human
***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: OBJECTIVES Message tailoring , based on individual needs and circumstances , is commonly used to enhance face-to-face patient counseling . Only recently has individual tailoring become feasible for printed messages . This study sought to determine whether printed tailored recommendations addressing women 's specific screening and risk status and perceptions about breast cancer and mammography are more effective than st and ardized printed recommendations . METHODS Computer-assisted telephone interviews were conducted with 435 women , aged 40 to 65 years , who had visited family practice groups within the previous 2 years . Subjects were r and omly allocated to receive individually tailored or st and ardized mammography recommendation letters mailed from physicians to patients ' homes . Follow-up interviews were conducted 8 months later . RESULTS Tailored letter recipients were more likely to remember and to have read more of their letters than st and ardized version recipients . After controlling for baseline status , tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $ 26,000 and for Black women . CONCLUSIONS Tailored messages are a more effective medium for physicians ' mammography recommendations ; tailoring may be especially important for women of low socioeconomic status BACKGROUND Although rates of mammography screening among women in the general population have been increasing they still fall short of national goals . This study evaluated the effects on rates of participation in mammography screening of obtaining risk factor information and providing general or personalized risk information through direct mailed correspondence . METHODS Women enrollees in a health maintenance organization ( N = 2,076 ) , age 50 and above , were r and omized to one of the following four groups : ( a ) no risk factor question naire + generic invitation , ( b ) no risk factor question naire + general risk invitation , ( c ) risk factor question naire + general risk invitation , and ( d ) risk factor question naire + personal risk invitation . Computerized visit records were monitored for 12 months following a mailed invitation to assess whether a mammogram had been obtained . RESULTS Overall participation was 37.5 % and the rate of participation did not differ significantly across groups ( P = 0.26 ) . Participation was related to age ( P < 0.02 ) , with rates highest for women ages 60 - 69 years ( 42.7 % ) compared with those for women ages 50 - 59 ( 35.5 % ) and those age 70 + ( 33.7 % ) . Among women with a family history of breast cancer , the personalized risk invitation was associated with significantly higher participation compared with general risk invitation ( 66.7 versus 42.9 % , respectively ; P < 0.003 ) . CONCLUSIONS Women with a family history of breast cancer are more likely to obtain a mammogram if that fact is reinforced as a risk factor . Research on environmental barriers to mammography screening may suggest alternative strategies for increasing participation Colorectal cancer is second only to lung cancer as a cause of cancer death in the United States . Studies have shown that fecal occult blood ( FOB ) tests are effective in detecting colorectal cancer in its early stages . To increase the participation in the FOB test among the working population , a r and omized controlled trial was conducted . A total 278 federal employees 40 years or older in Washington State were r and omly divided into a intervention group which received a Colorectal Cancer Risk Appraisal and a control group which received a simple information letter . After three months a follow-up question naire was sent to all participants to measure the effectiveness of the intervention . As a result of the study , the intervention group had a 4.3 % higher compliance rate with the FOB test during the three month follow-up period ( p = .10 ) . The largest effect of the intervention was on the employees ' intention to get a FOB test within the next year ( 62.6 % in the intervention group vs. 36.2 % in the control group , OR = 3.18 , p less than .001 ) OBJECTIVES We evaluated the impact of individualized breast cancer risk counseling on mammography use among women at risk for breast cancer . METHODS Participants ( n = 508 ) were r and omized to the breast cancer risk counseling intervention or a general health education control intervention  , and 85 % completed follow-up . RESULTS In multivariate modeling , a significant group-by-education interaction demonstrated that among less-educated participants , breast cancer risk counseling led to reduced mammography use . There was no intervention effect among the more-educated participants . CONCLUSIONS These results suggest that st and ard breast cancer risk counseling could have an adverse impact on the health behaviors of less-educated women 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 Mammography has been found significantly to impact mortality in women ; however , compliance is still problematic . A theoretical model which combined Health Belief Model ( HBM ) constructs with stage of mammography adoption was used to investigate the effect of an individualized belief and /or informational intervention on mammography compliance . A control group and three intervention groups ( belief , information , and belief and information ) were used . A probability sample of 405 women ages 40–88 years without a prior history of breast cancer was r and omly assigned to groups . Subjects in the intervention group received individually tailored messages to alter beliefs or provider information related to mammography