{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:24:35Z","timestamp":1790857475506,"version":"4.1.0"},"reference-count":64,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Patients undergoing surgery report a lack of involvement in health care decisions and increased anxiety. Three-dimensional (3D)-printed models serve as educational tools to encourage patient engagement, reduce anxiety levels, and aid understanding.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine the impact of 3D-printed anatomic models on shared decision-making (SDM) and patient anxiety during the preoperative surgical consultation for colon or rectal resection.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This single-center cluster randomized clinical trial was conducted from March 2022 to June 2023 at a colorectal surgery clinic at an academic medical institution and included adult patients scheduled for partial or complete colon and\/or rectal resection for colorectal cancer, diverticular disease, or inflammatory bowel disease.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Six surgeons (clusters) were randomized to counsel patients using a modular 3D-printed model or providing usual care during preoperative clinic visits.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was the patient\u2019s perception of involvement in decision-making using the 9-item Shared Decision Making Questionnaire. The secondary outcome was the change in anxiety level measured using the State-Trait Anxiety Inventory. Patient characteristics were compared between the 3D-printed model and usual care arms using a \u03c72<\/jats:sup> test for categorical variables and a t<\/jats:italic> test for comparisons between continuous variables.<\/jats:p><\/jats:sec>Results<\/jats:title>Among the 51 patients enrolled (mean [SD] age, 50.7 [14.5] years; 28 female [54.9%]), 28 (54.9%) were in the 3D-printed model arm and 23 (45.1%) were in the usual care arm. Patients counseled with the 3D-printed model reported a significantly higher involvement in SDM compared with those in the usual care group (mean [SD] score, 89.5 [17.6] vs 80.5 [14.4]; P<\/jats:italic>\u2009=\u2009.01). Additionally, using a 3D-printed model significantly reduced mean anxiety scores (from 53.5 [SD, 21.2] to 44.1 [SD, 15.8]) compared with conventional methods (from 50.4 [SD, 18.3] to 48.0 [SD, 15.3]) (P<\/jats:italic>\u2009=\u2009.04).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cluster randomized clinical trial found that counseling aided with 3D models during preoperative clinic visits improved SDM among patients undergoing colorectal surgery. This study highlights the potential of 3D-printed models as a tool to enhance patient\u2013clinician collaborations. Given the findings, further research into the effectiveness and implementation of these tools is recommended in more diverse clinical settings.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT06625008<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.13187","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T15:01:04Z","timestamp":1748962864000},"page":"e2513187","source":"Crossref","is-referenced-by-count":9,"title":["Three-Dimensional\u2013Printed Models and Shared Decision-Making"],"prefix":"10.1001","volume":"8","author":[{"given":"Aimal","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina E.","family":"Sellyn","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danish","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zorays","family":"Moazzam","sequence":"additional","affiliation":[{"name":"Department of Surgery, Henry Ford Hospital, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary","family":"Samaras","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon L.","family":"McChesney","sequence":"additional","affiliation":[{"name":"Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly M.","family":"Ford","sequence":"additional","affiliation":[{"name":"Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta L.","family":"Muldoon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M.","family":"Geiger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dann","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel I.","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle K.","family":"VanKoevering","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, The Ohio State University College of Medicine, Columbus"},{"name":"Skull Base Surgery Research Fellowship Program, The Ohio State University College of Medicine, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T.","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"issue":"1","key":"zoi250436r1","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.amjsurg.2010.12.010","article-title":"Beyond consent\u2014improving understanding in surgical