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: Underst and ing the effect of messages and other influences on health decision-making has the potential to decrease risky behavior such as tanning bed use . This study explores the effect of type of evidence , self- assessment s of risk for skin cancer , and personality factors on intention to use and use of tanning beds among Caucasian female college students . Specifically , it targeted the perceived susceptibility component of the Health Belief Model and its impact on intention to tan as well as changes in actual tanning behavior . College students ( N=141 ) in the southeast United States read r and omly assigned messages and self- assessment s , filled out surveys , and were later contacted for a follow-up telephone survey . The statistical message was rated higher on information value and also result ed in decreased intention to tan , decreased tanning behavior , and increased perceived susceptibility to skin cancer . The narrative message , in contrast , increased perceptions of realism and also worked to decrease intentions to tan . Additionally , the self- assessment manipulation result ed in increased susceptibility and decreased intention to tan and post tanning behavior . Personality factors explained small portions of variance . Key limitations and directions for future research are also addressed BACKGROUND Rates of malignant melanoma are rising , with those people with sun-sensitive skin most at risk . Health education interventions are needed to help people protect themselves by detecting early signs of melanoma and by protecting their skin from sunburn . This study aim ed to evaluate the impact of an interactive multimedia intervention " Skinsafe " on patients ' knowledge about melanoma and on their skin protective behaviors . METHODS In this cluster-r and omized , controlled trial conducted in Nottinghamshire , UK , doctors and nurses in 5 family practice s prescribed Skinsafe to patients with higher risk skin characteristics .  Measures of melanoma knowledge , perceived risk of melanoma and reported skin protective behaviors were obtained at baseline and at 6-month follow-up from 259 patients receiving the intervention and 330 patients with higher risk skin characteristics in 5 matched control practice s. RESULTS AND DISCUSSION Participants had low levels of melanoma knowledge at baseline . At follow-up , the intervention group had higher knowledge scores than control ( 3.71 vs. 3.03 , P < or = 0.001 ) , reported more protective skin behaviors ( 5.36 vs. 5.06 , P = 0.007 ) and were more likely to report mole checking ( odds ratio 1.67 , 95 % CI 1.04 to 2.70 , P = 0.035 ) . The Skinsafe intervention was evaluated positively by patients and could be used to support melanoma health education within clinical setting BACKGROUND Women overestimate both population and individual risk of cervical cancer . This may contribute to the recognised excess screening frequency for low-risk women . AIM To investigate whether an individualized risk communication package could affect stated preferences for screening interval and actual screening behaviour . DESIGN Pragmatic , practice -based cluster r and omised controlled trial . SETTING Twenty-nine practice s ( 15 intervention , 14 control ) in North Wales recruited 1890 women attending for cervical smears . METHOD A risk communication package containing visual material was compared with normal practice . Practice nurses received training in its delivery . The short-term primary outcome was stated preference for screening interval ; the long-term primary outcome was actual screening behaviour . RESULTS In the short term , intervention arm women were significantly less likely to prefer a shorter than recommended interval ( odds ratio [ OR ] = 0.51 , 95 % confidence interval [ CI ] = 0.41 to 0.64 ; P < 0.0001 ) . At the five-year follow-up , fewer women in the intervention arm had attended for screening sooner than their recommended recall . The magnitude of difference in excess screening interval preference and behaviour was similar , but behaviour had a wider confidence interval and a marginally non-significant P-value ( OR = 0.61 , 95 % CI = 0.36 to 1.03 ; P = 0.063 ) . Better knowledge and more accurate risk perceptions were demonstrated , with an improvement in measures of anxiety . The extra cost per woman receiving the intervention was 6 Pounds . CONCLUSIONS Women 's perception of risk contributes to determining screening intervals in addition to practice factors . Simple risk information delivered in primary care affected women 's stated preferences for tests . The impact on actual screening behaviour was more equivocal . Overall , the intervention showed a substantial benefit and any disbenefit can be ruled out . This approach to providing risk information could , at low cost , benefit other screening