screening . Women in the combined belief/information group were over two times more likely to have been compliant with mammography 1 year postintervention than those in the control . In addition , groups who received the belief intervention had significantly more women that went from a lower to a higher stage of mammography adoption BACKGROUND Mammography is the primary method used for breast cancer screening . However , compliance with recommended screening practice s is still below acceptable levels . This study examined the cost-effectiveness of five combinations of physician recommendation and telephone or in-person individualized counseling strategies for increasing compliance with mammography . METHODS There were 808 participants who were r and omly assigned to one of six groups . A logistic regression model with compliance as the dependent variable and group as the independent variable was used to test for significant differences and a ratio of cost to improvement in mammogram compliance evaluated the cost-effectiveness . RESULTS Three of the interventions ( in-person , telephone plus letter , and in-person plus letter ) had significantly better compliance rates compared with the control , physician letter , or telephone alone . However , when considering costs , only one emerged as the superior strategy . The cost-effectiveness ratios for the five interventions show that telephone-plus-letter is the most cost-effective strategy , achieving a 35.6 % mammography compliance at a marginal cost of $ 0.78 per 1 % increase in women screened . CONCLUSIONS A tailored phone prompt and physician reminder is an effective and economical intervention to increase mammography . Future research should confirm this finding and address its applicability to practice BACKGROUND Studies have shown that a majority of women with a family history of breast cancer have exaggerated perceptions of their own risk of this disease and experience excessive anxiety . In response to the need to communicate more accurate risk information to these women , specialized programs for breast cancer risk counseling have been initiated in medical centers across the United States . PURPOSE Our purpose was 1 ) to evaluate the impact of a st and ardized protocol for individualized breast cancer risk counseling on comprehension of personal risk among first-degree relatives of index breast cancer patients and 2 ) to identify women most and least likely to benefit from such counseling . METHODS This study is a prospect i ve r and omized trial comparing individualized breast cancer risk counseling to general health counseling ( control ) . We studied 200 women aged 35 years and older who had a family history of breast cancer in a first-degree relative . Women with a personal history of cancer were excluded .  Risk comprehension was assessed as the concordance between perceived " subjective " lifetime breast cancer risk and estimated " objective " lifetime risk . RESULTS The results of logistic regression analysis showed that women who received risk counseling were significantly more likely to improve their risk comprehension , compared with women in the control condition ( odds ratio [ OR ] = 3.5 ; 95 % confidence interval [ CI ] = 1.3 - 9.5 ; P = .01 ) . However , in both groups , about two thirds of women continued to overestimate their lifetime risks substantially following counseling . Examination of subjects by treatment interaction effects indicated that risk counseling did not produce improved comprehension among the large proportion of women who had high levels of anxious preoccupation with breast cancer at base line ( P = .02 ) . In addition , white women were less likely to benefit than African-American women ( OR = 0.34 ; 95 % CI = 0.11 - 0.99 ; P = .05 ) . CONCLUSION Efforts to counsel women about their breast cancer risks are not likely to be effective unless their breast cancer anxieties are also addressed . IMPLICATION S Attention to the psychological aspects of breast cancer risk will be critical in the development of risk-counseling programs that incorporate testing for the recently cloned breast cancer susceptibility gene , BRCA1 ( and BRCA2 when that gene has also been cloned ) Health risk appraisal ( HRA ) remains one of the most widely used health promotion tools despite only equivocal evidence for its effectiveness . Theories of behavior change predict conventional HRA 's ineffectiveness because risk information alone is seldom sufficient to change complex behaviors . In this study , a r and omized trial compared the effects of feedback from an enhanced HRA with a typical HRA and a control group among adult patients from eight family medicine practice s. The enhanced HRA assessed behavior-specific psychosocial factors and provided patients with computer-generated , individually-tailored behavior change information in addition to typical HRA risk feedback . Changes in seven behaviors were assessed at a 6 month follow-up . Overall , patients receiving enhanced HRA feedback were 18 % more likely to change at least one risk behavior than were patients receiving typical HRA feedback or no feedback ( OR = 1.18 , 95 % CI = 1.00 , 1.39 ) . The enhanced HRA feedback appeared to promote changes in cholesterol screening , dietary fat consumption and physical activity , but not in smoking , seat belt use , mammography and Pap smears . We conclude that the addition of theory-based , individually-tailored behavior change information may improve the effectiveness of HRA BACKGROUND In response to the isolation of the BRCA1 gene , a breast-ovarian cancer-susceptibility gene , biotechnology companies are already marketing genetic tests