patients.","volume":"203","author":"Mulsow","year":"2012","journal-title":"Am J Surg"},{"issue":"4","key":"zoi250436r2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jopan.2022.05.053","article-title":"Improving the patient experience through a preoperative educational initiative.","volume":"37","author":"Willemin","year":"2022","journal-title":"J Perianesth Nurs"},{"issue":"7842","key":"zoi250436r3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e256","article-title":"Shared decision making: really putting patients at the centre of healthcare.","volume":"344","author":"Stiggelbout","year":"2012","journal-title":"BMJ"},{"issue":"11","key":"zoi250436r4","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1001\/jamasurg.2023.2396","article-title":"Shared decision-making in the surgical sciences.","volume":"158","author":"Hawkins","year":"2023","journal-title":"JAMA Surg"},{"issue":"1","key":"zoi250436r5","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1056\/NEJMp1209500","article-title":"Shared decision making to improve care and reduce costs.","volume":"368","author":"Oshima Lee","year":"2013","journal-title":"N Engl J Med"},{"issue":"5","key":"zoi250436r6","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1097\/SLA.0b013e3182864fd6","article-title":"Decision aids for patients facing a surgical treatment decision: a systematic review and meta-analysis.","volume":"257","author":"Knops","year":"2013","journal-title":"Ann Surg"},{"issue":"1","key":"zoi250436r7","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.amjsurg.2018.01.011","article-title":"Association of shared decision-making on patient-reported health outcomes and healthcare utilization.","volume":"216","author":"Hughes","year":"2018","journal-title":"Am J Surg"},{"issue":"7","key":"zoi250436r8","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1111\/imj.16381","article-title":"Effect of a person-centred goals-of-care form and clinical communication training on shared decision-making and outcomes in an acute hospital: a prospective longitudinal interventional study.","volume":"54","author":"Tierney","year":"2024","journal-title":"Intern Med J"},{"issue":"1","key":"zoi250436r9","doi-asserted-by":"publisher","first-page":"62","DOI":"10.2106\/JBJS.21.00064","article-title":"Shared decision-making is associated with better outcomes in patients with knee but not hip osteoarthritis: the DECIDE-OA randomized study.","volume":"104","author":"Sepucha","year":"2022","journal-title":"J Bone Joint Surg Am"},{"key":"zoi250436r10","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01325","article-title":"Prospective evaluation of patient comprehension of informed consent.","author":"Crepeau","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"zoi250436r11","article-title":"Preoperative informed consent: is it truly informed?","author":"Jawaid","year":"2012","journal-title":"Iran J Public Health"},{"issue":"10","key":"zoi250436r12","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1016\/j.pec.2015.06.022","article-title":"Shared decision making: concepts, evidence, and practice.","volume":"98","author":"Stiggelbout","year":"2015","journal-title":"Patient Educ Couns"},{"issue":"1","key":"zoi250436r13","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1111\/scs.12823","article-title":"Patient involvement in surgical care\u2014healthcare personnel views and behaviour regarding patient involvement.","volume":"35","author":"Andersson","year":"2021","journal-title":"Scand J Caring Sci"},{"issue":"1","key":"zoi250436r14","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1080\/08998280.2017.11929552","article-title":"Improving health outcomes through patient education and partnerships with patients.","volume":"30","author":"Paterick","year":"2017","journal-title":"Proc (Bayl Univ Med Cent)"},{"issue":"3","key":"zoi250436r15","doi-asserted-by":"publisher","first-page":"313","DOI":"10.4065\/83.3.313","article-title":"Medical informed consent: general considerations for physicians.","volume":"83","author":"Paterick","year":"2008","journal-title":"Mayo Clin Proc"},{"key":"zoi250436r16","doi-asserted-by":"publisher","DOI":"10.1186\/s41205-023-00198-4","article-title":"The utility of three-dimensional modeling and printing in pediatric surgical patient and family education: a systematic review.","author":"Yang","year":"2024","journal-title":"3D Print Med"},{"issue":"11","key":"zoi250436r17","doi-asserted-by":"publisher","first-page":"365","DOI":"10.3390\/jcdd11110365","article-title":"Empowering EVAR: revolutionizing patient understanding and qualification with 3D printing.","volume":"11","author":"Kargul","year":"2024","journal-title":"J Cardiovasc Dev Dis"},{"key":"zoi250436r18","doi-asserted-by":"publisher","first-page":"e526","DOI":"10.1016\/j.wneu.2022.03.049","article-title":"Use