programmes and may relieve anxiety Approximately 20–30 % of women delay for 12 weeks or more from self-discovery of a breast symptom to presentation to a health care provider , and such delay intervals are associated with poorer survival . Underst and ing the factors that influence patient delay is important for the development of an effective , targeted health intervention programme to shorten patient delay . The aim of the study was to elicit knowledge and beliefs about breast cancer among a sample of the general female population , and examine age and socio-economic variations in responses . Participants were r and omly selected through the Postal Address File , and data were collected through the Office of National Statistics . Geographically distributed throughout the UK , 996 women participated in a short structured interview  to elicit their knowledge of breast cancer risk , breast cancer symptoms , and their perceptions of the management and outcomes associated with breast cancer . Women had limited knowledge of their relative risk of developing breast cancer , of associated risk factors and of the diversity of potential breast cancer-related symptoms . Older women were particularly poor at identifying symptoms of breast cancer , risk factors associated with breast cancer and their personal risk of developing the disease . Poorer knowledge of symptoms and risks among older women may help to explain the strong association between older age and delay in help-seeking . If these findings are confirmed they suggest that any intervention programme should target older women in particular , given that advancing age is a risk factor for both developing breast cancer and for subsequent delayed presentation Patients can benefit from accessible breast cancer risk information . The Gail model is a well-known means of providing risk information to patients and for guiding clinical decisions . Risk presentation often includes 5-year and lifetime percent chances for a woman to develop breast cancer . How do women perceive their risks after Gail model risk assessment ? This exploratory study used a r and omized clinical trial design to address this question among women not previously selected for breast cancer risk . Results suggest a brief  risk assessment intervention  changes quantitative and comparative risk perceptions and improves accuracy . This study improves our underst and ing of risk perceptions by evaluating an intervention in a population not previously selected for high-risk status and measuring perceptions in a variety of formats BACKGROUND Colorectal cancer is a leading cause of cancer mortality , yet effective screening tests are often underused . Electronic patient messages and personalized risk assessment s delivered via an electronic personal health record could increase screening rates . METHODS We conducted a r and omized controlled trial in 14 ambulatory health centers involving 1103 patients ranging in age from 50 to 75 years with an active electronic personal health record who were overdue for colorectal cancer screening . Patients were r and omly assigned to receive a single electronic message highlighting overdue screening status with a link to a Web-based tool to assess their personal risk of colorectal cancer .  The outcomes included colorectal cancer screening rates at 1 and 4 months . RESULTS Screening rates were higher at 1 month for patients who received electronic messages than for those who did not ( 8.3 % vs 0.2 % , P < .001 ) , but this difference was no longer significant at 4 months ( 15.8 % vs 13.1 % , P = .18 ) . Of 552 patients r and omized to receive the intervention , 296 ( 54 % ) viewed the message , and 47 ( 9 % ) used the Web-based risk assessment tool . Among 296 intervention patients who viewed the electronic message , risk tool users were more likely than nonusers to request screening examinations ( 17 % vs 4 % , P = .04 ) and to be screened ( 30 % vs 15 % , P = .06 ) . One-fifth of patients ( 19 % ) using the risk assessment tool were estimated to have an above-average risk for colorectal cancer . CONCLUSION Electronic messages to patients produce an initial increase in colorectal cancer screening rates , but this effect is not sustained over time . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01032746 Purpose : To assess the effectiveness of computerized familial risk assessment and tailored messages for identifying individuals for targeted cancer prevention strategies and motivating behavior change . Methods : We conducted a r and omized clinical trial in primary care patients aged 35–65 years using Family Healthware  , a self-administered , internet-based tool that collects family history for six common diseases including breast cancer , colon cancer , and ovarian cancer , stratifies risk into three tiers , and provides tailored prevention messages .  