Supplement

You have free access to this content

Informed decision making: What is its role in cancer screening?

  1. Barbara K. Rimer Dr.P.H.1,†,*,
  2. Peter A. Briss M.D., M.P.H.2,
  3. Paula K. Zeller M.A.3,
  4. Evelyn C.Y. Chan M.D., M.S.4,
  5. Steven H. Woolf M.D., M.P.H.5

Article first published online: 29 JUL 2004

DOI: 10.1002/cncr.20512

Issue

Cancer

Cancer

Supplement: Promoting Cancer Screening: Lessons Learned and Future Directions for Research and Practice

Volume 101, Issue Supplement S5, pages 1214–1228, 1 September 2004

Additional Information

How to Cite

Rimer, B. K., Briss, P. A., Zeller, P. K., Chan, E. C.Y. and Woolf, S. H. (2004), Informed decision making: What is its role in cancer screening?. Cancer, 101: 1214–1228. doi: 10.1002/cncr.20512

Author Information

  1. 1

    Department of Health Behavior and Health Education, School of Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

  2. 2

    Systematic Reviews Section, Community Guide Branch, Centers for Disease Control and Prevention, Atlanta, Georgia

  3. 3

    Communications Consultant, Olney, Maryland

  4. 4

    Biomedical Ethics, Division of General Internal Medicine, Department of Medicine, The University of Texas-Houston Health Science Center, Houston, Texas

  5. 5

    Departments of Family Medicine, Preventive Medicine, and Community Health, Virginia Commonwealth University, Richmond, Virginia

  1. †

    Fax: (919) 966-1787

*University of North Carolina Lineberger Comprehensive Cancer Center, CB 7295, Chapel Hill, NC 27599-7295

Publication History

  1. Issue published online: 18 AUG 2004
  2. Article first published online: 29 JUL 2004
  3. Manuscript Revised: 26 MAY 2004
  4. Manuscript Accepted: 26 MAY 2004
  5. Manuscript Received: 22 APR 2004

Funded by

  • K02 Independent Scientist Award from the Agency for Healthcare Research and Quality
  • Unknown funding agency. Grant Numbers: 5-P30-CA16086-28, 1-R01-CA105786-01

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (151K)

