***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 --To measure effects on terminally ill cancer patients and their families of coordinating the services available within the NHS and from local authorities and the voluntary sector . DESIGN --R and omised controlled trial . SETTING --Inner London health district . PATIENTS --Cancer patients were routinely notified from 1987 to 1990 . 554 patients expected to survive less than one year entered the trial and were r and omly allocated to a coordination or a control group . INTERVENTION -- All patients received routinely available services . Coordination group patients received the assistance of two nurse coordinators , whose role was to ensure that patients received appropriate and well coordinated services , tailored to their individual needs and circumstances . MAIN OUTCOME MEASURES -- Patients and carers were interviewed at home on entry to the trial and at intervals until death . Interviews after bereavement were also conducted . Outcome measures included the presence and severity of physical symptoms , psychiatric morbidity , use of and satisfaction with services , and carers ' problems . Results from the baseline interview , the interview closest to death , and the interview after bereavement were analysed . RESULTS --Few differences between groups were significant . Coordination group patients were less likely to suffer from vomiting , were more likely to report effective treatment for it , and less likely to be concerned about having an itchy skin . Their carers were more likely to report that in the last week of life the patient had had a cough and had had effective treatment for constipation , and they were less likely to rate the patient 's difficulty swallowing as severe or to report effective treatment for anxiety . Coordination group patients were more likely to have seen a chiropodist and their carers were more likely to contact a specialist nurse in a night time emergency . These carers were less likely to feel angry about the death of the patient . CONCLUSIONS --This coordinating service made little difference to patient or family outcomes , perhaps because the service did not have a budget with which it could obtain services or because the professional skills of the nurse-coordinators may have conflicted with the requirements of the coordinating role OBJECTIVES Dementia is a rapidly growing public health problem in low and middle income countries . There is an urgent need , in the absence of formal services , to develop interventions design ed to improve the lives of people with dementia , and their families . This study tests the effectiveness of the 10/66 caregiver intervention among people with dementia , and their carers . DESIGN A single blind parallel group r and omized controlled trial ( IS RCT N41039907 ) . SETTING Moscow . PARTICIPANTS Sixty family caregivers of people aged 65 and over with dementia were r and omized to receive the intervention and medical care as usual ( n = 30 ) or medical care as usual only ( n = 30 ) . Caregiver and person with dementia outcomes were assessed at baseline and after 6 months . INTERVENTION The caregiver education and training intervention was delivered over five , weekly , half-hour sessions and was made up of three modules : ( i ) assessment ( one session ) ; ( ii ) basic education about dementia ( two sessions ) ; and ( iii ) training regarding specific problem behaviors ( two sessions ) . MEASUREMENTS Dementia was diagnosed using DSM-IV criteria . Caregiver : Zarit Carer Burden Interview ; carer psychological distress ( SRQ 20 ) ; and carer Quality of Life ( WHOQOL-BREF ) . Person with dementia : Behavioural and Psychological symptoms ( NPI-Q ) ; quality of life ( DEMQOL ) . RESULTS Caregivers in the intervention group reported large and statistically significant net improvements at 6-month follow-up in burden compared to controls . No group differences were found on caregiver psychological distress and patient and caregiver quality of life . CONCLUSIONS The low-level intervention seems to be as , if not more , effective than similar interventions applied in high income countries Systematic review s provide the best evidence on the effectiveness of healthcare interventions including quality improvement strategies . The methods of systematic review of individual patient r and omised trials of healthcare interventions are well developed . We discuss method ological and practice issues that need to be considered when undertaking systematic review s of quality improvement strategies including developing a review protocol , identifying and screening evidence sources , quality assessment and data abstract ion , analytical methods , reporting systematic review s , and appraising systematic review s. This paper builds on our experiences within the Cochrane Effective Practice and Organisation of Care ( EPOC ) review group CONTEXT There are few r and omized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer . OBJECTIVE To determine the effect of a nursing-led intervention on quality of life , symptom intensity , mood , and re source use in patients with advanced cancer . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from November 2003 through May 2008 of 322 patients with advanced cancer in a rural , National Cancer Institute- design ated comprehensive cancer center in New Hampshire and affiliated outreach clinics and a VA medical center in Vermont . INTERVENTIONS A multicomponent , psychoeducational intervention ( Project ENABLE [ Educate , Nurture , Advise , Before Life Ends ] ) conducted by advanced practice nurses consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion ( n = 161 ) vs usual care ( n = 161 ) . MAIN OUTCOME MEASURES Quality of life was measured by the Functional Assessment of Chronic Illness Therapy for Palliative Care ( score range , 0 - 184 ) . Symptom intensity was measured by the Edmonton Symptom Assessment Scale ( score range , 0 - 900 ) . Mood was measured by the Center for Epidemiological Studies Depression Scale ( range , 0 - 60 ) . These measures were assessed at baseline , 1 month , and every 3 months until death or study completion . Intensity of service was measured as the number of days in the hospital and in the intensive care unit ( ICU ) and the number of emergency department visits recorded in the electronic medical record . RESULTS A total of 322 participants with cancer of the gastrointestinal tract ( 41 % ; 67 in the usual care group vs 66 in the intervention group ) , lung ( 36 % ; 58 vs 59 ) , genitourinary tract ( 12 % ; 20 vs 19 ) , and breast ( 10 % ; 16 vs 17 ) were r and omized . The estimated treatment effects ( intervention minus usual care ) for all participants were a mean ( SE ) of 4.6 ( 2 ) for quality of life ( P = .02 ) , -27.8 ( 15 ) for symptom intensity ( P = .06 ) , and -1.8 ( 0.81 ) for depressed mood ( P = .02 ) . The estimated treatment effects in participants who died during the study were a mean ( SE ) of 8.6 ( 3.6 ) for quality of life ( P = .02 ) , -24.2 ( 20.5 ) for symptom intensity ( P = .24 ) , and -2.7 ( 1.2 ) for depressed mood ( P = .03 ) . Intensity of service did not differ between the 2 groups . CONCLUSION Compared with participants receiving usual oncology care , those receiving a nurse-led , palliative care-focused intervention addressing physical , psychosocial , and care coordination provided concurrently with oncology care had higher scores for quality of life and mood , but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or emergency department visits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00253383 BACKGROUND Although  family caregiving  has been intensively studied in the past decade , little attention has been paid to the impact of end-of-life care on caregivers who are family members of persons with dementia or to the caregivers ' responses to the death of the patient . METHODS Using st and ardized assessment instruments and structured questions , we assessed the type and intensity of care provided by 217 family caregivers to persons with dementia during the year before the patient 's death and assessed the caregivers '  responses to the death . RESULTS Half the caregivers reported spending at least 46 hours per week assisting patients with activities of daily living and instrumental activities of daily living . More than half the caregivers reported that they felt they were " on duty " 24 hours a day , that the patient had frequent pain , and that they had had to end or reduce employment owing to the dem and s of caregiving . Caregivers exhibited high levels of depressive symptoms while providing care to the relative with dementia , but they showed remarkable resilience after the death . Within three months of the death , caregivers had clinical ly significant declines in the level of depressive symptoms , and within one year the levels of symptoms were substantially lower than levels reported while they were acting as caregivers . Seventy-two percent of caregivers reported that the death was a relief to them , and more than 90 percent reported belief that it was a relief to the patient . CONCLUSIONS End-of-life care for patients with dementia was extremely dem and ing of family caregivers . Intervention and support services were needed most before the patient 's death . When death was preceded by a protracted and stressful period of caregiving , caregivers reported considerable relief at the death itself We examined the efficacy of an innovative family-based intervention design ed to decrease caregiving stress and increase family communication among individuals with chronic , life-limiting illnesses and their family caregivers in a r and omized , contact control group design . The intervention group received three home visits in which the interventionist actively worked with the family to construct a personal Legacy , usually a scrapbook with photographs or audiotaped stories .  Control group families received three supportive telephone calls . Of the 42 families that entered the project , 31 families completed follow-up assessment s within 9 to 10 weeks ( 14 control ; 17 intervention ; 72 % African American ) for a retention rate of 74 % . Intervention caregivers showed reduced caregiving stress in comparison with control group caregivers , who showed increases in stress . Intervention patients reported decreased breathing difficulty and increased religious meaning . Caregivers and patients reported greater social interaction on the part of the patient . All participants in the intervention group initiated a Legacy activity and reported that Legacy improved family communication .  Legacy interventions hold promise and are simple to implement Terminally ill cancer patients at a Veterans Administration hospital were r and omly assigned to receive hospice or conventional care . The hospice care was provided both in a special inpatient unit and at home . 137 hospice patients and 110 control patients and their familial care givers ( FCGs ) were followed until the patient 's death . No significant differences were noted between the patient groups in measures of pain , symptoms , activities of daily living , or affect . Hospice patients expressed more satisfaction with the care they received ; and hospice patients ' FCGs showed somewhat more satisfaction and less anxiety than did those of controls . Hospice care was not associated with a reduced use of hospital inpatient days or therapeutic procedures and was at least as expensive as conventional care In this study , we investigated whether a clinical nursing intervention focusing on teaching family caregivers and their cancer patients skills to better manage the patients ' symptoms would reduce caregiver depressive symptomatology .  Two hundred thirty-seven patient/caregiver dyads were recruited for the study . These dyads were r and omized into either the 10-contact , 20-week experimental intervention group ( n=118 ) , which focused on assisting the patient and caregiver in managing patient symptoms and reducing emotional distress , or to a conventional care control group ( n=119 ) . A longitudinal r and om effects regression analysis did not indicate that the clinical nursing intervention was effective in decreasing caregiver depression over the 20-week course of the study . The relationship of the intervention to caregiver depressive symptomatology seems to be a complex one . We recommend further research to explore whether a lengthened intervention and /or delayed follow-up might reveal delayed positive effects of such interventions BACKGROUND The purpose of this study was to determine if patients with advanced breast cancer and their family caregivers , who participated in a family based intervention , report better quality of life and other psychosocial outcomes than dyads who received st and ard care alone . METHODS Using a r and omized clinical trial , 134 patients and their family caregivers were assigned to usual care ( control ) or to usual care plus the family intervention ( experimental condition ) . Dyads were assessed at baseline , three- and six-months later . The intervention consisted of five sessions and addressed  family involvement , optimistic attitude , coping effectiveness , uncertainty reduction , and symptom management . RESULTS Patients in the family intervention reported significantly less hopelessness and less negative appraisal of illness than controls ; their family caregivers reported significantly less negative appraisal of caregiving . Intervention effects were evident at three-months , but were not sustained at six-months . No difference was found in the quality of life of dyads in experimental or control conditions . CONCLUSIONS Although the family intervention had positive effects initially , these effects were not sustained over time . Future studies need to consider program dose and duration of effect , outcome measures that are more sensitive to change , and realistic end-points for patients with advanced cancer This study used a r and omized controlled trial design to investigate the impact of hospice at home ( HAH ) on  caregiver bereavement outcome . Secondary analyses considered the association between bereavement , place of death , and carers ’ assessment of support .  Ninety-six informal carers of patients referred to HAH  were surveyed six weeks post-bereavement about the quality of terminal care . Carers next completed measures of their own bereavement response and general health six months post-bereavement . There was no evidence that HAH had an impact on bereavement outcome . In contrast , perceptions of inadequate terminal support and high symptom severity were associated with worse carer bereavement response . However , it remains unclear whether carers ’ retrospective ratings constitute an accurate account of sympt 
    Output:
    
Evidence was less clear on the indirect interventions .
There were no evaluations of coping with the caring role , quality of life , service use or adverse outcomes .
AUTHORS ' CONCLUSIONS There is evidence that supportive interventions may help reduce  caregivers ' psychological distress .