Cancer screening adherence and consultation were measured at baseline and 6-month follow-up . Results : Of 3283 participants , 34 % were at strong or moderate risk of at least one of the cancers . Family Healthware identified additional participants for whom earlier screening ( colon cancer , 4.4 % ; breast cancer , women ages : 35–39 years , 9 % ) or genetic assessment ( colon cancer , 2.5 % ; breast cancer , 10 % ; and ovarian cancer , 4 % ) may be indicated . Fewer than half were already adherent with risk-based screening . Screening adherence improved for all risk categories with no difference between intervention and control groups . Consultation with specialists did not differ between groups . Conclusion : Family Healthware identified patients for intensified cancer prevention . Engagement of clinicians and patients , integration with clinical decision support , and inclusion of nonfamilial risk factors may be necessary to achieve the full potential of computerized risk assessment The objective was to evaluate the effect of an assessment strategy using the computer decision support system ( the GRAIDS software ) , on the management of familial cancer risk in British general practice in comparison with best current practice . The design included cluster r and omised controlled trial , and involved forty-five general practice teams in East Anglia , UK . R and omised to GRAIDS ( Genetic Risk Assessment on the Internet with Decision Support ) support ( intervention n=23 ) or comparison ( n=22 ) . Training in the new assessment strategy and access to the GRAIDS software ( GRAIDS arm ) was conducted , compared with an educational session and guidelines about managing familial breast and colorectal cancer risk ( comparison ) were mailed . Outcomes were measured at practice , practitioner and patient levels . The primary outcome measure , at practice level , was the proportion of referrals made to the Regional Genetics Clinic for familial breast or colorectal cancer that were consistent with referral guidelines . Other measures included practitioner confidence in managing familial cancer ( GRAIDS arm only ) and , in patients : cancer worry , risk perception and knowledge about familial cancer . There were more referrals to the Regional Genetics Clinic from GRAIDS than comparison practice s ( mean 6.2 and 3.2 referrals per 10 000 registered patients per year ; mean difference 3.0 referrals ; 95 % confidence interval ( CI ) 1.2–4.8 ; P=0.001 ) ; referrals from GRAIDS practice s were more likely to be consistent with referral guidelines ( odds ratio (OR)=5.2 ; 95 % CI 1.7–15.8 , P=0.006 ) . Patients referred from GRAIDS practice s had lower cancer worry scores at the point of referral ( mean difference −1.44 95 % CI −2.64 to −0.23 , P=0.02 ) . There were no differences in patient knowledge about familial cancer . The intervention increased GPs ' confidence in managing familial cancer . Compared with education and mailed guidelines , assessment including computer decision support increased the number and quality of referrals to the Regional Genetics Clinic for familial cancer risk , improved practitioner confidence and had no adverse psychological effects in patients . Trials are registered under N0181144343 in the UK National Research Register BACKGROUND Shared decision making ( SDM ) is a widely recommended yet unproven strategy for increasing colorectal cancer ( CRC ) screening uptake . Previous trials of decision aids to increase SDM and CRC screening uptake have yielded mixed results . PURPOSE To assess the impact of decision aid-assisted SDM on CRC screening uptake . DESIGN RCT . SETTING / PARTICIPANTS The study was conducted at an urban , academic safety-net hospital and community health center between 2005 and 2010 . Participants were asymptomatic , average-risk patients aged 50 - 75 years due for CRC screening . INTERVENTION Study participants ( n=825 ) were r and omized to one of two intervention arms ( decision aid plus personalized risk assessment or decision aid alone ) or control arm . The interventions took place just prior to a routine office visit with their primary care providers . MAIN OUTCOME MEASURES The primary outcome was completion of a CRC screening test within 12 months of the study visit . Logistic regression was used to identify predictors of test completion and mediators of the intervention effect . Analysis was completed in 2011 . RESULTS Patients in the decision-aid group were more likely to complete a screening test than control patients ( 43.1 % vs 34.8 % , p=0.046 ) within 12 months of the study visit ; conversely , test uptake for the decision aid and decision aid plus personalized risk assessment arms was similar ( 43.1 % vs 37.1 % , p=0.15 ) . Assignment to the decision-aid arm ( AOR=1.48 , 95 % CI=1.04 , 2.10 ) , black race ( AOR=1.52 , 95 % CI=1.12 , 2.06 ) and a preference for a patient 
