***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 this study was conducted to evaluate the feasibility and acceptability of a managed-care approach ( group visits ) on delivering care to uninsured or inadequately insured patients with type 2 diabetes . METHODS One hundred twenty patients with uncontrolled type 2 diabetes were r and omly assigned to receive care in group visits or usual care for 6 months . At baseline , 3 months , and 6 months , the feasibility and acceptability of this model of healthcare delivery were assessed through the patients ' responses to the Primary Care Assessment Tool and the Trust in Physician Scale . Attendance records were kept for each group . RESULTS Patients who received care in group visits showed an improved sense of trust in their physician compared with patients who continued to receive usual care . There was a tendency for patients in groups to report better coordination of their care , better community orientation , and more culturally competent care . Patient attendance at the groups also indicated good acceptance of this form of healthcare delivery . CONCLUSIONS Group visits were feasible and acceptable to these uninsured and inadequately insured patients with uncontrolled type 2 diabetes and fostered an improved sense of trust in their physician PURPOSE The purpose of the study was to evaluate perceptions of care delivered through group visits to disadvantaged patients with type 2 diabetes . METHODS One hundred eighty-six patients with uncontrolled type 2 diabetes were r and omly assigned to receive care in group visits or usual care for 12 months . Their perceptions of the care they received were measured at baseline and 6 and 12 months by the  Primary Care Assessment Tool ( PCAT ) , the Diabetes-Specific Locus of Control ( DLC ) survey , and the Trust in Physician Scale ( TPS ) .  RESULTS Compared to patients in usual care , group visit patients ' PCAT scores were higher in the domains of ongoing care ( P = .001 ) , community orientation ( P < .0001 ) , and cultural competence ( P = .022 ) . In addition , group patients had higher scores for the Powerful-Other Health Professional subscale of the DLC survey ( P = .010 ) . CONCLUSIONS Patients assigned to group visits had generally more positive perceptions about their care in the areas of ongoing care , community orientation of care , and cultural competence of care than did those in usual care . The perception that one 's health professional is powerful , however , has been associated with a reluctance of patients to make medication changes on their own in previous studies . These findings suggest the need for modification in the way that group visits are conducted to empower and activate patients while still delivering continuous , culturally competent , and community-oriented care 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 OBJECTIVE Assess use of and reactions to an interactive , tailored CD-ROM to enhance  oncologist-patient communication . METHODS Participating oncologists ( n=48 ) agreed to have patient interactions audio recorded , be r and omly assigned to receive/not receive a CD-ROM  , have CD-ROM usage monitored ( intervention group ) and complete a follow-up survey . RESULTS Twenty-one of 24 in the intervention group reported using the CD-ROM . Median usage minutes were 63.8 . At follow-up , oncologists rated the CD-ROM from 1 ( " none " or " not at all helpful " ) to 5 ( " a great deal " or " very helpful " ) . Mean responses were : 3.1 and 3.0 for 2 items assessing perceived impact on communications , 3.8 - 4.0 for 6 items assessing perceived helpfulness , 3.0 and 3.10 for 2 items assessing impact on affecting oncologists ' communication with patients and assistance with challenging conversations , respectively , and 3.6 for whether using the CD-ROM was worth their time . Self-report of how much oncologists had used the covered skills before and after intervention showed a perceived increase ( 2.8 before and 3.2 after ) . CONCLUSIONS Findings suggest the tailored interactive CD-ROM has promise for use and acceptance among oncologists . PRACTICE IMPLICATION S If ultimately found effective in changing oncologist 's communication with patients , the CD-ROM 's widespread dissemination should be explored Abstract BACKGROUND : Disclosure of medical errors is encouraged , but research on how patients respond to specific practice s is limited . OBJECTIVE : This study sought to determine whether full disclosure , an existing positive physician-patient relationship , an offer to waive associated costs , and the severity of the clinical outcome influenced patients ’ responses to medical errors . PARTICIPANTS : Four hundred and seven health plan members participated in a r and omized experiment in which they viewed video depictions of medical error and disclosure . DESIGN : Subjects were r and omly assigned to experimental condition . Conditions varied in type of medication error , level of disclosure , reference to a prior positive physician-patient relationship , an offer to waive costs , and clinical outcome . MEASURES : Self-reported likelihood of changing physicians and of seeking legal advice ; satisfaction , trust , and emotional response . RESULTS : Nondisclosure increased the likelihood of changing physicians , and reduced satisfaction and trust in both error conditions . Nondisclosure increased the likelihood of seeking legal advice and was associated with a more negative emotional response in the missed allergy error condition , but did not have a statistically significant impact on seeking legal advice or emotional response in the monitoring error condition . Neither the existence of a positive relationship nor an offer to waive costs had a statistically significant impact . CONCLUSIONS : This study provides evidence that full disclosure is likely to have a positive effect or no effect on how patients respond to medical errors . The clinical outcome also influences patients ’ responses . The impact of an existing positive physician-patient relationship , or of waiving costs associated with the error remains uncertain BACKGROUND Concern regarding financial conflict of interest for physicians has led to calls for disclosure