REFERENCES

  • 1
    Howard J. Using mammography for cancer control: an unrealized potential. CA Cancer J Clin. 1987; 37: 33–48.
    Direct Link:
  • 2
    Rimer BK, Keintz MK, Kessler HB, Engstrom PF, Rosan JR. Why women resist screening mammography: patient-related barriers. Radiology. 1989; 172: 243–246.
  • 3
    Fox SA, Siu AL, Stein JA. The importance of physician communication on breast cancer screening of older women. Arch Intern Med. 1994; 154: 2058–2068.
  • 4
    Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999; 49: 651–661.
  • 5
    Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992; 267: 2221–2226.
  • 6
    Brock DW. The ideal of shared decision making between physicians and patients. Kennedy Inst Ethics J. 1991; 1: 28–47.
  • 7
    U.S. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making health care decisions: a report on the ethical and legal implications of informed consent in the patient-practitioner relationship. Washington, DC: U.S. Government Printing Office, 1982.
  • 8
    Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992; 117: 1016–1037.
  • 9
    U.S. Preventive Services Task Force. Guide to clinical preventive services: report of the U.S. Preventive Services Task Force, 2nd ed. Washington, DC: U.S. Department of Health and Human Services, 1996.
  • 10
    Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002; 137(5 Pt 1): 347–360.
  • 11
    U.S. Preventive Services Task Force. Aspirin for the primary prevention of cardiovascular events: recommendations and rationale. Rockville: Agency for Healthcare Research and Quality, 2002. Available from URL: http://www.ahcpr.gov/clinic/3rduspstf/aspirin/asprr.htm [accessed Aug 1, 2003].
  • 12
    McConnell JD, Barry MJ, Bruskewitz RC. Benign prostatic hyperplasia: diagnosis and treatment. Clinical practice guideline no. 8. Rockville: Agency for Health Care Policy and Research, 1994.
  • 13
    Harris R, Leininger L. Clinical strategies for breast cancer screening: weighing and using the evidence. Ann Intern Med. 1995; 122: 539–547.
  • 14
    Morton E, Tambor E, Rimer BK, Tessaro I, Farrell D, Siegler IC. Impact of National Cancer Institute revised mammography screening guidelines on women 40–49. Women's Health Issues. 1996; 6: 246–254.
  • 15
    Kinsinger LS, Harris R. Breast cancer screening discussions for women in their forties. Breast Disease. 2001; 13: 21–31.
  • 16
    Saslow D, Runowicz CD, Solomon D, et al. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin. 2002; 52: 342–362.
    Direct Link:
  • 17
    Pignone M, Bucholtz D, Harris R. Patient preferences for colon cancer screening. J Gen Intern Med. 1999; 14: 432–437.
    Direct Link:
  • 18
    Woolf SH. The best screening test for colorectal cancer—a personal choice. N Engl J Med. 2000; 343: 1641–1643.
  • 19
    Chan EC, Sulmasy DP. What should men know about prostate-specific antigen screening before giving informed consent? Am J Med. 1998; 105: 266–274.
  • 20
    Volk RJ, Cass AR, Spann SJ. A randomized controlled trial of shared decision making for prostate cancer screening. Arch Fam Med. 1999; 8: 333–340.
  • 21
    Myers RE, Chodak GW, Wolf TA, et al. Adherence by African American men to prostate cancer education and early detection. Cancer. 1999; 86: 88–104.
    Direct Link:
  • 22
    Meisel A, Roth LH. Toward an informed discussion of informed consent: a review and critique of the empirical studies. Ariz Law Rev. 1983; 25: 265–346.
  • 23
    van den Borne HW. The patient from receiver of information to informed decision-maker. Patient Educ Couns. 1998; 34: 89–102.
  • 24
    Kaplan RM. Shared medical decision-making: a new paradigm for behavioral medicine—1997 presidential address. Ann Behav Med. 1999; 21: 3–11.
  • 25
    Elwyn G, Edwards A, Eccles M, Rovner D. Decision analysis in patient care. Lancet. 2001; 358: 571–574.
  • 26