    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: Underst and ing the effect of messages and other influences on health decision-making has the potential to decrease risky behavior such as tanning bed use . This study explores the effect of type of evidence , self- assessment s of risk for skin cancer , and personality factors on intention to use and use of tanning beds among Caucasian female college students . Specifically , it targeted the perceived susceptibility component of the Health Belief Model and its impact on intention to tan as well as changes in actual tanning behavior . College students ( N=141 ) in the southeast United States read r and omly assigned messages and self- assessment s , filled out surveys , and were later contacted for a follow-up telephone survey . The statistical message was rated higher on information value and also result ed in decreased intention to tan , decreased tanning behavior , and increased perceived susceptibility to skin cancer . The narrative message , in contrast , increased perceptions of realism and also worked to decrease intentions to tan . Additionally , the self- assessment manipulation result ed in increased susceptibility and decreased intention to tan and post tanning behavior . Personality factors explained small portions of variance . Key limitations and directions for future research are also addressed BACKGROUND Rates of malignant melanoma are rising , with those people with sun-sensitive skin most at risk . Health education interventions are needed to help people protect themselves by detecting early signs of melanoma and by protecting their skin from sunburn . This study aim ed to evaluate the impact of an interactive multimedia intervention " Skinsafe " on patients ' knowledge about melanoma and on their skin protective behaviors . METHODS In this cluster-r and omized , controlled trial conducted in Nottinghamshire , UK , doctors and nurses in 5 family practice s prescribed Skinsafe to patients with higher risk skin characteristics .  Measures of melanoma knowledge , perceived risk of melanoma and reported skin protective behaviors were obtained at baseline and at 6-month follow-up from 259 patients receiving the intervention and 330 patients with higher risk skin characteristics in 5 matched control practice s. RESULTS AND DISCUSSION Participants had low levels of melanoma knowledge at baseline . At follow-up , the intervention group had higher knowledge scores than control ( 3.71 vs. 3.03 , P < or = 0.001 ) , reported more protective skin behaviors ( 5.36 vs. 5.06 , P = 0.007 ) and were more likely to report mole checking ( odds ratio 1.67 , 95 % CI 1.04 to 2.70 , P = 0.035 ) . The Skinsafe intervention was evaluated positively by patients and could be used to support melanoma health education within clinical setting BACKGROUND Women overestimate both population and individual risk of cervical cancer . This may contribute to the recognised excess screening frequency for low-risk women . AIM To investigate whether an individualized risk communication package could affect stated preferences for screening interval and actual screening behaviour . DESIGN Pragmatic , practice -based cluster r and omised controlled trial . SETTING Twenty-nine practice s ( 15 intervention , 14 control ) in North Wales recruited 1890 women attending for cervical smears . METHOD A risk communication package containing visual material was compared with normal practice . Practice nurses received training in its delivery . The short-term primary outcome was stated preference for screening interval ; the long-term primary outcome was actual screening behaviour . RESULTS In the short term , intervention arm women were significantly less likely to prefer a shorter than recommended interval ( odds ratio [ OR ] = 0.51 , 95 % confidence interval [ CI ] = 0.41 to 0.64 ; P < 0.0001 ) . At the five-year follow-up , fewer women in the intervention arm had attended for screening sooner than their recommended recall . The magnitude of difference in excess screening interval preference and behaviour was similar , but behaviour had a wider confidence interval and a marginally non-significant P-value ( OR = 0.61 , 95 % CI = 0.36 to 1.03 ; P = 0.063 ) . Better knowledge and more accurate risk perceptions were demonstrated , with an improvement in measures of anxiety . The extra cost per woman receiving the intervention was 6 Pounds . CONCLUSIONS Women 's perception of risk contributes to determining screening intervals in addition to practice factors . Simple risk information delivered in primary care affected women 's stated preferences for tests . The impact on actual screening behaviour was more equivocal . Overall , the intervention showed a substantial benefit and any disbenefit can be ruled out . This approach to providing risk information could , at low cost , benefit other screening programmes