to health care providers and to the public . Initial studies indicate interest in BRCA1 testing in the general public and in population s at high risk . However , the optimal strategies for educating and counseling individuals have yet to be determined . PURPOSE Our goal was to evaluate the impact of alternate strategies for pretest education and counseling on decision-making regarding BRCA1 testing among women at low to moderate risk who have a family history of breast and /or ovarian cancer . METHODS A r and omized trial design was used to evaluate the effects of education only ( educational approach ) and education plus counseling ( counseling approach ) , as compared with a waiting-list ( control ) condition ( n = 400 for all groups combined ) . The educational approach review ed information about personal risk factors , inheritance of cancer susceptibility , the benefits , limitations , and risks of BRCA1 testing , and cancer screening and prevention options . The counseling approach included this information , as well as a personalized discussion of experiences with cancer in the family and the potential psychological and social impact of testing . Data on knowledge of inherited cancer and BRCA1 test characteristics , perceived risk , perceived benefits , limitations and risks of BRCA1 testing , and testing intentions were collected by use of structured telephone interviews at baseline and at 1-month follow-up . Provision of a blood sample for future testing served as a proxy measure of intention to be tested ( in the education and counseling arms of the study ) . The effects of intervention group on study outcomes were evaluated by use of hierarchical linear regression modeling and logistic regression modeling ( for the blood sample outcome ) . All P values are for two-sided tests . RESULTS The educational and counseling approaches both led to significant increases in knowledge , relative to the control condition ( P < .001 for both ) . The counseling approach , but not the educational approach , was superior to the control condition in producing significant increases in perceived limitations and risks of BRCA1 testing ( P < .01 ) and decreases in perceived benefits ( P < .05 ) . However , neither approach produced changes in intentions to have BRCA1 testing . Prior to and following both education only and education plus counseling , approximately one half of the participants stated that they intended to be tested ; after the session , 52 % provided a blood sample . CONCLUSIONS St and ard educational approaches may be equally effective as exp and ed counseling approaches in enhancing knowledge . Since knowledge is a key aspect of medical decision-making , st and ard education may be adequate in situations where genetic testing must be streamlined . On the other h and , it has 
    Output:
    
agent
***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: OBJECTIVES Message tailoring , based on individual needs and circumstances , is commonly used to enhance face-to-face patient counseling . Only recently has individual tailoring become feasible for printed messages . This study sought to determine whether printed tailored recommendations addressing women 's specific screening and risk status and perceptions about breast cancer and mammography are more effective than st and ardized printed recommendations . METHODS Computer-assisted telephone interviews were conducted with 435 women , aged 40 to 65 years , who had visited family practice groups within the previous 2 years . Subjects were r and omly allocated to receive individually tailored or st and ardized mammography recommendation letters mailed from physicians to patients ' homes . Follow-up interviews were conducted 8 months later . RESULTS Tailored letter recipients were more likely to remember and to have read more of their letters than st and ardized version recipients . After controlling for baseline status , tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $ 26,000 and for Black women . CONCLUSIONS Tailored messages are a more effective medium for physicians ' mammography recommendations ; tailoring may be especially important for women of low socioeconomic status BACKGROUND Although rates of mammography screening among women in the general population have been increasing they still fall short of national goals . This study evaluated the effects on rates of participation in mammography screening of obtaining risk factor information and providing general or personalized risk information through direct mailed correspondence . METHODS Women enrollees in a health maintenance organization ( N = 2,076 ) , age 50 and above , were r and omized to one of the following four groups : ( a ) no risk factor question naire + generic invitation , ( b ) no risk factor question naire + general risk invitation , ( c ) risk factor question naire + general risk invitation , and ( d ) risk factor question naire + personal risk invitation . Computerized visit records were monitored for 12 months following a mailed invitation to assess whether a mammogram had been obtained . RESULTS Overall participation was 37.5 % and the rate of participation did not differ significantly across groups ( P = 0.26 ) . Participation was related to age ( P < 0.02 ) , with rates highest for women ages 60 - 69 years ( 42.7 % ) compared with those for women ages 50 - 59 ( 35.5 % ) and those age 70 + ( 33.7 % ) . Among women with a family history of breast cancer , the personalized risk invitation was associated with significantly higher participation compared with general risk invitation ( 66.7 versus 42.9 % , respectively ; P < 0.003 ) . CONCLUSIONS Women with a