of financial incentives to patients . However , limited data on the outcomes of disclosure exist to guide policy . METHODS This r and omized trial was conducted among 8000 adult patients at 2 multispecialty group practice s based in the Boston , Mass , and Los Angeles , Calif , areas . Intervention patients were mailed a compensation disclosure letter written by the chief medical officer of their physician group , and all patients were surveyed approximately 3 months later . RESULTS Disclosure patients were significantly more able to identify correctly the compensation model of their primary care physician , in Boston ( adjusted odds ratio , 2.30 ; 95 % confidence interval , 1.92 - 2.75 ) and in Los Angeles ( adjusted odds ratio , 1.37 ; 95 % confidence interval , 1.03 - 1.82 ) . Disclosure patients also had more confidence in their ability to judge the possible influence of incentives on their health care : in Boston , 32.5 % vs 17.8 % ( P<.001 ) ; and in Los Angeles , 31.8 % vs 26.4 % ( P = .20 ) . The disclosure intervention did not change trust in primary care physicians overall . However , of patients who remembered receiving the disclosure , 21.4 % in Boston and 24.4 % in Los Angeles responded that the disclosure had increased trust either greatly or somewhat , while in both cities less than 5 % of patients responded that the information decreased trust . Patients ' loyalty to their physician group was higher among disclosure patients in Boston ( 73.4 % vs 70.2 % ; P = .03 ) and Los Angeles ( 74.1 % vs 66.9 % ; P = .08 ) . CONCLUSIONS Among diverse patient population s , a single mailed disclosure letter from physician groups was associated with improved knowledge of physicians ' compensation models . Patients ' trust in their physicians was unharmed , and their loyalty to their physician group was strengthened . For physician groups with similar compensation programs , disclosure to patients should be considered an effective method to enhance the patient-physician relationship BACKGROUND Many physicians receive financial incentives to limit their ordering of expensive tests and procedures . While Medicare m and ates disclosure of incentives , it is not clear how to inform patients without undermining trust . METHODS Our objective was to determine public opinion about physician  disclosure of financial incentives and how this might be best communicated to patients . The 2002 General Social Survey included 2765 interviews from a probability sample of English-speaking US households . The interview included questions about financial incentives and an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance image . Respondents heard 1 of 6 r and omly selected disclosure strategies . The measurements included ratings of trust , satisfaction , agreement with the physician 's decision , and likelihood of remaining with the physician/health plan or seeking a second opinion . RESULTS Nearly half ( 48.8 % ) of respondents had previously heard of financial incentives to limit test ordering . Of the respondents , 94.8 % wanted to be told about incentives , at the time of enrollment in a health plan ( 80.5 % ) , by a health plan representative ( 44.8 % ) , their physician ( 17.1 % ) , or both ( 38.1 % ) . Of the 6 different disclosure strategies , " addressing emotions " and " negotiation " were associated with the best outcomes , while " common enemy " and " denying influences " were most negatively perceived . Black and Hispanic subjects were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion . CONCLUSIONS The public wants information about physician financial incentives . Specific communication styles enhance how this information is conveyed to patients , increasing trust and supporting the physician-patient relationship OBJECTIVE To assess the impact of patient-centered communication ( PCC ) behaviors on patients '  evaluations of physicians and acceptance of clinical recommendations . METHODS We r and omized 248 patients to view video-recorded , st and ardized vignettes , depicting a  cardiologist  using a high vs. low degree of PCC while recommending bypass surgery to a patient with angina and 3-vessel coronary artery disease . We compared patients ' ratings of the physician and their decision making in response to the physician 's recommendation , for high vs. low PCC vignettes . RESULTS Patients viewing high PCC vignettes rated the video physician more favorably overall ( 3.01 vs. 2.12 , p<0.001 ) and as more competent ( 3.22 vs. 2.66 , p<0.001 ) and trustworthy ( 2.93 vs. 2.28 , p<0.001 ) than those viewing the low PCC version ( 0 - 4 range for all scales ) . Patients viewing the high PCC version more frequently said they would undergo bypass surgery ( 96 % vs. 74 % , p<0.001 ) if they were the patient in the video . CONCLUSION Patients expressed greater confidence in physicians who used more  PCC behaviors , and greater willingness to accept an evidence -based recommendation . PRACTICE IMPLICATION S PCC may make physicians more effective in the delivery of evidence -based care Existing scales to measure  trust in physicians  have differing content and limited testing . To improve on these measures , a large item pool ( n = 78 ) was generated following a detailed conceptual model and expert review . After pilot testing , the best-performing items were vali date d with a r and om national sample ( n = 9 ) and a regional sample of HMO members ( n = 99 ) . Various psychometric tests produced a 10-item unidimensional scale consistent with most aspects of the conceptual model . Compared with previous scales , the Wake Forest physician trust scale has a somewhat improved combination of internal consistency , variability , and discriminability . The scale is more strongly correlated with satisfaction , desire to remain with a physician , willingness to recommend to friends , and not seeking second opinions ; it is less correlated with insurer trust , membership in managed 
    Output:
    
Overall , there remains insufficient evidence to conclude that any intervention may increase or decrease trust in doctors .
This may be due in part to the sensitivity of trust instruments , and a ceiling effect , as trust in doctors is generally high .