of three-dimensional printed brain models during deep brain stimulation surgery consultation for patient health literacy: a randomized controlled investigation.","volume":"162","author":"Hirt","year":"2022","journal-title":"World Neurosurg"},{"issue":"10","key":"zoi250436r19","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.70822","article-title":"Impact of 3D-printed anatomical models on doctor-patient communication in orthopedic consultations: a randomized clinical trial.","volume":"16","author":"Sanchez","year":"2024","journal-title":"Cureus"},{"issue":"1","key":"zoi250436r20","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1007\/s00261-018-1710-1","article-title":"Impact of a 3D printed model on patients\u2019 understanding of renal cryoablation: a prospective pilot study.","volume":"44","author":"Schmit","year":"2019","journal-title":"Abdom Radiol (NY)"},{"key":"zoi250436r21","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOSGlobal-D-24-00116","article-title":"Improving patient understanding of femoroacetabular impingement syndrome with three-dimensional models.","author":"Kahsai","year":"2024","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"issue":"1","key":"zoi250436r22","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1186\/s13019-021-01604-w","article-title":"A three-dimensional printed model in preoperative consent for ventricular septal defect repair.","volume":"16","author":"Deng","year":"2021","journal-title":"J Cardiothorac Surg"},{"issue":"1","key":"zoi250436r23","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1038\/s41598-023-28423-4","article-title":"Application of 3D printing technology for pre-operative evaluation, education and informed consent in pediatric retroperitoneal tumors.","volume":"13","author":"Youn","year":"2023","journal-title":"Sci Rep"},{"issue":"5","key":"zoi250436r24","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1590\/s1677-5538.ibju.2018.0162","article-title":"Personalized 3D kidney model produced by rapid prototyping method and its usefulness in clinical applications.","volume":"44","author":"Lee","year":"2018","journal-title":"Int Braz J Urol"},{"key":"zoi250436r25","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/8054698","article-title":"The feasibility of 3D printing technology on the treatment of pilon fracture and its effect on doctor-patient communication.","volume":"2018","author":"Zheng","year":"2018","journal-title":"Biomed Res Int"},{"issue":"4","key":"zoi250436r26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-007165","article-title":"3D-manufactured patient-specific models of congenital heart defects for communication in clinical practice: feasibility and acceptability.","volume":"5","author":"Biglino","year":"2015","journal-title":"BMJ Open"},{"issue":"3","key":"zoi250436r27","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s00345-015-1632-2","article-title":"Personalized 3D printed model of kidney and tumor anatomy: a useful tool for patient education.","volume":"34","author":"Bernhard","year":"2016","journal-title":"World J Urol"},{"issue":"4","key":"zoi250436r28","doi-asserted-by":"publisher","first-page":"398","DOI":"10.3340\/jkns.2019.0092","article-title":"Obtaining informed consent using patient specific 3D printing cerebral aneurysm model.","volume":"62","author":"Kim","year":"2019","journal-title":"J Korean Neurosurg Soc"},{"issue":"6","key":"zoi250436r29","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1007\/s11255-018-1881-2","article-title":"Usefulness of personalized three-dimensional printed model on the satisfaction of preoperative education for patients undergoing robot-assisted partial nephrectomy and their families.","volume":"50","author":"Teishima","year":"2018","journal-title":"Int Urol Nephrol"},{"issue":"2","key":"zoi250436r30","doi-asserted-by":"publisher","first-page":"931","DOI":"10.21037\/tau.2020.01.03","article-title":"Role of 3D printing in surgical education for robotic urology procedures.","volume":"9","author":"Ghazi","year":"2020","journal-title":"Transl Androl Urol"},{"issue":"2","key":"zoi250436r31","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3390\/jfb8020013","article-title":"Patient education for endoscopic sinus surgery: preliminary experience using 3D-printed clinical imaging data.","volume":"8","author":"Sander","year":"2017","journal-title":"J Funct Biomater"},{"key":"zoi250436r32","doi-asserted-by":"publisher","DOI":"10.1186\/s41205-019-0041-3","article-title":"Patient-specific 3D printed and augmented reality kidney and prostate cancer models: impact on patient education.","author":"Wake","year":"2019","journal-title":"3D Print Med"},{"issue":"6","key":"zoi250436r33","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.8533","article-title":"Evaluating