***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: ABSTRACT BACKGROUND Decisions about cardiopulmonary resuscitation ( CPR ) and intubation are a core part of advance care planning , particularly for seriously ill hospitalized patients . However , these discussion s are often avoided . OBJECTIVES We aim ed to examine the impact of a video decision tool for CPR and intubation on patients ’ choices , knowledge , medical orders , and discussion s with providers . DESIGN This was a prospect i ve r and omized trial conducted between 9 March 2011 and 1 June 2013 on the internal medicine services at two hospitals in Boston . PARTICIPANTS One hundred and fifty seriously ill hospitalized patients over the age of 60 with an advanced illness and a prognosis of 1 year or less were included . Mean age was 76 and 51 % were women . INTERVENTIONThree-minute video describing CPR and intubation plus verbal communication of participants ’ preferences to their physicians ( intervention ) ( N = 75 ) or control arm ( usual care ) ( N = 75).MAIN MEASURES The primary outcome was participants ’ preferences for CPR and intubation ( immediately after viewing the video in the intervention arm ) . Secondary outcomes included : orders to withhold CPR/intubation , documented discussion s with providers during hospitalization , and participants ’ knowledge of CPR/ intubation ( five-item test , range 0–5 , higher scores indicate greater knowledge ) . RESULTS Intervention participants ( vs. controls ) were more likely not to want CPR ( 64 % vs. 32 % , p < 0.0001 ) and intubation ( 72 % vs. 43 % , p < 0.0001 ) . Intervention participants ( vs. controls ) were also more likely to have orders to withhold CPR ( 57 % vs. 19 % , p < 0.0001 ) and intubation ( 64 % vs.19 % , p < 0.0001 ) by hospital discharge , documented discussion s about their preferences ( 81 % vs. 43 % , p < 0.0001 ) , and higher mean knowledge scores ( 4.11 vs. 2.45 ; p < 0.0001 ) . CONCLUSIONS Seriously ill patients who viewed a video about CPR and intubation were more likely not to want these treatments , be better informed about their options , have orders to forgo CPR/ intubation , and discuss preferences with providers . Trial registration : Clinical trials.gov NCT01325519 Registry Name : A prospect i ve r and omized trial using video images in advance care planning in seriously ill hospitalized patients BACKGROUND Few patients with end-stage dementia are enrolled in hospice care . A palliative care approach would nonetheless seem to be appropriate in various care setting s , including the acute care hospital . METHODS We conducted a r and omized controlled trial of palliative care in patients with advanced dementia ( Functional Assessment Staging Tool [ FAST ] stage 6d-7f ) who were hospitalized with acute illness . Intervention patients received recommendations by a palliative care team with the goal of enhancing patient comfort ; control patients received usual care without these recommendations . RESULTS Among 99 patients enrolled over 3 years , groups were comparable at baseline in terms of gender , age , race , dementia stage , and advance directive status . Outcomes were similar in terms of mean number of hospitalizations , average length of stay , and mortality . Intervention patients were more likely than control patients to receive a palliative care plan  ( 23 % versus 4 % ; p = 0.008 ) , usually on discharge , and more decisions were made to forgo certain medical treatments but the numbers were small . Fewer patients in the intervention group received intravenous therapy  throughout the admission ( 66 % vs. 81 % , p = 0.025 ) . Overall , additional interventions included  daily phlebotomy  for at least half of the admission ( 41 % ) ,  systemic antibiotics  ( 75 % ) , and  new feeding tubes  ( 44 % ) . Including tubes present at the time of r and omization , a total of 69 % received long-term enteral feeding . CONCLUSION It was difficult for a palliative care research team to influence the care of advanced dementia patients in the acute hospital setting . When patients have advanced dementia , there may be unique barriers , including perceived prognostic uncertainty , difficulty assessing comfort level , and perceptions about tube feeding . There must be a reexamination of treatment approaches for this severely impaired group of patients . Further study should attempt to identify patients prior to the need for acute hospitalization so goals can be established when there is less urgency to make life and death decisions A r and omised controlled trial was undertaken to assess the effectiveness