    Eysenbach G, Jadad AR. Consumer health informatics in the Internet age. In: EdwardsA, ElwynG, editors. Evidence-based patient choice: inevitable or impossible? New York: Oxford University Press, 2001: 289–307.
  • 27
    Institute of Medicine. Speaking of health: assessing health communication strategies for diverse populations. Washington, DC: National Research Council, Institute of Medicine, 2002.
  • 28
    Kulkarni R, Graham J. Information technology in patient care: the Internet, telemedicine and clinical decision support. In: TierneyL, McPheeSJ, PapadakisMA, editors. Current medical diagnosis and treatment, 42nd ed. New York: Lange Medical Books/McGraw-Hill, 2003: 1678–1687.
  • 29
    Woolf SH. The logic and limits of shared decision making. J Urol. 2001; 166: 244–245.
  • 30
    Mulley AG. Supporting the patient's role in decision making. J Occup Med. 1990; 32: 1227–1228.
  • 31
    Flood AB, Wennberg JE, Nease RF Jr., Fowler FJ Jr., Ding J, Hynes LM. The importance of patient preference in the decision to screen for prostate cancer. Prostate Patient Outcomes Research Team. J Gen Intern Med. 1996; 11: 342–349.
  • 32
    Lawrence VA, Streiner D, Hazuda HP, Naylor R, Levine M, Gafni A. A cross-cultural consumer-based decision aid for screening mammography. Prev Med. 2000; 30: 200–208.
  • 33
    Jepson RG, Forbes CA, Sowden AJ, Lewis RA. Increasing informed uptake and non-uptake of screening: evidence from a systematic review. Health Expect. 2001; 4: 116–126.
    Direct Link:
  • 34
    Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press, 2001. Available from URL: http://www.nap.edu/books/0309072808/html/index.html [accessed November 26, 2003].
  • 35
    Braddock CH III, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999; 282: 2313–2320.
  • 36
    Chan EC. Promoting informed decision making about prostate cancer screening. Compr Ther. 2001; 27: 195–201.
  • 37
    Chan EC, Vernon SW, O'Donnell FT, Ahn C, Greisinger A, Aga DW. Informed consent for cancer screening with prostate-specific antigen: how well are men getting the message? Am J Public Health. 2003; 93: 779–785.
  • 38
    Rimer BK, Halabi S, Strigo TS, Crawford Y, Lipkus IM. Confusion about mammography: prevalence and consequences. J Womens Health Gender Based Med. 1999; 8: 509–520.
  • 39
    Rimer BK, Halabi S, Sugg Skinner C, et al. Effects of a mammography decision-making intervention at 12 and 24 months. Am J Prev Med. 2002; 22: 247–257.
  • 40
    Chamot E, Perneger TV. Misconceptions about efficacy of mammography screening: a public health dilemma. J Epidemiol Commun Health. 2001; 55: 799–803.
  • 41
    Gattellari M, Butow PN, Tattersall MH. Sharing decisions in cancer care. Soc Sci Med. 2001; 52: 1865–1878.
  • 42
    Briss P, Rimer B, Reilley B, et al. Promoting informed decisions about cancer screening in communities and healthcare systems. Am J Prev Med. 2004; 26: 67–80.
  • 43
    Sheridan SL, Harris RP, Woolf SH. Shared decision making about screening and chemoprevention. A suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med. 2004; 26: 56–66.
  • 44
    Barry MJ. Health decision aids to facilitate shared decision making in office practice. Ann Intern Med. 2002; 136: 127–135.
  • 45
    Whitney SN, McGuire AL, McCullough LB. A typology of shared decision making, informed consent, and simple consent. Ann Intern Med. 2004; 140: 54–59.
  • 46
    Beauchamp TL, Childress JF. Respect for autonomy. Principles of biomedical ethics, 5th ed. New York: Oxford University Press, 2001: 57–112.
  • 47
    O'Connor AM, Fiset V, DeGrasse C, et al. Decision aids for patients considering options affecting cancer outcomes: evidence of efficacy and policy implications. J Natl Cancer Inst Monogr. 1999;25: 67–80.
  • 48
    O'Connor AM, Stacey D, Rovner D, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2001; 1: CD001431.
  • 49
    Whelan TM, O'Brien MA, Villasis-Keever M, et al. Impact of cancer-related decision aids. Evidence report/technology assessment number 46. Rockville: Agency for Healthcare Research and Quality, 2002. Available from URL: http://www.ahcpr.gov/clinic/evrptfiles.htm#canceraids [accessed November 19, 2003].
