***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: Abstrac Objective : To test the effect of extra non-directive information about prenatal testing , given individually or in a class . Setting : Antenatal clinics in a district general hospital and a university hospital . Design : R and omised controlled trial ; participants allocated to control group or offer of extra information individually or in class . Subjects : 1691 women booking antenatal care before 15 weeks ' gestation . Interventions : All participants received the usual information about prenatal tests from hospital staff . Individual participants were offered a separate session with a research midwife in which prenatal screening was described in detail . Class participants were offered the same extra information in an early prenatal class . Main outcome measures : Attendance at extra information sessions ; uptake rates of prenatal tests ; levels of anxiety , underst and ing , and satisfaction with decisions . Results : Attendance at classes was lower than at individual sessions ( adjusted odds ratio 0.45 ; 95 % confidence interval 0.35 to 0.58 ) .  Ultrasonography  was almost universally accepted ( 99 % ) and was not affected by either intervention . Uptake of cystic fibrosis testing , high in controls ( 79 % ) , was lowered in the individual group ( 0.44 ; 0.20 to 0.97 ) and classes ( 0.39 ; 0.18 to 0.86 ) . Uptake of screening for Down 's syndrome , already low ( 34 % ) in controls , was not further depressed by extra information in classes ( 0.99 ; 0.70 to 1.39 ) and was slightly higher in the individual group ( 1.45 ; 1.04 to 2.02 ) . Women offered extra information had improved underst and ing and were more satisfied with information received ; satisfaction with decisions about prenatal testing was unchanged . The offer of individual information reduced anxiety later in pregnancy . Conclusions : Ultrasonography is valued for non-medical reasons and chosen even by fully informed people who eschew prenatal diagnosis . The offer of extra information has no overall adverse effects on anxiety and reduces uptake of blood tests when background uptake rate is high ( but not when it is already low ) . High uptake of prenatal blood tests suggests compliant behaviour and need for more information The purpose of this study was to determine if providing men with information about screening for prostate cancer would enable them to assume a more active role in decision making with their family physician , and lower levels of anxiety and decisional conflict .  Men were recruited from one family medical clinic in Winnipeg , Manitoba . One hundred men scheduled for a periodic health examination ( PHE ) were r and omly assigned to receive verbal and written information either prior to the PHE , or following the second interview . Men completed measures of preferred decisional role and anxiety prior to the PHE ; and assumed decisional role , decisional conflict , and anxiety post PHE . Results demonstrated that men who received the information prior to the PHE assumed a significantly more active role in making a screening decision , and had lower levels of decisional conflict post PHE . The two groups did not differ with regard to levels of state anxiety . Providing men with information enables them to make informed screening decisions with their family physicians Patient satisfaction measures have previously addressed satisfaction with medical care , satisfaction with providers , and satisfaction with outcomes , but not satisfaction with the health care decision itself . As patients become more involved in health care decisions , it is important to underst and specific dynamics of the decision itself The  Satisfaction with Decision ( SWD ) scale  measures satisfaction with health care decisions . It was developed in the context of postmenopausal hormone-replacement therapy decisions The six-item scale has excellent reliability ( Cronbach 's alpha = 0.86 ) . Discriminant validity , tested by performing principal- components analysis of items pooled from the SWD scale and two conceptually related measures , was good . Correlation of the  SWD scale  with measures of satisfaction with other aspects of the decision-making process showed the  SWD scale  was correlated most highly ( 0.64 ) with " decisional confidence , " and least with " desire to participate in health care de cisions " and " satisfaction with provider " The  SWD  scale predicts decision certainty in this study . Use in an independent study showed that the  SWD scale  was correlated with the likelihood of patients ' intentions to get a flu shot . Further investigation in relation to other health decisions will establish the utility of the  SWD scale  as an outcome measure Key words : patient satisfaction ; medical decision making ; decision support ( Med Decis Making 1996;16:58 - 64 A r and omised-controlled trial compared outcomes for women recently diagnosed with breast cancer who either received support and information from a multidisciplinary team or used a shared decision-making programme on an interactive video disk ( IVD ) system .  Using the IVD did not have a significant effect on the decisions women made about treatment , yet it was evaluated positively by those who used it . The results suggest that the role of clinical staff is more significant than the form of information provided . Potential benefits for the IVD were apparent such as st and ardising the information received by patients , promoting evidence -based practice and providing a measure for quality assurance Abstract Objective : To determine whether a decision aid on benign prostatic hypertrophy influences decision making , health outcomes , and re source use . Design : R and omised controlled trial . Setting : 33 general practice s in the United Kingdom . Participants : 112 men with benign prostatic hypertrophy . Intervention : Patients ' decision aid consisting of an interactive multimedia programme with booklet and printed summary . Outcome measures : Patients ' and general practitioners ' perceptions of who made the decision , decisional conflict scores , treatment choice and prostatectomy rate , American Urological Association symptom scale , costs , anxiety , utility , and general health status . Results : Both patients and general practitioners found the decision aid acceptable . A higher proportion of patients ( 32 % v 4 % ; mean difference 28 % , 95 % confidence interval 14 % to 41 % ) and their general practitioners ( 46 % v 25 % ; 21 % , 3 % to 40 % ) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group . Patients in the intervention group had significantly lower decisional conflict scores than those in the control group at three months ( 2.3 v 2.6 ; −0.3 , −0.5 to −0.1 , P<0.01 ) and this was maintained at nine months . No differences were found between the groups for anxiety , general health status , prostatic symptoms , utility , or costs ( excluding costs associated with the video disc equipment ) . Conclusions : The decision aid reduced decisional conflict in men with benign prostatic hypertrophy , and the patients played a more active part in decision making . Such programmes could be delivered cheaply by the internet , and there are good arguments for coordinated investment in them , particularly for conditions in which patient utilities are important . What is already known on this topic Patients want more information about their condition and treatment options , and many want to play an active part in decision making Decision aids improve patients ' knowledge of their conditions and treatment options What this study adds The decision aid was highly acceptable to both the patients and their general practitioners Decisional conflict was reduced in the intervention group Patients who viewed the programme played a more active part in the decision making process and were less anxious than control patients Such aids could be introduced throughout the NHS at relatively low cost by using the Abstract Objective : To determine whether a decision aid on hormone replacement therapy influences decision making and health outcomes . Design : R and omised controlled trial . Setting : 26 general practice s in the United Kingdom . Participants : 205 women considering hormone replacement therapy .  Intervention : Patients ' decision aid consisting of an interactive multimedia programme with booklet and printed summary . Outcome measures : Patients ' and general practitioners ' perceptions of who made the decision , decisional conflict , treatment choice , menopausal symptoms , costs , anxiety , and general health status . Results : Both patients and general practitioners found the decision aid acceptable . At three months , mean scores for decisional conflict were significantly lower in the intervention group than in the control group ( 2.5 v 2.8 ; mean difference −0.3 , 95 % confidence interval −0.5 to −0.2 ) ; this difference was maintained during follow up . A higher proportion of general practitioners perceived that treatment decisions had been made “ mainly or only ” by the patient in the intervention group than in the control group ( 55 % v 31 % ; 24 % , 8 % to 40 % ) . At three months a lower proportion of women in the intervention group than in the control group were undecided about treatment ( 14 % v 26 % ; −12 % , −23 % to −0.4 % ) , and a higher proportion had decided against hormone replacement therapy  ( 46 % v 32 % ; 14 % , 1 % to 28 % ) ; these differences were no longer apparent by nine months . No differences were found between the groups for anxiety , use of health service re sources , general health status , or utility . The higher costs of the intervention were largely due to the video disc technology used . Conclusions : An interactive multimedia decision aid in the NHS would be popular with patients , reduce decisional conflict , and let patients play a more active part in decision making without increasing anxiety . The use of web based technology would reduce the cost of the intervention . What is already known on this topic Patients want more information about their conditions and treatment options , and many want to play an active part in decision making Decision aids improve patients ' knowledge of their conditions and treatment options What this study adds The decision aid was acceptable to both the patients and their general practitioners Decisional conflict was reduced in the intervention group Patients who viewed the programme played a more active part in the decision making process and were no more anxious than control patients Such aids could be introduced throughout the NHS at relatively low cost by using the Decision aids help patients make treatment choices . There is little empirical evidence to explain how they work . The results from this r and omised controlled trial comparing routine with decision-aided consultations in the prenatal diagnosis for Down 's syndrome context are used to describe the strategies employed during decision making , to assess the impact of a decision aid on decision processes , and to investigate decision process and outcome associations . Data were elicited from two content analyses of consultation transcripts and question naires assessing knowledge , anxiety , decisional conflict , reasons , and information usefulness .  68/106 women completed measures at consultation and follow-up . Decision-aided women employed more cognitive and emotional strategies during decision making . More negative evaluations during decision making were associated with better outcomes . Decision-aided consultations facilitated the employment of strategies associated with more effective choices . These consultations take longer and elicit greater expressions of negative affect , so may be less rewarding encounters for health professionals A decision aid for the surgical treatment of early breast cancer was evaluated in a r and omized controlled trial . The decision aid , a tape and workbook , includes explicit presentation of probabilities , photographs and graphics , and a values clarification exercise . Community surgeons were r and omized to use the decision aid or a control pamphlet .  Patients completed a question naire prior to using the decision aid , after review ing it but prior to surgery , and 6 months after enrollment . There was no difference in anxiety , knowledge , or decisional regret across the 2 groups . There was a nonsignificant trend toward lower decisional conflict in the decision aid group . A subgroup of women who were initially leaning toward mastectomy or were unsure had lower decisional conflict . Although the decision aid had minimal impact on the main study outcomes , a subgroup may have benefited . Such subgroups should be identified , and appropriate decision support interventions should be developed and evaluated The purpose of this study was to explore the hypothesis that assisting men with prostate cancer to obtain information would enable them to assume a more active role in treatment decision making and decrease their levels of anxiety and depression .  Respondents were recruited from one community urology clinic in Winnipeg , Manitoba . Sixty newly diagnosed men were r and omly assigned to receive either a self-efficacy information intervention that consisted of a written information package with discussion , a list of questions they could ask their physician , and an audiotape of the medical consultation ( n = 30 ) , or a written information package alone ( n = 30 ) . Men completed measures of preferred decisional role as the pretest ; anxiety and depression before the intervention , and at 6 weeks post-intervention ; and assumed decisional role at 6 weeks post-intervention . Results demonstrated that men in the intervention group assumed a significantly more active role in treatment decision making , and had lower state anxiety levels at 6 weeks . Levels of depression were similar for both groups at 6 weeks . This group of older men do want to be informed and participate in medical decisions . Further efforts are required to evaluate the efficacy of such an intervention in other community urology clinics 
    Output:
    
Some patterns emerged between level of anxiety and characteristics of the decision .
As raised levels of anxiety are associated with both more effective decision strategies and stressful health interventions , anxiety is an inappropriate measure to employ when evaluating decision aids .