***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 Men considering the prostate specific antigen ( PSA ) test for prostate cancer , an increasingly common male cancer , are encouraged to make informed decisions , as the test is limited in its accuracy and the natural history of the condition is poorly understood . The Web-based PSA decision aid , Prosdex , was developed as part of the UK Prostate Cancer Risk Management Programme in order to help men make such informed decisions . Objectives The aim of this study was to evaluate the effect of the Web-based PSA decision aid , Prosdex , on informed decision making . Methods A Web-based r and omized controlled trial was conducted in South Wales , United Kingdom . Men aged 50 to 75 who had not previously had a PSA test were r and omly allocated to two intervention and two control groups . Participants in the intervention groups either viewed Prosdex or were given a paper version of the text . The main outcome measures were the three components of informed decision making : ( 1 ) knowledge of prostate cancer and PSA , ( 2 ) attitude toward PSA testing , ( 3 ) behavior using a proxy measure , intention to undergo PSA testing . Decisional conflict and anxiety were also measured as was uptake of the PSA test . Outcomes were measured by means of an online question naire for the Prosdex group , the paper version group , and one of two control groups . Six months later , PSA test uptake was ascertained from general practitioners ’ records , and the online question naire was repeated . Results are reported in terms of the Mann-Whitney U-statistic divided by the product of the two sample sizes ( U/mm ) , line of no effect 0.50 . Results Participants were 514 men . Compared with the control group that completed the initial online question naire , men in the Prosdex group had increased knowledge about the PSA test and prostate cancer ( U/mn 0.70 ; 95 % CI 0.62 - 0.76 ) ; less favourable attitudes to PSA testing ( U/mn 0.39 , 95 % CI 0.31 - 0.47 ) ; were less likely to undergo PSA testing ( U/mn 0.40 , 95 % CI 0.32 - 0.48 ) ; and had less decisional conflict ( U/mn 0.32 , 95 % CI 0.25 - 0.40 ) ; while anxiety level did not differ ( U/mn 0.50 , 95 % CI 0.42 - 0.58 ) . For these outcomes there were no significant differences between men in the Prosdex group and the paper version group . However , in the Prosdex group , increased knowledge was associated with a less favourable attitude toward testing ( Spearman rank correlation [ ρ ] = -0.49 , P < .001 ) and lower intention to undergo testing ( ρ = -0.27 , P = .02 ) . After six months , PSA test uptake was lower in the Prosdex group than in the paper version and the question naire control group ( P = .014 ) . Test uptake was also lower in the control group that did not complete a question naire than in the control group that did , suggesting a possible Hawthorne effect of the question naire in favour of PSA testing . Conclusions Exposure to Prosdex was associated with improved knowledge about the PSA test and prostate cancer . Men who had a high level of knowledge had a less favourable attitude toward and were less likely to undergo PSA testing  . Prosdex appears to promote informed decision making regarding the PSA test . Trial Registration IS RCT N48473735 ; http://www.controlled-trials.com/IS RCT N48473735 ( Archived by WebCite at http://www.webcitation.org/5r1TLQ5nK Background : People with sickle cell disease ( SCD ) or sickle cell trait ( SCT ) may not have information about genetic inheritance needed for making informed reproductive health decisions . CHOICES is a Web-based , multimedia educational intervention that provides information about reproductive options and consequences to help those with SCD or SCT identify and implement an informed parenting plan . Efficacy of CHOICES compared with usual care must be evaluated . Objective : The purpose was to compare immediate posttest effects of CHOICES versus an attention-control usual care intervention ( e-Book ) on SCD-/SCT-related reproductive health knowledge , intention , and behavior . Methods : In a r and omized controlled study , we recruited subjects with SCD/SCT from clinics , community setting s , and online networks with data collected at sites convenient to the 234 subjects with SCD ( n = 136 ) or SCT ( n = 98 ) . Their ages ranged from 18 to 35 years ; 65 % were women , and 94 % were African American . Subjects completed a measure of sickle cell reproductive knowledge , intention , and behavior before and immediately after the intervention . Results : Compared with the e-Book group , the CHOICES group had significantly higher average knowledge scores and probability of reporting a parenting plan to avoid SCD or SCD and SCT when pretest scores were controlled . Effects on intention and planned behavior were