***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 
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    Input: There is an ever-growing trend toward more patient involvement in making health care decisions . This trend has been accompanied by the development of “ informed decision-making ” interventions to help patients become more engaged and comfortable with making these decisions . We describe the effects of a prostate cancer screening decision aid on knowledge , beliefs about screening , risk perception , control preferences , decisional conflict , and decisional anxiety . Data were collected from 200 males aged 50–70 years in the general population who r and omly were assigned to exposure to the decision aid or no exposure as a control condition .  A Solomon four-group design was used to test for possible pretest sensitization effects and to assess the effects of exposure to the decision aid . No significant pretest sensitization effects were found . Analysis of the exposure effects found that knowledge increased significantly for those exposed to the decision aid compared with those unexposed . Exposure to the decision aid also had some influence on decreasing both decisional conflict and decisional anxiety . Decision aids can play an important role in increasing patients ' knowledge and decreasing anxiety when asked to make health care decisions 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 Most women use some method of pain relief during labour . There is extensive research evidence available of pharmacological pain relief during labour ; however this evidence is not readily available to pregnant women . Decision aids are tools that present evidence based information and allow preference elicitation . Methods We developed a labour analgesia decision aid . Using a RCT design women either received a decision aid or a pamphlet .  Eligible women were primiparous , ≥ 37 weeks , planning a vaginal birth of a single infant and had sufficient English to complete the trial material s. We used a combination of affective ( anxiety , satisfaction and participation in decision-making ) and behavioural outcomes ( intention and analgesia use ) to assess the impact of the decision aid , which were assessed before labour . Results 596 women were r and omised ( 395 decision aid group , 201 pamphlet group ) . There were significant differences in knowledge scores between the decision aid group and the pamphlet group ( mean difference 8.6 , 95 % CI 3.70 , 13.40 ) . There were no differences between decisional conflict scores ( mean difference -0.99 ( 95 % CI -3.07 , 1.07 ) , or anxiety ( mean difference 0.3 , 95 % CI -2.15 , 1.50 ) . The decision aid group were significantly more likely to consider their care providers opinion ( RR 1.28 95%CI 0.64 , 0.95 ) . There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use . Conclusions This decision aid improves women 's labour analgesia knowledge without increasing anxiety . Significantly , the decision aid group were more informed of labour analgesia options , and considered the opinion of their care providers more often when making their analgesia decisions , thus improving informed decision making . Trial Registration Trial registration no : IS RCT 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 : To evaluate a decision aid ( DA ) design ed to promote informed decision making for prostate cancer screening . Methods : Twelve work sites were r and omly assigned to an intervention or nonintervention comparison condition . Intervention sites received access to a computer-tailored DA at the workplace . Male employees age 45 years and above ( n = 625 ) completed surveys at baseline and at 3-month follow-up , documenting aspects of informed decision making . Results : Using an intention-to-treat analysis , men in the intervention group were significantly more likely to have made a screening decision and to have improved knowledge without increased decisional conflict , relative to men in the comparison group . These changes were observed despite the fact that only 30 % of men in intervention sites used the DA . Among DA users , similar improvements were observed , although the magnitudes of changes were substantially greater , and significant improvements in decision self-efficacy were observed . Conclusions : A DA offered in the workplace promoted decision making , improved knowledge , and increased decision self-efficacy among users , without increasing decisional conflict . However , participation was suboptimal , suggesting that better methods for engaging men in workplace interventions are needed . Impact Statement : This trial shows the efficacy of a computer-tailored DA in promoting informed decisions about prostate cancer screening . The DA was delivered through work sites , thereby providing access to re sources required to participate in informed decision making without requiring a medical appointment . However , participation rates were suboptimal , and additional strategies for engaging men are needed . Cancer Epidemiol Biomarkers Prev ; 19(9 ) ; 2172–86 . © 2010 AACR Purpose To determine if particular values clarification exercises included in a patient decision aid had discernible impact on postdecisional regret in patients with early-stage prostate cancer . Methods A multicenter r and omized controlled trial compared 2 versions of a computerized patient decision aid : only structured information compared to the structured information plus values clarification exercises . Assessment s were conducted during the decision aid visit ; telephone follow-up interviews were conducted when patients made their decisions with their physician , 3 months after completing treatment , and > 1 year later ( per a mailing ) . Outcome measures included the Decisional Conflict Scale , the Preparation for Decision Making Scale , and the Decision Regret Scale . Results A total of 156 patients participated , 75 provided information only and 81 provided information plus values clarification exercises . The groups did not differ significantly on any outcome evaluated at the decision aid visit ; in both groups , decisional conflict decreased immediately after using the decision aid . Between-group differences emerged after the decision was actually made . The values clarification exercises group reported higher Preparation for Decision Making Scale scores at the decision follow-up and at the > 1-year follow-up . Regret did not differ significantly between groups at the 3-month follow-up but was lower for the values clarification exercises group than for the information group at the > 1-year follow-up . Conclusion The results suggest that the values clarification exercises led to better preparation for decision making and to less regret . The impact , however , only emerged after the decision was made OBJECTIVE To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients . METHODS Newly diagnosed female patients with early stage breast cancer from two public hospitals were r and omized to receive an entertainment-based decision aid for breast cancer treatment along with usual care ( intervention arm ) or to receive usual care only ( control arm ) . Pre-decision ( baseline ) , pre-surgery , and 1-year follow-up assessment s were conducted . RESULTS Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery ;  however , they appeared better informed and clearer about their surgical options than women assigned to the control group . No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group . CONCLUSIONS Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options . PRACTICE IMPLICATION S Incorporating patient decision aids , particularly computer-based decision aids , into st and ard clinical practice remains a challenge ; however , patients may be directed to view programs at home or at public locations ( e.g. , libraries , community centers ) OBJECTIVE To examine whether explanatory illustrations can improve older adults '  comprehension of written health information . METHODS Six short health-related texts were selected from websites and pamphlets . Young and older adults were r and omly assigned to read health-related texts alone or texts accompanied by explanatory illustrations .  Eye movements were recorded while reading . Word recognition , text comprehension , and comprehension of the illustrations were assessed after reading . RESULTS Older adults performed as well as or better than young adults on the word recognition and text comprehension measures . However , older adults performed less well than young adults on the illustration comprehension measures . Analysis of readers ' eye movements showed that older adults spent more time reading illustration-related phrases and fixating on the illustrations than did young adults , yet had poorer comprehension of the illustrations . CONCLUSION Older adults might not benefit from text illustrations because illustrations can be difficult to integrate with the text . PRACTICE IMPLICATION S Health practitioners should not assume that illustrations 
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Conclusions It appears that PtDAs result in patients having higher knowledge scores and in reduced feelings of being uninformed over patients who receive usual care .
It also appears that PtDAs with more detailed information generally result in slightly higher knowledge and lower “ Feeling Uninformed ” scores than those with simpler information , but the differences are small and can be reversed under some circumstances