and may relieve anxiety Approximately 20–30 % of women delay for 12 weeks or more from self-discovery of a breast symptom to presentation to a health care provider , and such delay intervals are associated with poorer survival . Underst and ing the factors that influence patient delay is important for the development of an effective , targeted health intervention programme to shorten patient delay . The aim of the study was to elicit knowledge and beliefs about breast cancer among a sample of the general female population , and examine age and socio-economic variations in responses . Participants were r and omly selected through the Postal Address File , and data were collected through the Office of National Statistics . Geographically distributed throughout the UK , 996 women participated in a short structured interview  to elicit their knowledge of breast cancer risk , breast cancer symptoms , and their perceptions of the management and outcomes associated with breast cancer . Women had limited knowledge of their relative risk of developing breast cancer , of associated risk factors and of the diversity of potential breast cancer-related symptoms . Older women were particularly poor at identifying symptoms of breast cancer , risk factors associated with breast cancer and their personal risk of developing the disease . Poorer knowledge of symptoms and risks among older women may help to explain the strong association between older age and delay in help-seeking . If these findings are confirmed they suggest that any intervention programme should target older women in particular , given that advancing age is a risk factor for both developing breast cancer and for subsequent delayed presentation Patients can benefit from accessible breast cancer risk information . The Gail model is a well-known means of providing risk information to patients and for guiding clinical decisions . Risk presentation often includes 5-year and lifetime percent chances for a woman to develop breast cancer . How do women perceive their risks after Gail model risk assessment ? This exploratory study used a r and omized clinical trial design to address this question among women not previously selected for breast cancer risk . Results suggest a brief  risk assessment intervention  changes quantitative and comparative risk perceptions and improves accuracy . This study improves our underst and ing of risk perceptions by evaluating an intervention in a population not previously selected for high-risk status and measuring perceptions in a variety of formats BACKGROUND Colorectal cancer is a leading cause of cancer mortality , yet effective screening tests are often underused . Electronic patient messages and personalized risk assessment s delivered via an electronic personal health record could increase screening rates . METHODS We conducted a r and omized controlled trial in 14 ambulatory health centers involving 1103 patients ranging in age from 50 to 75 years with an active electronic personal health record who were overdue for colorectal cancer screening . Patients were r and omly assigned to receive a single electronic message highlighting overdue screening status with a link to a Web-based tool to assess their personal risk of colorectal cancer .  The outcomes included colorectal cancer screening rates at 1 and 4 months . RESULTS Screening rates were higher at 1 month for patients who received electronic messages than for those who did not ( 8.3 % vs 0.2 % , P < .001 ) , but this difference was no longer significant at 4 months ( 15.8 % vs 13.1 % , P = .18 ) . Of 552 patients r and omized to receive the intervention , 296 ( 54 % ) viewed the message , and 47 ( 9 % ) used the Web-based risk assessment tool . Among 296 intervention patients who viewed the electronic message , risk tool users were more likely than nonusers to request screening examinations ( 17 % vs 4 % , P = .04 ) and to be screened ( 30 % vs 15 % , P = .06 ) . One-fifth of patients ( 19 % ) using the risk assessment tool were estimated to have an above-average risk for colorectal cancer . CONCLUSION Electronic messages to patients produce an initial increase in colorectal cancer screening rates , but this effect is not sustained over time . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01032746 Purpose : To assess the effectiveness of computerized familial risk assessment and tailored messages for identifying individuals for targeted cancer prevention strategies and motivating behavior change . Methods : We conducted a r and omized clinical trial in primary care patients aged 35–65 years using Family Healthware  , a self-administered , internet-based tool that collects family history for six common diseases including breast cancer , colon cancer , and ovarian cancer , stratifies risk into three tiers , and provides tailored prevention messages .  