disease relapse and death , but it is often difficult for women to sustain therapy during the 5 years required to obtain maximum benefit . Objectives : We sought to examine the influence of patient-centered care activities on ongoing tamoxifen use 4 years after initiation , we examined key components of patient-centered care and rates of ongoing tamoxifen . Methods : Using a prospect i ve cohort study that included observational data from the National Initiative for Cancer Care Quality ( NICCQ ) , we studied 881 patients with stage I-III breast cancer who were registered with an initial diagnosis in 1998 by an American College of Surgeons-approved hospital cancer registry in 1 of 5 metropolitan areas , who initiated tamoxifen treatment .  A patient survey and medical record abstract ion were used as measurements . Results : Among women who initiated tamoxifen , 79 % were still taking it 4 years later . Other than older age and the severity of side effects , other demographic , clinical and cancer characteristics , and treatments did not predict ongoing tamoxifen use . In contrast , after adjusting for these factors , the proportion of patients with ongoing tamoxifen use was lower for patients reporting less support than needed ( 82 % vs. 69 % , P = 0.0051 ) , less than wanted role in decision-making ( 80 % vs. 70 % , P = 0.0486 ) , decision-making about tamoxifen without doctor input ( 79 % vs. 64 % , P = 0.0182 ) , and for patients who were n't told about side effects in advance ( 82 % vs. 72 % , P = 0.0016 ) . Conclusions : Although age and the severity of side-effects remain important , patient-centered care was a primary mediator of patient adherence to ongoing cancer treatment with tamoxifen OBJECTIVE This study examines whether cancer patients ' Internet use  leads them to prefer a more active role in medical decision making and whether the effects of Internet use on active participation preferences vary according to patients ' education levels . METHODS R and omly drawn sample ( N=2013 ) from the Pennsylvania Cancer Registry , comprised of breast , prostate , and colon cancer patients , completed mail surveys  in the fall of 2006 ( overall response rate=64 % ) . Of 2013 baseline respondents , 85 % agreed to participate in follow-up survey ( N=1703 ) . Of those who agreed , 76 % ( N=1293 ) completed follow-up surveys in the fall of 2007 . RESULTS Cancer patients '  Internet use for health information at wave one led them to want to be more active participants in medical decision making at wave two ( β=.06 , p<.05 ) . This applied to all cancer patients regardless of their education levels . CONCLUSION Higher levels of Internet use among cancer patients may lead patients to want to be more actively involved in medical decision making . PRACTICE IMPLICATION S Considering the beneficial effects of patients ' active participation in medical decision making , it will be worthwhile for health educators to recommend Internet use to cancer patients OBJECTIVE We prospect ively examined the psychosocial predictors and the decision-making process regarding contralateral prophylactic mastectomy ( CPM ) among women with sporadic breast cancer . BACKGROUND Increasing numbers of women with breast cancer are seeking CPM . Data are limited about the surgical decision-making process and the psychosocial factors that influence interest in CPM . METHODS Women with early-stage unilateral breast cancer ( n = 117 ) were recruited before their first surgical visit at MD And erson and completed question naires assessing knowledge of and interest in CPM and associated psychosocial factors . After the appointment , women and their surgeons completed questions about the extent that various surgical options ( including CPM ) were discussed ; also , the women rated their perceived likelihood of having CPM and the surgeons rated the appropriateness of CPM . RESULTS Before their first visit , 50 % of women were moderately to extremely interested in  CPM  and 12 ( 10 % ) of women had CPM at the time of their primary breast cancer surgery . Less knowledge about breast cancer ( P = 0.02 ) and greater cancer worry ( P = 0.03 ) predicted interest in CPM .  Greater cancer worry predicted who had CPM ( P = 0.02 ) . Interest in CPM  before surgical visit and the likelihood of having CPM  after the visit differed ( P ≤ 0.001 ) . Surgeons ' rating of the appropriateness of CPM  and the patient 's reported likelihood of having CPM  were not significantly different ( P = 0.49 ) . CONCLUSIONS Interest in CPM  is common among women with sporadic breast cancer . The informational and emotional aspects of CPM may affect the decision to have CPM and should be addressed when discussing surgical options 
    Output:
    
The identified themes for barriers to SDM were uncertainty in the treatment decision , concern regarding adverse effects , and poor physician communication .
Themes for facilitators for SDM included physician consideration of patient preferences , positive physician actions and behaviors , and use or encouragement of support systems .