  • 50
    Myers RE, Kunkel EJ. Preparatory education for informed decision-making in prostate cancer early detection and treatment. Semin Urol Oncol. 2000; 18: 172–177.
  • 51
    Whelan T, Sawka C, Levine M, et al. Helping patients make informed choices: a randomized trial of a decision aid for adjuvant chemotherapy in lymph node-negative breast cancer. J Natl Cancer Inst. 2003; 95: 581–587.
  • 52
    Ubel PA. Is information always a good thing? Helping patients make “good” decisions. Med Care. 2002; 40: V39–V44.
  • 53
    Dolan JG. Are patients capable of using the analytic hierarchy process and willing to use it to help make clinical decisions? Med Decis Making. 1995; 15: 76–80.
  • 54
    Dolan JG, Frisina S. Randomized controlled trial of a patient decision aid for colorectal cancer screening. Med Decis Making. 2002; 22: 125–139.
  • 55
    Dolan JG. A survey of clinicians' opinions regarding the value of published decision analyses as sources of clinically useful information. Med Decis Making. 1997; 17: 427–430.
  • 56
    McBride CM, Bastian LA, Halabi S, et al. A tailored intervention to aid decision-making about hormone replacement therapy. Am J Public Health. 2002; 92: 1112–1114.
  • 57
    Bastian LA, McBride CM, Fish L, et al. Evaluating participants' use of a hormone replacement therapy decision-making intervention. Patient Educ Couns. 2002; 48: 283–291.
  • 58
    Weinstein ND, Sandman PM. The precaution adoption process model. In: GlanzK, RimerBK, LewisFM, editors. Health behavior and health education: theory, research, and practice, 3rd ed. San Francisco: Jossey-Bass, 2002: 121–143.
  • 59
    Prochaska JO, Redding CA. The transtheoretical model and stages of change. In: GlanzK, RimerBK, LewisFM, editors. Health behavior and health education: theory, research, and practice, 3rd ed. San Francisco: Jossey-Bass, 2002: 99–120.
  • 60
    Myers RE. Self-regulation and decision-making about cancer screening. In: CameronLD, LeventhalH, KatouzianHD, editors. The self-regulation of health and illness behavior. New York: Routledge, 2003: 297–313.
  • 61
    Llewellyn-Thomas HA. Patients' health-care decision making: a framework for descriptive and experimental investigations. Med Decis Making. 1995; 15: 101–106.
  • 62
    Gafni A, Charles C, Whelan T. The physician-patient encounter: the physician as a perfect agent for the patient versus the informed treatment decision-making model. Soc Sci Med. 1998; 47: 347–354.
  • 63
    Entwistle VA, Sheldon TA, Sowden A, Watt IS. Evidence-informed patient choice. Practical issues of involving patients in decisions about health care technologies. Int J Technol Assess Health Care. 1998; 14: 212–225.
  • 64
    O'Connor AM, Tugwell P, Wells GA, et al. Randomized trial of a portable, self-administered decision aid for postmenopausal women considering long-term preventive hormone therapy. Med Decis Making. 1998; 18: 295–303.
  • 65
    Rothert ML, O'Connor AM. Health decisions and decision support for women. Annu Rev Nurs Res. 2001; 19: 307–324.
  • 66
    Wolf AM, Nasser JF, Wolf AM, Schorling JB. The impact of informed consent on patient interest in prostate-specific antigen screening. Arch Intern Med. 1996; 156: 1333–1336.
  • 67
    Davison BJ, Kirk P, Degner LF, Hassard TH. Information and patient participation in screening for prostate cancer. Patient Educ Couns. 1999; 37: 255–263.
  • 68
    Schapira MM, VanRuiswyk J. The effect of an illustrated pamphlet decision-aid on the use of prostate cancer screening tests. J Fam Pract. 2000; 49: 418–424.
  • 69
    Frosch DL, Kaplan RM, Felitti V. The evaluation of two methods to facilitate shared decision making for men considering the prostate-specific antigen test. J Gen Intern Med. 2001; 16: 391–398.
    Direct Link:
  • 70
    Wilt TJ, Paul J, Murdoch M, Nelson D, Nugent S, Rubins HB. Educating men about prostate cancer screening. A randomized trial of a mailed pamphlet. Eff Clin Pract. 2001; 4: 112–120.