of a  hospital Palliative Care Team ( PCT )  on physical symptoms and health-related quality of life ( HRQoL ) ; patient , family carer and primary care professional reported satisfaction with care ; and health service re source use . The full package of advice and support provided by a multidisciplinary specialist PCT ( ‘ full-PCT ’ ) was compared with limited telephone advice ( ‘ telephone-PCT ’ , the control group ) in the setting of a teaching hospital trust in the SW of Engl and . The trial recruited 261 out of 684 new inpatient referrals ; 175 were allocated to ‘ full-PCT ’  , 86 to  ‘ telephone-PCT ’  ( 2 : 1 r and omisation ) ; with 191 ( 73 % ) being assessed at 1 week . There were highly significant improvements in symptoms , HRQoL , mood and ‘ emotional bother ’ in ‘ full-PCT ’ at 1 week , maintained over the 4-week follow-up . A smaller effect was seen in ‘ telephone-PCT ’ ; there were no significant differences between the groups . Satisfaction with care in both groups was high and there was no significant difference between them . These data reflect a high st and ard of care of patients dying of cancer and other chronic diseases in an acute hospital environment , but do not demonstrate a difference between the two models of service delivery of specialist palliative care Objective To investigate the impact of advance care planning on end of life care in elderly patients . Design Prospect i ve r and omised controlled trial . Setting Single centre study in a university hospital in Melbourne , Australia . Participants 309 legally competent medical in patients aged 80 or more and followed for six months or until death . Interventions Participants were r and omised to receive usual care or usual care plus facilitated advance care planning . Advance care planning aim ed to assist patients to reflect on their goals , values , and beliefs ; to consider future medical treatment preferences ; to appoint a surrogate ; and to document their wishes . Main outcome measures The primary outcome was whether a patient ’s end of life wishes were known and respected . Other outcomes included patient and family satisfaction with hospital stay and levels of stress , anxiety , and depression in relatives of patients who died . Results 154 of the 309 patients were r and omised to advance care planning  , 125 ( 81 % ) received advance care planning , and 108 ( 84 % ) expressed wishes or appointed a surrogate , or both . Of the 56 patients who died by six months , end of life wishes were much more likely to be known and followed in the intervention group ( 25/29 , 86 % ) compared with the control group ( 8/27 , 30 % ; P<0.001 ) . In the intervention group , family members of patients who died had significantly less stress ( intervention 5 , control 15 ; P<0.001 ) , anxiety ( intervention 0 , control 3 ; P=0.02 ) , and depression ( intervention 0 , control 5 ; P=0.002 ) than those of the control patients . Patient and family satisfaction was higher in the intervention group . Conclusions Advance care planning improves end of life care and patient and family satisfaction and reduces stress , anxiety , and depression in surviving relatives . Trial registration Australian New Zeal and clinical trials registry ACTRN12608000539336 Background Widespread implementation of palliative care treatment plans could reduce suffering in the last days of life by adopting best practice s of traditionally home-based hospice care in inpatient setting s. Objective To evaluate the effectiveness of a multi-modal intervention strategy to improve processes of end-of-life care in inpatient setting s. Design Implementation trial with an intervention staggered across hospitals using a multiple-baseline , stepped wedge design . Participants Six Veterans Affairs Medical Centers ( VAMCs ) . InterventionS taff training was targeted to all hospital providers and focused on identifying actively dying patients and implementing best practice s from home-based hospice care , supported with an electronic order set and paper-based educational tools . Main Measures Several processes of care were identified as quality endpoints for end-of-life care ( last 7 days ) and abstract ed from electronic medical records of veterans who died before or after intervention ( n = 6,066 ) . Primary endpoints were proportion with an order for opioid pain medication at time of death , do-not-resuscitate order , location of death , nasogastric tube , intravenous line infusing , and physical restraints . Secondary endpoints were administration of opioids , order/administration of antipsychotics , benzodiazepines , and  scopolamine  ( for death rattle ) ; sublingual administration ; advance directives ; palliative care consultations ; and pastoral care services . Generalized estimating equations were conducted adjusting for longitudinal trends . Key Results Significant intervention effects were observed for orders for opioid pain medication ( OR : 1.39 ) , antipsychotic medications ( OR : 1.98 ) , benzodiazepines ( OR : 1.39 ) , death rattle medications ( OR : 2.77 ) , sublingual administration ( OR : 4.12 ) , nasogastric tubes ( OR : 0.71 ) , and advance directives ( OR : 1.47 ) . Intervention effects were not significant for location of death , do-not-resuscitate orders , intravenous lines , or restraints . Conclusions This broadly targeted intervention strategy led to modest but statistically significant changes in several processes of care , indicating its potential for widespread dissemination to improve end-of-life care for thous and s of patients who die each year in inpatient setting PURPOSE To determine whether the place of death for patients with cancer is associated with patients ' quality of life ( QoL ) at the end of life ( EOL ) and psychiatric disorders in bereaved caregivers . PATIENTS AND METHODS Prospect i ve , longitudinal , multisite study of patients with advanced cancer and their caregivers ( n = 342 dyads ) . Patients were followed from enrollment to death , a median of 4.5 months later . Patients ' QoL at the EOL was assessed by caregiver report within 2 weeks of death . Bereaved caregivers ' mental health was assessed at baseline and 6 months after loss with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , and the  Prolonged Grief Disorder interview . RESULTS In adjusted analyses , patients with cancer who died in an intensive care unit ( ICU ) or hospital experienced more physical and emotional distress and worse QoL at the EOL ( all P ≤ .03 ) , compared with patients who died at home with hospice . ICU deaths were associated with a heightened risk for posttraumatic stress disorder , compared with home hospice deaths ( 21.1 % [ four of 19 ] v 4.4 % [ six of 137 ] ; adjusted odds ratio [ AOR ] , 5.00 ; 95 % CI , 1.26 to 19.91 ; P = .02 ) , after adjustment for caregivers ' preexisting psychiatric illnesses . Similarly , hospital deaths were associated with a heightened risk for prolonged grief disorder ( 21.6 % [ eight of 37 ] v 5.2 % [ four of 77 ] , AOR , 8.83 ; 95 % CI , 1.51 to 51.77 ; P = .02 ) , compared with home hospice deaths . CONCLUSION Patients with cancer who die in a hospital or ICU have worse QoL compared with those who die at home , and their bereaved caregivers are at increased risk for developing psychiatric illness . Interventions aim ed at decreasing terminal hospitalizations or increasing hospice utilization may enhance patients ' QoL at the EOL and minimize bereavement-related distress Background : Although many healthcare providers and research ers consider it necessary to assist patients with end-stage chronic illnesses to plan for the end of life , they tend to avoid discussing end-of-life issues with patients before major surgery . Consequently , surgical patients and their families generally have insufficient knowledge to make plans in case of life-threatening complications . Objective : The objective of this study was to evaluate short-term effects of Patient-Centered Advance Care Planning ( PC-ACP ) . Design and Subjects : Thirty-two dyads of patients undergoing cardiac surgery and their surrogates were r and omly assigned to receive either the  PC-ACP intervention ( PC-ACP ) or usual care . Measures : Measures studied were patient – surrogate congruence regarding goals for future medical care , patient and surrogate knowledge of advance care planning and anxiety , and patient decisional conflict . Congruence and anxiety were measured before and after the intervention . Decisional conflict and knowledge of advance care planning were measured after the intervention . Results : Compared with the control group , PC-ACP significantly improved patient – surrogate congruence ( Δ = 1.27 , P < 0.01 ) and reduced patients ’ decisional conflict ( Δ = −0.77 , P < 0.05 ) . Anxiety change ( pre/post ) did not differ between treatment and control groups . No difference in knowledge of advance care planning was found between the 2 groups . Conclusions : The PC-ACP can be an effective approach to advance care planning . Its specificity and relevance to 
    Output:
    
Interventions which target both the patient and substitute decision maker in an effort to achieve these changes would be beneficial