not significant . The CHOICES group showed significant change in their intention and planned behavior , whereas the e-Book group did not show significant change in their intention , but their planned behavior differed significantly . Discussion : Initial efficacy findings are encouraging but warrant planned booster sessions and outcome follow-ups to determine sustained intervention efficacy on reproductive health knowledge , intention , and actual behavior of persons with SCD/SCT OBJECTIVE Genetic testing is increasingly part of routine clinical care for women with a family history of breast cancer . Given their substantially elevated risk for breast cancer , BRCA1/BRCA2 mutation carriers must make the difficult decision whether or not to opt for risk reducing mastectomy . To help BRCA1/2 carriers make this decision , the authors developed a computer-based interactive decision aid that was tested against usual care in a r and omized controlled trial . DESIGN After the completion of genetic counseling , 214 female ( aged 21 - 75 ) BRCA1/BRCA2 mutation carriers were r and omized to Usual Care  ( UC ; N = 114 ) or Usual Care plus Decision Aid ( DA ; N = 100 ) arms . UC participants received no additional intervention . DA participants were sent the CD-ROM DA to view at home . MAIN OUTCOME MEASURES The authors measured final management decision , decisional conflict , decisional satisfaction , and receipt of risk reducing mastectomy at 1- , 6- , and 12-months postr and omization . RESULTS Longitudinal analyses revealed that the DA was effective among carriers who were initially undecided about how to manage their breast cancer risk . Within this group , the DA led to an increased likelihood of reaching a management decision ( OR = 3.09 , 95 % CI = 1.62 , 5.90 ; p < .001 ) , decreased decisional conflict ( B = -.46 , z = -3.1 , p < 002 ) , and increased satisfaction ( B = .27 , z = 3.1 , p = .002 ) compared to UC . Among carriers who had already made a management decision by the time of r and omization , the DA had no benefit relative to UC . CONCLUSION These results demonstrate that BRCA1/BRCA2 mutation carriers who are having difficulty making a breast cancer risk management decision can benefit from adjunct decision support OBJECTIVE The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate , vs. usual education alone , on conflict associated with decision making , plus explore time-to-treatment , and treatment choice . METHODS A r and omized , multi-center clinical trial was conducted with measures at baseline , 1- , and 6 months . Men with newly diagnosed localized prostate cancer ( CaP ) who sought consultation at urology , radiation oncology , or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited . Intervention group participants used the Personal Patient Profile-Prostate , a decision support system comprised of customized text and video coaching regarding potential outcomes , influential factors , and communication with care providers . The primary outcome , patient-reported decisional conflict , was evaluated over time using generalized estimating equations to fit generalized linear models . Additional outcomes , time-to-treatment , treatment choice , and program acceptability/usefulness , were explored . RESULTS A total of 494 eligible men were r and omized ( 266 intervention ; 228 control ) . The intervention reduced adjusted decisional conflict over time compared with the control group , for the uncertainty score ( estimate -3.61 ; ( confidence interval , -7.01 , 0.22 ) , and values clarity ( estimate -3.57 ; confidence interval ( -5.85,-1.30 ) . Borderline effect was seen for the total decisional conflict score ( estimate -1.75 ; confidence interval ( -3.61,0.11 ) . Time-to-treatment was comparable between groups , while undecided men in the intervention group chose brachytherapy more often than in the control group . Acceptability and usefulness were highly rated . CONCLUSION The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences Abstract Background Low utilization of effective coronary heart disease ( CHD ) prevention strategies may be due to many factors , but chief among them is the lack of patient involvement in prevention decisions . We undertook this study to test the effectiveness of an individually-tailored , computerized decision aid about CHD on patients ' discussion s with their doctor and their plans for CHD prevention . Methods We conducted a pilot r and omized trial in a convenience sample of adults with no previous history of cardiovascular disease to test the effectiveness of an individually-tailored , computerized decision aid about CHD prevention against a risk factor list that patients could present to their doctor . Results We enrolled 75 adults . Mean age was 53 . 59 % were female , 73 % white , and 23 % African-American . 