Cancer screening adherence and consultation were measured at baseline and 6-month follow-up . Results : Of 3283 participants , 34 % were at strong or moderate risk of at least one of the cancers . Family Healthware identified additional participants for whom earlier screening ( colon cancer , 4.4 % ; breast cancer , women ages : 35–39 years , 9 % ) or genetic assessment ( colon cancer , 2.5 % ; breast cancer , 10 % ; and ovarian cancer , 4 % ) may be indicated . Fewer than half were already adherent with risk-based screening . Screening adherence improved for all risk categories with no difference between intervention and control groups . Consultation with specialists did not differ between groups . Conclusion : Family Healthware identified patients for intensified cancer prevention . Engagement of clinicians and patients , integration with clinical decision support , and inclusion of nonfamilial risk factors may be necessary to achieve the full potential of computerized risk assessment The objective was to evaluate the effect of an assessment strategy using the computer decision support system ( the GRAIDS software ) , on the management of familial cancer risk in British general practice in comparison with best current practice . The design included cluster r and omised controlled trial , and involved forty-five general practice teams in East Anglia , UK . R and omised to GRAIDS ( Genetic Risk Assessment on the Internet with Decision Support ) support ( intervention n=23 ) or comparison ( n=22 ) . Training in the new assessment strategy and access to the GRAIDS software ( GRAIDS arm ) was conducted , compared with an educational session and guidelines about managing familial breast and colorectal cancer risk ( comparison ) were mailed . Outcomes were measured at practice , practitioner and patient levels . The primary outcome measure , at practice level , was the proportion of referrals made to the Regional Genetics Clinic for familial breast or colorectal cancer that were consistent with referral guidelines . Other measures included practitioner confidence in managing familial cancer ( GRAIDS arm only ) and , in patients : cancer worry , risk perception and knowledge about familial cancer . There were more referrals to the Regional Genetics Clinic from GRAIDS than comparison practice s ( mean 6.2 and 3.2 referrals per 10 000 registered patients per year ; mean difference 3.0 referrals ; 95 % confidence interval ( CI ) 1.2–4.8 ; P=0.001 ) ; referrals from GRAIDS practice s were more likely to be consistent with referral guidelines ( odds ratio (OR)=5.2 ; 95 % CI 1.7–15.8 , P=0.006 ) . Patients referred from GRAIDS practice s had lower cancer worry scores at the point of referral ( mean difference −1.44 95 % CI −2.64 to −0.23 , P=0.02 ) . There were no differences in patient knowledge about familial cancer . The intervention increased GPs ' confidence in managing familial cancer . Compared with education and mailed guidelines , assessment including computer decision support increased the number and quality of referrals to the Regional Genetics Clinic for familial cancer risk , improved practitioner confidence and had no adverse psychological effects in patients . Trials are registered under N0181144343 in the UK National Research Register BACKGROUND Shared decision making ( SDM ) is a widely recommended yet unproven strategy for increasing colorectal cancer ( CRC ) screening uptake . Previous trials of decision aids to increase SDM and CRC screening uptake have yielded mixed results . PURPOSE To assess the impact of decision aid-assisted SDM on CRC screening uptake . DESIGN RCT . SETTING / PARTICIPANTS The study was conducted at an urban , academic safety-net hospital and community health center between 2005 and 2010 . Participants were asymptomatic , average-risk patients aged 50 - 75 years due for CRC screening . INTERVENTION Study participants ( n=825 ) were r and omized to one of two intervention arms ( decision aid plus personalized risk assessment or decision aid alone ) or control arm . The interventions took place just prior to a routine office visit with their primary care providers . MAIN OUTCOME MEASURES The primary outcome was completion of a CRC screening test within 12 months of the study visit . Logistic regression was used to identify predictors of test completion and mediators of the intervention effect . Analysis was completed in 2011 . RESULTS Patients in the decision-aid group were more likely to complete a screening test than control patients ( 43.1 % vs 34.8 % , p=0.046 ) within 12 months of the study visit ; conversely , test uptake for the decision aid and decision aid plus personalized risk assessment arms was similar ( 43.1 % vs 37.1 % , p=0.15 ) . Assignment to the decision-aid arm ( AOR=1.48 , 95 % CI=1.04 , 2.10 ) , black race ( AOR=1.52 , 95 % CI=1.12 , 2.06 ) and a preference for a patient 
    Output:
    