  • 71
    Pignone M, Harris R, Kinsinger L. Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000; 133: 761–769.
  • 72
    Wolf AM, Schorling JB. Does informed consent alter elderly patients' preferences for colorectal cancer screening? Results of a randomized trial. J Gen Intern Med. 2000; 15: 24–30.
    Direct Link:
  • 73
    Rimer BK, Halabi S, Sugg Skinner C, et al. The short-term impact of tailored mammography decision-making interventions. Patient Educ Couns. 2001; 43: 269–285.
  • 74
    Briss PA, Zaza S, Pappaioanou M, et al. Developing an evidence-based Guide to Community Preventive Services—methods. The Task Force on Community Preventive Services. Am J Prev Med. 2000; 18: 35–43.
  • 75
    Volk RJ, Spann SJ, Cass AR, Hawley ST. Patient education for informed decision making about prostate cancer screening: a randomized controlled trial with 1-year follow-up. Ann Fam Med. 2003; 1: 22–28.
  • 76
    Harris R, Lohr KN. Screening for prostate cancer: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002; 137: 917–929.
  • 77
    Wolf AM, Becker DM. Cancer screening and informed patient discussions. Truth and consequences. Arch Intern Med. 1996; 156: 1069–1072.
  • 78
    Entwistle VA, Sowden AJ, Watt IS. Evaluating interventions to promote patient involvement in decision-making: by what criteria should effectiveness be judged? J Health Serv Res Policy. 1998; 3: 100–107.
  • 79
    U.S. Preventive Services Task Force. Screening for breast cancer: recommendations and rationale. Rockville: Agency for Healthcare Research and Quality, 2002. Available from URL: http://www.ahcpr.gov/clinic/3rduspstf/breastcancer/brcanrr.htm [accessed August 1, 2003].
  • 80
    U.S. Preventive Services Task Force. Screening for cervical cancer: recommendations and rationale. Rockville: Agency for Healthcare Research and Quality, 2002. Available from URL: http://www.ahcpr.gov/clinic/3rduspstf/cervcan/cervcanrr.htm [accessed August 1, 2003].
  • 81
    U.S. Preventive Services Task Force. Screening for colorectal cancer: recommendations and rationale. Rockville: Agency for Healthcare Research and Quality, 2002. Available from URL: http://www.ahcpr.gov/clinic/3rduspstf/colorectal/colorr.htm [accessed August 1, 2003].
  • 82
    Newcomb PA, Storer BE, Morimoto LM, Templeton A, Potter JD. Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. J Natl Cancer Inst. 2003; 95: 622–625.
  • 83
    Forbes C, Jepson R, Martin-Hirsch P. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev. 2002; 3: CD002834.
  • 84
    Walsh JM, McPhee SJ. Prevention in the year 2002: some news, some issues. Prim Care. 2002; 29: 727–49, xi.
  • 85
    Harris Interactive. Cyberchondriacs continue to grow in America. Harris Health Care News. 2002; 2: 1–4.
  • 86
    Thorne SE. Communication in cancer care: what science can and cannot teach us. Cancer Nurs. 1999; 22: 370–378.
  • 87
    Harrington J, Noble LM, Newman SP. Improving patients' communications with doctors: a systematic review of intervention studies [review]. Patient Educ Couns. 2004; 52: 7–16.
  • 88
    Ende J, Kazis L, Ash A, Moskowitz MA. Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med. 1989; 4: 23–30.
  • 89
    Nease RF Jr., Brooks WB. Patient desire for information and decision making in health care decisions: the Autonomy Preference Index and the Health Opinion Survey. J Gen Intern Med. 1995; 10: 593–600.
  • 90
    O'Dell KJ, Volk RJ, Cass AR, Spann SJ. Screening for prostate cancer with the prostate-specific antigen test: are patients making informed decisions? J Fam Pract. 1999; 48: 682–688.
  • 91
    Thornton H, Dixon-Woods M. Prostate specific antigen testing for prostate cancer. BMJ. 2002; 325: 725–726.
  • 92
    Frosch DL, Kaplan RM. Shared decision making in clinical medicine: past research and future directions. Am J Prev Med. 1999; 17: 285–294.
  • 93