66 % had some college education . 43 % had a 10-year CHD risk of 0–5 % , 25 % a risk of 6–10 % , 24 % a risk of 11–20 % , and 5 % a risk of > 20 % . 78 % had at least one option to reduce their CHD risk , but only 45 % accurately identified the strategies best supported by evidence . 41 patients received the decision aid  , 34 received  usual care . In unadjusted analysis , the decision aid increased the proportion of patients who discussed CHD risk reduction with their doctor from 24 % to 40 % ( absolute difference 16 % ; 95 % CI -4 % to + 37 % ) and increased the proportion who had a specific plan to reduce their risk from 24 % to 37 % ( absolute difference 13 % ; 95 % CI -7 % to + 34 % ) . In pre-post testing , the decision aid also appeared to increase the proportion of patients with plans to intervene on their CHD risk ( absolute increase ranging from 21 % to 47 % for planned medication use and 5 % to 16 % for planned behavioral interventions ) . Conclusion Our study confirms patients ' limited knowledge about their CHD risk and effective risk reduction options and provides preliminary evidence that an individually-tailored decision aid about CHD prevention might be expected to increase patients ' discussion s about CHD prevention with their doctor and their plans for CHD risk reduction . These findings should be replicated in studies with a larger sample size and patients at overall higher risk of CHD . Trial Registration : Clinical Trials.gov OBJECTIVE Knowledge relevant to women 's peri- and postmenopausal health decisions has been evolving rapidly . Web-based decision supports can be rapidly up date d and have the potential to improve the quality of patients ' decisions . We developed and tested a web-based decision support for peri- and postmenopausal health decisionmaking . METHODS We recruited 409 women aged 45 - 75 for one r and omized , controlled trial and 54 women with an upcoming clinic appointment for a subsequent trial . Women were r and omized to use the web-based decision support versus a printed brochure ( first trial ) and usual care ( second trial ) . Outcomes were changes in decisional satisfaction , decisional conflict , and knowledge , both within each trial and compared across the trials . RESULTS Intervention subjects had greater increases in decisional satisfaction in the second trial and knowledge in both trials . A high dropout rate among women r and omized to the website in the first trial effectively negated benefits in that trial , but not in the second . CONCLUSIONS The utility of this web-based decision support in two trials depended on a number of factors that appear related to the urgency of making a decision . PRACTICE IMPLICATION S Decision aids should be targeted to patients actively trying to make a decision OBJECTIVE To examine the effect of patient narratives that discuss decision processes versus patient experiences on decisions about treatments for early stage breast cancer . METHODS We recruited 300 women with no previous history of breast cancer to imagine that they had been diagnosed with early stage breast cancer and to choose between mastectomy and lumpectomy with radiation .  Before learning about their treatment options , participants were r and omly assigned to one of four conditions with videotaped stories from fictitious cancer survivors , using a 2 ( content : experience versus process ) × 2 ( emotional valence : positive only vs. positive and negative ) factorial design , or a control condition with no stories . We measured information search , treatment intentions , and decision satisfaction . RESULTS Participants viewing process narratives spent more time search ing for information . Participants viewing experience narratives reported a greater ability to imagine what it was like to experience the treatments ; they also evaluated their decision more positively on several dimensions . CONCLUSIONS Process narratives appeared to guide information search , and experience narratives improved evaluations of the decision process . PRACTICE IMPLICATION S There is no evidence that process and experience narratives ' bias ' decisions in the same manner as outcome narratives . Further , their potential to focus patient attention on key information and increase patient confidence in decision making appears significant In patients 
    Output:
    
As expected , computer-based decision aids performed better than usual care or alternative aids ; however , some features performed better than others .
Conclusions Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making .
The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids , in an effort to facilitate reporting of these features and to promote integration of such features into decision aids .
The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids .