***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 To assess whether presentation approaches design ed to be more meaningful result in greater weighting of quality information in decisions . An emerging body of research indicates that the way information is presented affects how it is interpreted and how it is weighted in decisions . Comparative health plan performance reports are not being used by consumers possibly because the information presented is difficult to use . The next generation of these reports should be design ed to support decision making . DESIGN AND STUDY PARTICIPANTS The study uses a controlled experimental design . Participants ( n = 162 ) were r and omly assigned to different conditions and asked to complete tasks related to using quality information and making health plan selection s. Dependent variables included the amount of weight given to quality information in choices and decision accuracy . RESULTS Some presentation approaches make it easier for users to process and integrate quality data into their choices . However , other presentation formats influence consumers '  decisions in ways that undermine their self-interest . CONCLUSIONS Findings indicate that presenting quality data in a more evaluable format increases the weight it carries in consumer decisions . Every change made in the presentation of comparative data has the potential to influence decisions . Those who disseminate information have a responsibility to be aware of how they use that influence and to direct it in productive and defensible ways . The alternative is to manipulate people in ways that are unknown , are not thought out , or are not defensible , but are no less manipulative Objective : To determine whether the use of verbal descriptors suggested by the European Union ( EU ) such as “ common ” ( 1–10 % frequency ) and “ rare ” ( 0.01–0.1 % ) effectively conveys the level of risk of side effects to people taking a medicine . Design : R and omised controlled study with unconcealed allocation . Participants : 120 adults taking simvastatin or atorvastatin after cardiac surgery or myocardial infa rct ion . Setting : Cardiac rehabilitation clinics at two hospitals in Leeds , UK . Intervention : A written statement about one of the side effects of the medicine ( either constipation or pancreatitis ) . Within each side effect condition half the patients were given the information in verbal form and half in numerical form ( for constipation , “ common ” or 2.5 % ; for pancreatitis , “ rare ” or 0.04 % ) . Main outcome measure : The estimated likelihood of the side effect occurring . Other outcome measures related to the perceived severity of the side effect , its risk to health , and its effect on decisions about whether to take the medicine . Results : The mean likelihood estimate given for the constipation side effect was 34.2 % in the verbal group and 8.1 % in the numerical group ; for pancreatitis it was 18 % in the verbal group and 2.1 % in the numerical group . The verbal descriptors were associated with more negative perceptions of the medicine than their equivalent numerical descriptors . Conclusions : Patients want and need underst and able information about medicines and their risks and benefits . This is essential if they are to become partners in medicine taking . The use of verbal descriptors to improve the level of information about side effect risk leads to overestimation of the level of harm and may lead patients to make inappropriate decisions about whether or not they take the medicine Abstract Objective : To examine the effect of the method of data display on physician investigators ' decisions to stop hypothetical clinical trials for an unplanned statistical analysis . Design : Prospect i ve , mixed model design with variables between subjects and within subjects ( repeated measures ) . Setting : Comprehensive cancer centre . Participants : 34 physicians , stratified by academic rank , who were conducting clinical trials . Interventions : Participants were shown tables , pie charts , bar graphs , and icon displays containing hypothetical data from a clinical trial and were asked to decide whether to continue the trial or stop for an unplanned statistical analysis . Main outcome measure : Percentage of accurate decisions with each type of display . Results : Accuracy of decisions was affected by the type of data display and positive or negative framing of the data . More correct decisions were made with icon displays than with tables , pie charts , and bar graphs ( 82 % v 68 % , 56 % , and 43 % , respectively ; P=0.03 ) and when data were negatively framed rather than positively framed in tables ( 93 % v 47 % ; P=0.004 ) . Conclusions : Clinical investigators ' decisions can be affected by factors unrelated to the actual data . In the design of clinical trials information systems , careful consideration should be given to the method by which data are framed and displayed in order to reduce the impact of these extraneous factors Patients frequently overestimate the benefit of st and ard breast cancer adjuvant therapy . This is due in part to vague doctor-patient communication . To examine how the doctor 's description and patient 's expectations of the benefit of st and ard therapy affect clinical trial participation , we r and omized 282 female cancer patients to one of two versions of a clinical vignette describing a choice between st and ard cyclophosphamide , methotrexate , and fluorouracil ( 5FU ) ( CMF ) and a r and omized trial comparing CMF with cyclophosphamide , doxorubicin , and 5FU ( CAF ) . The vignettes differed only on whether results with CMF were described verbally or numerically in terms of disease-free survival ( DFS ) . After selecting CMF or the trial , patients estimated their 10-year DFS with CMF . Patients were r and omized 3:1 to the verbal vignette . The trial was selected by 110 of 210 ( 52.4 % ) verbal vignette patients versus 25 of 72 ( 34.7 % ) numeric vignette patients ( P = .01 ) . Estimates of 10-year DFS with  CMF  varied considerably ; many were inaccurate . When patients in the verbal vignette group were divided into thirds according to DFS estimate , 22 of 64 ( 34.4 % ) in the top third selected the trial versus 38 of 64 ( 59.4 % ) and 38 of 65 ( 58.5 % ) in the middle and bottom third , respectively ( P = .005 ) . Younger age , college education , and previous participation in a trial also predicted trial selection . Multivariate logistic regression suggested that the benefit expected from CMF was more important than how benefit was described in treatment selection . Assuring realistic patient expectations of st and ard adjuvant therapy benefit is likely to be important during discussion of clinical trials OBJECTIVE To assess how the manner of presentation of graphic data to older patients influences their treatment preferences . DESIGN Cross-sectional structured interviews with patients . SETTING A university-based Department of Veterans Affairs Medical Center . PATIENTS One hundred sixty-six consecutive patients ( mean age = 64.8 years , range of ages 29 - 82 ) seen in a Department of Veterans Affairs general medicine clinic . MEASUREMENTS Five pairs of  5-year survival curves  were presented to patients . Each pair was composed of two survival curves for alternative unidentified treatments for an unidentified medical condition . Curve A ( LT = better long-term , worse short-term survival ) was fixed throughout all curve pairs . Curve B ( ST = better short-term , worse long-term survival ) changed in each curve pair , showing incrementally better chances of short-term survival across the five curve pairs . Patients were r and omly assigned to view the curve pairs in forward ( increasing short-term survival ) or backward ( decreasing short-term survival ) order . RESULTS Order is a significant predictor of patients ' initial preferences for the short-term survival curve ( P = 0.0004 ) as well as their willingness to shift preferences during presentation of the five curve pairs . Patients > or = 65 were more likely to initially choose the ST curve in forward order presentation than patients < 65 . More educated patients generally were less likely to prefer the ST curve under both elicitation orders . CONCLUSIONS The data indicate that the method of eliciting patients ' preferences strongly influenced their expressed preferences , and that these preferences may have predictable relationships with demographic characteristics such as age Abstract BACKGROUND : Patients often face medical decisions that involve outcomes that occur and change over time . Survival curves are a promising communication tool for patient decision support because they present information about the probability of an outcome over time in a simple graphic format . However , previous studies of survival curves did not measure comprehension , used face-to-face explanations , and focused on a VA population . METHODS : In this study , 246 individuals awaiting jury duty at the Philadelphia County Courthouse were r and omized to receive one of two question naires . The control group received a question naire describing two hypothetical treatments and a graph with two survival curves showing the outcomes of each treatment . The practice group received the same question naire preceded by a practice exercise asking questions about a graph containing a single curve . Subjects ’ ability to interpret survival from a curve and ability to calculate change in survival over time were measured . RESULTS : Underst and ing of survival at a single point in time from a graph containing two survival curves was high overall , and was improved by the use of a single curve practice exercise . With a practice exercise , subjects were over 80 % accurate in interpreting survival at a single point in time . Underst and ing of changes in survival over time was lower overall , and was not improved by the use of a practice exercise . With or without a practice exercise , subjects were only 55 % accurate in calculating changes in survival . CONCLUSION : The majority of the general public can interpret survival at a point in time from self-administered survival curves . This underst and ing is improved by a single curve practice exercise . However , a significant proportion of the general public can not calculate change in survival over time . Further research is necessary to determine the effectiveness of survival curves in improving risk communication and patient decision making Purpose . To compare relative accuracy and relative response times ( RTs ) as well as impact of foreground and background colors in a treatment decision context of judging larger/smaller when the following elements are added to the graphics studied previously : 1 ) a number ( the displayed percentage ) , 2 ) a referent scale , and 3 ) a number and a referent scale . Method . An experiment compared pie charts , vertical bars , horizontal bars , digits , systematic ovals , and r and om ovals . On each trial , participants saw 2 percentages ( in 1 format ) and were asked to choose the larger chance of survival or the smaller chance of side effects . Outcomes were errors and RT . Formats were either black and white or blue and yellow ; background color was either white or blue . Participants were 216 volunteers from the community older than 50 years . Results . Formats with a number produced the same relative errors and relative RT as the formats with a number and scale . Formats with only a scale , however , shifted relative performance : Errors increased with more difficult formats ( pie charts and r and om ovals by 3%-4 % v. ∼1 % with other formats ) , but RT decreased with easier formats ( vertical bars , horizontal bars , and systematic ovals decreased 100 - 200 ms v. an increase of 0 - 300 ms with other formats ) . Vertical bars with scales were the fastest and most accurately processed . Neither foreground nor background color had any impact on either outcome . Conclusions . For supporting older people ’s judgments of relative extent , risk information is best presented using vertical bars with a scale ; the format systematic ovals with a scale are among the next most easily processed OBJECTIVE Web-based patient information is widespread and information on the benefits and risks of treatments is often difficult to underst and . We therefore evaluated different risk presentation formats - numerical , graphical and others - addressing the pros and cons of tight control versus usual treatment approaches for diabetes . METHOD DESIGN R and omised controlled trial . SETTING Online . Publicity disseminated via Diabetes UK . PARTICIPANTS People with diabetes or their carers . INTERVENTIONS Control group information based on British Medical Journal ' Best Treatments ' . Four intervention groups received enhanced information re sources : ( 1 ) detailed numerical information ( absolute/relative risk , numbers-needed-to-treat ) ; ( 2 ) ' anchoring ' to familiar risks or descriptions ; ( 3 ) graphical ( bar charts , thermometer scales , crowd figure formats ) ; ( 4 ) combination of 1 - 3 .  OUTCOMES Decision conflict scale ( DCS , a measure of uncertainty ) ; satisfaction with information ; further free text responses for qualitative content analysis . RESULTS Seven hundred and ten people visited the website and were r and omised . Five hundred and eight completed the question naire for quantitative data . Mean DCS scores ranged from 2.12 to 2.24 for the five r and omisation groups , indicating neither clear delay or vacillation about decisions ( usually DCS>2.5 ) nor tending to make decisions ( usually DCS<2.0 ) . There were no statistically significant effects of the interventions on DCS , or satisfaction with information .  Two hundred and fifty-six participants provided responses for qualitative analysis : most found graphical representations helpful , specifically bar chart formats ; many found other graphic formats ( thermometer style , crowd figures/smiley faces ) and ' anchoring ' information unhelpful , and indicated information overload . Many negative experiences with healthcare indicate a challenging context for effective information provision and decision support . CONCLUSION Online evaluation of different risk representation formats was feasible . There was a lack of intervention effects on quantitative outcomes , perhaps reflecting already well-informed participants from the Diabetes UK patient organisation . The large qualitative data set included many comments about what participants found helpful as formats for communicating risk information . PRACTICE IMPLICATION S These findings assist the design of online decision aids and the representation of risk information . The challenge is to provide more information , in appropriate and clear formats , but without risking information overload . Interactive web design s hold much promise to achieve this OBJECTIVES Health service managers and other decision-makers are required to act on the basis of data . Little attention has been paid to the effects of data presentation on the decisions taken . This study uses a r and omized controlled trial design to investigate the effects of two forms of data presentation -- league tables and control charts -- on health service decision-makers . METHODS Directors of public health in 122 health authorities in the UK were mailed three case studies and a question naire . The case studies showed data on variations in mortality by health service provider . The question naire asked 
    Output:
    
As regards format , tables and pictographs appeared better understood than bar charts despite the latter being preferred .
Although accessible to less numerate and older population s , pictographs tended to lead to more risk avoidance .
Tables appeared accessible to all .
Aspects of content enhancing the impact of data displays included giving visual explanatory cues and context ual information while still attempting simplicity ( ' less is more ' ) ; ordering data ; consistency .
Icons rather than numbers were more user-friendly but could lead to over-estimation of risk .
Uncertainty was not widely understood , nor well represented .
Though heterogeneous and limited in scope , there is sufficient research evidence to inform the presentation of quantitative data that compares the performance of healthcare providers .