the use of a generic three-dimensionally (3D) printed abdominal aortic aneurysm model as an adjunct patient education tool.","volume":"12","author":"Khural","year":"2020","journal-title":"Cureus"},{"issue":"2","key":"zoi250436r34","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.jcrc.2005.04.005","article-title":"Randomization and allocation concealment: a practical guide for researchers.","volume":"20","author":"Doig","year":"2005","journal-title":"J Crit Care"},{"issue":"20","key":"zoi250436r35","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.","volume":"310","author":"World Medical Association","year":"2013","journal-title":"JAMA"},{"issue":"2","key":"zoi250436r36","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1080\/105294199277860","article-title":"The International Conference on Harmonization Good Clinical Practice guideline.","volume":"6","author":"Dixon","year":"1998","journal-title":"Qual Assur"},{"issue":"5-6","key":"zoi250436r37","doi-asserted-by":"publisher","first-page":"e747","DOI":"10.1093\/milmed\/usab486","article-title":"Shared decision-making during labor and birth among low-risk, active duty women in the U.S. military.","volume":"187","author":"Iobst","year":"2022","journal-title":"Mil Med"},{"key":"zoi250436r38","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110115","article-title":"Shared decision making with breast cancer patients\u2014does it work? results of the cluster-randomized, multicenter DBCG RT SDM trial.","volume":"193","author":"S\u00f8ndergaard","year":"2024","journal-title":"Radiother Oncol"},{"issue":"1","key":"zoi250436r39","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.pec.2009.09.034","article-title":"The 9-item Shared Decision Making Questionnaire (SDM-Q-9): development and psychometric properties in a primary care sample.","volume":"80","author":"Kriston","year":"2010","journal-title":"Patient Educ Couns"},{"key":"zoi250436r40","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2012.712615","article-title":"Measurement variation across health literacy assessments: implications for assessment selection in research and practice.","author":"Haun","year":"2012","journal-title":"J Health Commun"},{"issue":"1","key":"zoi250436r41","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1007\/s11606-013-2568-0","article-title":"Psychometric properties of the Brief Health Literacy Screen in clinical practice.","volume":"29","author":"Wallston","year":"2014","journal-title":"J Gen Intern Med"},{"issue":"4","key":"zoi250436r42","first-page":"359","article-title":"Minimal important difference for anxiety and depression surveys after intervention to increase daily physical activity in smokers.","volume":"21","author":"Corsaletti","year":"2014","journal-title":"Fisioter Pesqui"},{"issue":"3","key":"zoi250436r43","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1111\/j.2044-8260.1992.tb00997.x","article-title":"The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI).","volume":"31","author":"Marteau","year":"1992","journal-title":"Br J Clin Psychol"},{"issue":"6","key":"zoi250436r44","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1111\/j.1524-4733.2010.00758.x","article-title":"Measuring patient anxiety in primary care: Rasch analysis of the 6-item Spielberger State Anxiety Scale.","volume":"13","author":"Court","year":"2010","journal-title":"Value Health"},{"issue":"6","key":"zoi250436r45","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1097\/ACO.0000000000001186","article-title":"Preoperative anxiety.","volume":"35","author":"Friedrich","year":"2022","journal-title":"Curr Opin Anaesthesiol"},{"issue":"1","key":"zoi250436r46","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s13584-018-0250-z","article-title":"Promoting patient comprehension of relevant health information.","volume":"7","author":"Kreps","year":"2018","journal-title":"Isr J Health Policy Res"},{"issue":"3","key":"zoi250436r47","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.pec.2011.04.029","article-title":"Development and validation of motivational messages to improve prescription medication adherence for patients with chronic health problems.","volume":"83","author":"Kreps","year":"2011","journal-title":"Patient Educ Couns"},{"issue":"4","key":"zoi250436r50","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1007\/s00246-017-1586-9","article-title":"Piloting the use of patient-specific cardiac models as a novel tool to facilitate communication during clinical consultations.","volume":"38","author":"Biglino","year":"2017","journal-title":"Pediatr Cardiol"},{"issue":"5","key":"zoi250436r51","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.8377","article-title":"Evaluation of a novel 3D-printed urinary catheterization simulation model in undergraduate medical