***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: OBJECTIVE Little is known about the effectiveness of advance care planning in the United Kingdom , although policy documents recommend that it should be available to all those with life-limiting illness . METHOD An exploratory patient preference r and omized controlled trial of advance care planning discussion s with an independent mediator ( maximum three sessions ) was conducted in London outpatient oncology clinics and a nearby hospice . Seventy-seven patients ( mean age 62 years , 39 male ) with various forms of recurrent progressive cancer participated , and 68 ( 88 % ) completed follow-up at 8 weeks . Patients completed  visual analogue scales assessing perceived ability to discuss end-of-life planning with healthcare professionals or family and friends  ( primary outcome ) , happiness with the level of communication , and satisfaction with care , as well as a st and ardized measure of anxiety and depression . RESULTS Thirty-eight patients ( 51 % ) showed preference for the intervention . Discussion s with professionals or family and friends about the future increased in the intervention arms , whether r and omized or preference , but happiness with communication was unchanged or worse , and satisfaction with services decreased . Trial participation did not cause significant anxiety or depression and attrition was low . SIGNIFICANCE OF RESULTS A r and omized trial of advance care planning is possible . This study provides new evidence on its acceptability and effectiveness for patients with advanced cancer AIM To develop and pilot an advance care planning ( ACP ) intervention for lung cancer nurses to use in discussing end-of-life preferences and choices for care with patients diagnosed with inoperable lung cancer . DESIGN A prospect i ve qualitative design with semistructured individual patient interviews . A grounded theory approach was used for the analysis . SAMPLE Fifteen patients took part in ACP discussion s with their nurse and nine agreed to be interviewed by a research er about their perceptions of the intervention . RESULTS Patients ' reactions to the ACP process varied , but they welcomed the recording of their wishes and appreciated the courage of the nurses in bringing up the subject of future care . CONCLUSION This study explored the role of ACP as a method of enabling patient choice for lung cancer patients in the UK . Further research is needed to determine the components of ACP and the training needs of staff PURPOSE / OBJECTIVES To determine oncology nurses '  knowledge of , attitudes toward , and experiences with advance directives ( ADs ) . DESIGN Descriptive , correlation survey . SAMPLE Usable responses from 794 ( 21 % return ) of 3,840 r and omly selected members of the Oncology Nursing Society . The typical respondent was female , Caucasian , married or living as married , middle-aged , and Christian . METHODS A mailed survey using the Knowledge , Attitudinal , and Experiential Survey on Advance Directives instrument . MAIN RESEARCH VARIABLES Knowledge , attitudes , experiences , confidence , and ADs . FINDINGS Overall , oncology nurses were most knowledgeable about ADs in general ( 70 % correct ) and less knowledgeable about the Patient Self-Determination Act ( 51 % correct ) and their state laws ( 53 % correct ) . The mean total knowledge score based on the three subscales was 17.4 out of a possible 30 , or 58 % correct . The nurses ' experience with ADs was measured using a five-item subscale with a mean score of 4 ( SD = 1.11 ) . They were less confident in their ability to assist patients with completing ADs . Respondent attitudes reflected an advocacy role in end-of-life decisions . Attitude items were review ed individually . Respondents strongly agreed ( 97 % ) with the statement that patients should receive sufficient medication to relieve pain even though it may hasten death , which reflects the emphasis in oncology on adequate pain management at the end of life . CONCLUSIONS Nurses ' knowledge scores were low . Nurses in the study were not highly confident in their ability to assist patients with ADs . Demographic variables generally did not influence knowledge , confidence , or experience scores . IMPLICATION S FOR NURSING More education related to ADs is needed and could be administered through in-service classes or continuing education . Nurses ' responses indicated that they need more time to assist patients with completing ADs . This is difficult in the current practice environment but must be recognized as critically important OBJECTIVE The aim of this study was to explain the role of patient advocacy in the Advance Care Planning ( ACP-ing ) process . Nurses rate prolonging the dying process with inappropriate measures as their most disturbing ethical issue and protecting patients ' rights to be of great concern ( Johnston et al 2002 ) . Paradoxically ethical codes assume nurses have the autonomy to uphold patients ' health-care choices . Advance Directives ( AD ) design ed to improve end-of-life care are poorly taken up and acute hospitals are generally not geared for the few they receive . The Respecting Patient Choices Program ( RPCP ) improves AD utilisation through providing a supportive framework for ACP-ing and primarily equipping nurses as RPC consultants . Assisting patients with this process requires attributes consistent with patient advocacy arising out of nursing 's most basic tenet , the care of others . DESIGN Likert Scales survey administered pre and