    Benbassat J, Pilpel D, Tidhar M. Patients' preferences for participation in clinical decision making: a review of published surveys. Behav Med. 1998; 24: 81–88.
  • 94
    Myers RE. African American men, prostate cancer early detection examination use, and informed decision-making. Semin Oncol. 1999; 26: 375–381.
  • 95
    Arora NK, McHorney CA. Patient preferences for medical decision making: who really wants to participate? Med Care. 2000; 38: 335–341.
  • 96
    Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985; 102: 520–528.
  • 97
    Karlawish JH, Fox E, Pearlman R. How changes in health care practices, systems, and research challenge the practice of informed consent. Med Care. 2002; 40: V12–V19.
  • 98
    Woloshin S, Schwartz LM, Moncur M, Gabriel S, Tosteson AN. Assessing values for health: numeracy matters. Med Decis Making. 2001; 21: 382–390.
  • 99
    Edwards A, Unigwe S, Elwyn G, Hood K. Personalised risk communication for informed decision making about entering screening programs. Cochrane Database Syst Rev. 2003; 1: CD001865.
  • 100
    Martin W, Lobchuk M. Breast cancer risk perception and surveillance: an integrative review. Online J Knowl Synth Nurs. 2003; 10: 2.
  • 101
    Farrell MH, Murphy MA, Schneider CE. How underlying patient beliefs can affect physician-patient communication about prostate-specific antigen testing. Eff Clin Pract. 2002; 5: 120–129.
  • 102
    Cantor SB, Volk RJ, Cass AR, Gilani J, Spann SJ. Psychological benefits of prostate cancer screening: the role of reassurance. Health Expect. 2002; 5: 104–113.
    Direct Link:
  • 103
    Nekhlyudov L, Ross-Degnan D, Fletcher SW. Beliefs and expectations of women under 50 years old regarding screening mammography. J Gen Intern Med. 2003; 18: 182–189.
    Direct Link:
  • 104
    Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999; 282: 583–589.
  • 105
    Davey HM, Barratt AL, Davey E, et al. Medical tests: women's reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results. Health Expect. 2002; 5: 330–340.
    Direct Link:
  • 106
    Nguyen TT, McPhee SJ. Patient-provider communication in cancer screening. J Gen Intern Med. 2003; 18: 402–403.
    Direct Link:
  • 107
    McPhee SJ. Caring for a 70-year-old Vietnamese woman. JAMA. 2002; 287: 495–504.
  • 108
    Holmes-Rovner M, Wills CE. Improving informed consent: insights from behavioral decision research. Med Care. 2002; 40: V30–V38.
  • 109
    Say RE, Thomson R. The importance of patient preferences in treatment decisions—challenges for doctors. BMJ. 2003; 327: 542–545.
  • 110
    Bruera E, Willey JS, Palmer JL, Rosales M. Treatment decisions for breast carcinoma: patient preferences and physician perceptions. Cancer. 2002; 94: 2076–2080.
    Direct Link:
  • 111
    Tiller K, Meiser B, Reeson E, et al. A decision aid for women at increased risk for ovarian cancer. Int J Gynecol Cancer. 2003; 13: 15–22.
    Direct Link:
  • 112
    Arora NK, Ayanian JZ, Guadagnoli E. Facilitating patient participation in medical decision-making: an evaluation of constructs of the transtheoretical model of behavior change. Presented at the annual meeting of the Academy of Health Services Research and Health Policy, Atlanta, Georgia, June 10, 2001.
  • 113
    Marteau TM, Kinmouth AL. Screening for cardiovascular risk: public health imperative or matter for individual informed choice? BMJ. 2002; 325: 78–80.
  • 114
    Rohrmann B. A socio-pyschological model for analyzing risk communication processes. Australas J Disaster Trauma Studies. 2000–2002. Available from URL: http://www.massey.ac.nz/≈trauma/issues/2000-2/rohrmann.htm [accessed October 13, 2003].
  • 115
    Fischhoff B. Why (cancer) risk communication can be hard. J Natl Cancer Inst Monogr. 1999; 25: 7–13.
  • 116
    Wolf AM, Schorling JB. Preferences of elderly men for prostate-specific antigen screening and the impact of informed consent. J Gerontol A Biol Sci Med Sci. 1998; 53: M195–M200.
View Full Article (HTML) Get PDF (151K)