teaching.","volume":"12","author":"Gillis","year":"2020","journal-title":"Cureus"},{"issue":"10","key":"zoi250436r52","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1016\/j.jacr.2020.05.030","article-title":"Effectiveness of three-dimensionally printed models in anatomy education for medical students and resident physicians: systematic review and meta-analysis.","volume":"17","author":"Fleming","year":"2020","journal-title":"J Am Coll Radiol"},{"issue":"6","key":"zoi250436r53","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1007\/s00246-019-02146-8","article-title":"Utility of 3D printed cardiac models for medical student education in congenital heart disease: across a spectrum of disease severity.","volume":"40","author":"Smerling","year":"2019","journal-title":"Pediatr Cardiol"},{"key":"zoi250436r54","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.ijsu.2014.12.020","article-title":"Three-dimensional (3D) simulation versus two-dimensional (2D) enhances surgical skills acquisition in standardised laparoscopic tasks: a before and after study.","volume":"14","author":"Ashraf","year":"2015","journal-title":"Int J Surg"},{"issue":"2","key":"zoi250436r55","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1053\/j.semtcvs.2018.10.017","article-title":"Personalized 3D-printed model for informed consent for stage I lung cancer: a randomized pilot trial.","volume":"31","author":"Yoon","year":"2019","journal-title":"Semin Thorac Cardiovasc Surg"},{"issue":"4","key":"zoi250436r56","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1002\/lary.29757","article-title":"To pack a nose: high-fidelity epistaxis simulation using 3D printing technology.","volume":"132","author":"Gao","year":"2022","journal-title":"Laryngoscope"},{"issue":"1","key":"zoi250436r57","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1186\/s12911-020-01211-0","article-title":"Shared decision making in surgery: a scoping review of patient and surgeon preferences.","volume":"20","author":"Shinkunas","year":"2020","journal-title":"BMC Med Inform Decis Mak"},{"issue":"6","key":"zoi250436r58","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.jaad.2019.05.085","article-title":"The use of 3-dimensionally printed models to optimize patient education and alleviate perioperative anxiety in Mohs micrographic surgery: a randomized controlled trial.","volume":"81","author":"Biro","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"zoi250436r59","doi-asserted-by":"publisher","first-page":"1949","DOI":"10.2147\/PPA.S419866","article-title":"The effect of health literacy on preoperative anxiety levels in patients undergoing elective surgery.","volume":"17","author":"Demirel","year":"2023","journal-title":"Patient Prefer Adherence"},{"issue":"2","key":"zoi250436r60","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/s00540-013-1712-7","article-title":"The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparoscopic cholecystectomy.","volume":"28","author":"Ali","year":"2014","journal-title":"J Anesth"},{"issue":"1","key":"zoi250436r61","doi-asserted-by":"publisher","first-page":"6312","DOI":"10.1038\/s41598-022-10302-z","article-title":"The effect of preoperative patient-reported anxiety on morbidity and mortality outcomes in patients undergoing major general surgery.","volume":"12","author":"Kassahun","year":"2022","journal-title":"Sci Rep"},{"issue":"1","key":"zoi250436r62","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.amjcard.2012.08.060","article-title":"Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery.","volume":"111","author":"Williams","year":"2013","journal-title":"Am J Cardiol"},{"issue":"6","key":"zoi250436r63","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1177\/0272989X16638330","article-title":"Self-management skills in chronic disease management: what role does health literacy have?","volume":"36","author":"Mackey","year":"2016","journal-title":"Med Decis Making"},{"issue":"8","key":"zoi250436r64","doi-asserted-by":"publisher","first-page":"1676","DOI":"10.3390\/ijerph15081676","article-title":"Beyond reading and understanding: health literacy as the capacity to act.","volume":"15","author":"Rademakers","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"zoi250436r48","year":"2018"},{"key":"zoi250436r49","volume-title":"Health Literacy: A Prescription to End Confusion","year":"2004"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2834851\/khan_2025_oi_250436_1748026088.0523.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T15:01:09Z","timestamp":1748962869000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2834851"}},"subtitle":["A Cluster Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":64,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.13187","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,3]]}}}