family history of breast cancer are more likely to obtain a mammogram if that fact is reinforced as a risk factor . Research on environmental barriers to mammography screening may suggest alternative strategies for increasing participation Colorectal cancer is second only to lung cancer as a cause of cancer death in the United States . Studies have shown that fecal occult blood ( FOB ) tests are effective in detecting colorectal cancer in its early stages . To increase the participation in the FOB test among the working population , a r and omized controlled trial was conducted . A total 278 federal employees 40 years or older in Washington State were r and omly divided into a intervention group which received a Colorectal Cancer Risk Appraisal and a control group which received a simple information letter . After three months a follow-up question naire was sent to all participants to measure the effectiveness of the intervention . As a result of the study , the intervention group had a 4.3 % higher compliance rate with the FOB test during the three month follow-up period ( p = .10 ) . The largest effect of the intervention was on the employees ' intention to get a FOB test within the next year ( 62.6 % in the intervention group vs. 36.2 % in the control group , OR = 3.18 , p less than .001 ) OBJECTIVES We evaluated the impact of individualized breast cancer risk counseling on mammography use among women at risk for breast cancer . METHODS Participants ( n = 508 ) were r and omized to the breast cancer risk counseling intervention or a general health education control intervention  , and 85 % completed follow-up . RESULTS In multivariate modeling , a significant group-by-education interaction demonstrated that among less-educated participants , breast cancer risk counseling led to reduced mammography use . There was no intervention effect among the more-educated participants . CONCLUSIONS These results suggest that st and ard breast cancer risk counseling could have an adverse impact on the health behaviors of less-educated women 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 Mammography has been found significantly to impact mortality in women ; however , compliance is still problematic . A theoretical model which combined Health Belief Model ( HBM ) constructs with stage of mammography adoption was used to investigate the effect of an individualized belief and /or informational intervention on mammography compliance . A control group and three intervention groups ( belief , information , and belief and information ) were used . A probability sample of 405 women ages 40–88 years without a prior history of breast cancer was r and omly assigned to groups . Subjects in the intervention group received individually tailored messages to alter beliefs or provider information related to mammography screening . Women in the combined belief/information group were over two times more likely to have been compliant with mammography 1 year postintervention than those in the control . In addition , groups who received the belief intervention had significantly more women that went from a lower to a higher stage of mammography adoption BACKGROUND Mammography is the primary method used for breast cancer screening . However , compliance with recommended screening practice s is still below acceptable levels . This study examined the cost-effectiveness of five combinations of physician recommendation and telephone or in-person individualized counseling strategies for increasing compliance with mammography . METHODS There were 808 participants who were r and omly assigned to one of six groups . A logistic regression model with compliance as the dependent variable and group as the independent variable was used to test for significant differences and a ratio of cost to improvement in mammogram compliance evaluated the cost-effectiveness . RESULTS Three of the interventions ( in-person , telephone plus letter , and in-person plus letter ) had significantly better compliance rates compared with the control , physician letter , or telephone alone . However , when considering costs , only one emerged as the superior strategy . The cost-effectiveness ratios for the five interventions show that telephone-plus-letter is the most cost-effective strategy , achieving a 35.6 % mammography compliance at a marginal cost of $ 0.78 per 1 % increase in women screened . CONCLUSIONS A tailored phone prompt and physician reminder is an effective and economical intervention to increase mammography . Future research should confirm this finding and address its applicability to practice BACKGROUND Studies have shown that a majority of women with a family history of breast cancer have exaggerated perceptions of their own risk of this disease and experience excessive anxiety . In response to the need to communicate more accurate risk information to these women , specialized programs for breast cancer risk counseling have been initiated in medical centers across the United States . PURPOSE Our purpose was 1 ) to evaluate the impact of a st and ardized protocol for individualized breast cancer risk counseling on comprehension of personal risk among first-degree relatives of index breast cancer patients and 2 ) to identify women most and least likely to benefit from such counseling . METHODS This study is a prospect i ve r and omized trial comparing individualized breast cancer risk counseling to general health counseling ( control ) . We studied 200 women aged 35 years and older who had a family history of breast cancer in a first-degree relative . Women with a personal history of cancer were excluded .  Risk comprehension was assessed as the concordance between perceived " subjective " lifetime breast cancer risk and estimated " objective " lifetime risk . RESULTS The results of logistic regression analysis showed that women who received risk counseling were significantly more likely to improve their risk comprehension , compared with women in the control condition ( odds ratio [ OR ] = 3.5 ; 95 % confidence interval [ CI ] = 1.3 - 9.5 ; P = .01 ) . However , in both groups , about two thirds of women continued to overestimate their lifetime risks substantially following counseling . Examination of subjects by treatment interaction effects indicated that risk counseling did not produce improved comprehension among the large proportion of women who had high levels of anxious preoccupation with breast cancer at base line ( P = .02 ) . In addition , white women were less likely to benefit than African-American women ( OR = 0.34 ; 95 % CI = 0.11 - 0.99 ; P = .05 ) . CONCLUSION Efforts to counsel women about their breast cancer risks are not likely to be effective unless their breast cancer anxieties are also addressed . IMPLICATION S Attention to the psychological aspects of breast cancer risk will be critical in the development of risk-counseling programs that incorporate testing for the recently cloned breast cancer susceptibility gene , BRCA1 ( and BRCA2 when that gene has also been cloned ) Health risk appraisal ( HRA ) remains one of the most widely used health promotion tools despite only equivocal evidence for its effectiveness . Theories of behavior change predict conventional HRA 's ineffectiveness because risk information alone is seldom sufficient to change complex behaviors . In this study , a r and omized trial compared the effects of feedback from an enhanced HRA with a typical HRA and a control group among adult patients from eight family medicine practice s. The enhanced HRA assessed behavior-specific psychosocial factors and provided patients with computer-generated , individually-tailored behavior change information in addition to typical HRA risk feedback . Changes in seven behaviors were assessed at a 6 month follow-up . Overall , patients receiving enhanced HRA feedback were 18 % more likely to change at least one risk behavior than were patients receiving typical HRA feedback or no feedback ( OR = 1.18 , 95 % CI = 1.00 , 1.39 ) . The enhanced HRA feedback appeared to promote changes in cholesterol screening , dietary fat consumption and physical activity , but not in smoking , seat belt use , mammography and Pap smears . We conclude that the addition of theory-based , individually-tailored behavior change information may improve the effectiveness of HRA BACKGROUND In response to the isolation of the BRCA1 gene , a breast-ovarian cancer-susceptibility gene , biotechnology companies are already marketing genetic tests to health care providers and to the public . Initial studies indicate interest in BRCA1 testing in the general public and in population s at high risk . However , the optimal strategies for educating and counseling individuals have yet to be determined . PURPOSE Our goal was to evaluate the impact of alternate strategies for pretest education and counseling on decision-making regarding BRCA1 testing among women at low to moderate risk who have a family history of breast and /or ovarian cancer . METHODS A r and omized trial design was used to evaluate the effects of education only ( educational approach ) and education plus counseling ( counseling approach ) , as compared with a waiting-list ( control ) condition ( n = 400 for all groups combined ) . The educational approach review ed information about personal risk factors , inheritance of cancer susceptibility , the benefits , limitations , and risks of BRCA1 testing , and cancer screening and prevention options . The counseling approach included this information , as well as a personalized discussion of experiences with cancer in the family and the potential psychological and social impact of testing . Data on knowledge of inherited cancer and BRCA1 test characteristics , perceived risk , perceived benefits , limitations and risks of BRCA1 testing , and testing intentions were collected by use of structured telephone interviews at baseline and at 1-month follow-up . Provision of a blood sample for future testing served as a proxy measure of intention to be tested ( in the education and counseling arms of the study ) . The effects of intervention group on study outcomes were evaluated by use of hierarchical linear regression modeling and logistic regression modeling ( for the blood sample outcome ) . All P values are for two-sided tests . RESULTS The educational and counseling approaches both led to significant increases in knowledge , relative to the control condition ( P < .001 for both ) . The counseling approach , but not the educational approach , was superior to the control condition in producing significant increases in perceived limitations and risks of BRCA1 testing ( P < .01 ) and decreases in perceived benefits ( P < .05 ) . However , neither approach produced changes in intentions to have BRCA1 testing . Prior to and following both education only and education plus counseling , approximately one half of the participants stated that they intended to be tested ; after the session , 52 % provided a blood sample . CONCLUSIONS St and ard educational approaches may be equally effective as exp and ed counseling approaches in enhancing knowledge . Since knowledge is a key aspect of medical decision-making , st and ard education may be adequate in situations where genetic testing must be streamlined . On the other h and , it has 
    Output:
    