six months post-intervention to pilot and control groups , with coinciding focus groups . SETTING Selected wards in an acute care public hospital in South Australia . SUBJECTS Nurses on the palliative care , respiratory , renal and colo-rectal pilot wards and the haem-oncology , coronary care , cardiology and neurology/geriatric control wards . INTERVENTION The RPCP during the 2004 - 2005 South Australian pilot of the ( RPCP ) . MAIN OUTCOMES The organisational endorsement of ACP-ing gave nurses the autonomy to be patient advocates with respect to end-of-life care , reconciling clinical practice to their code of ethics and easing distress about prolonging the dying process inappropriately . RESULTS Statistically significant survey results in the post-intervention group showed nurses experienced : encouragement to ensure patients could make informed choices about their end-of-life treatment ( 84 % ) ; the ability to uphold these wishes in practice ( 73 % ) ; and job satisfaction from delivering appropriate end-of-life care ( 67 % ) ; compared to approximately half ( 42 - 55 % ) of respondents in the pre-intervention and control groups . Focus group participants shared that it used to be hard to advocate for patients , but now they could act legitimately and felt ethically comfortable about ensuing end-of-life-care . CONCLUSION Findings suggested patient advocacy , fostered by the supportive RPC environment , effectuates the ACP-ing process . It is recommended that the RPCP should be recognised and developed as integral to promoting quality end-of-life assurance and associated job satisfaction BACKGROUND The use of advance directives is recommended so that people can determine the medical care they will receive when they are no longer competent , but the effectiveness of such directives is not clear . METHODS In a prospect i ve study conducted over a two-year period , 126 competent residents of a nursing home and 49 family members of incompetent patients were interviewed to determine their preferences with respect to hospitalization , intensive care , cardiopulmonary resuscitation , artificial ventilation , surgery , and tube feeding in the event of critical illness , terminal illness , or permanent unconsciousness . Advance directives , consisting of signed statements of treatment preferences , were placed in the medical record to assist in care in the nursing home and to be forwarded to the hospital if necessary . RESULTS In an analysis of 96 outcome events ( hospitalization or death in the nursing home ) , care was consistent with previously expressed wishes 75 percent of the time ; however , the presence of the written advance directive in the medical record did not facilitate consistency . Among the 24 events in which inconsistencies occurred , care was provided more aggressively than had been requested in 6 cases , largely because of unanticipated surgery or artificial ventilation , and less aggressively than requested in 18 , largely because hospitalization or cardiopulmonary resuscitation was withheld . Inconsistencies were more likely in the nursing home than in the hospital . CONCLUSIONS . The effectiveness of written advance directives is limited by inattention to them and by decisions to place priority on considerations other than the patient 's autonomy . Since our study was performed in only one nursing home and one hospital , other studies are necessary to determine the generalizability of our findings OBJECTIVE Few available tools facilitate cancer patients and physicians ' discussion s of quality of life and end-of-life . Our objective was to develop a web-based tool to promote advance care planning for women with ovarian cancer . METHODS Women with ovarian cancer , their families , clinicians and research ers met to identify ways to improve cancer care . A prototype website was created to address advance care planning , focusing on advance healthcare directives ( AHD ) and palliative care consultation .  Patients were recruited from a gynecologic oncology clinic for a pilot r and omized controlled trial . Primary outcomes included completion of an AHD and palliative care consultation .  RESULTS At study completion , 53 women with ovarian cancer were enrolled and 35 completed the study . The mean age at enrollment was 57.9 ± 9.5 years ; most were newly diagnosed or at first recurrence . There were no statistical differences in completion of AHD  ( p=0.220 ) or  palliative care consultation  ( p=0.440 ) between intervention and control groups . However , women in the intervention group showed evidence of moving toward decision making regarding AHD and palliative care and lower decisional conflict . Women assigned to the intervention , compared to control website , were highly satisfied with the amount ( p=0.054 ) and quality ( p=0.119 ) of information and when they accessed the website , used it longer ( p=0.049 ) . Overall website use was lower than expected , result ing from several patient-related and design barriers . CONCLUSIONS A website providing information and decisional support for women with ovarian cancer is feasible . Increasing frequency of website use requires future research The process of completing and executing advance directives ( ADs ) is not without problems and issues that need to be studied . Nurses , by the nature of their practice , are in a unique position to help patients complete ADs . The findings reported in this article focus on an open-ended question that was part of a larger quantitative survey . The open-ended question , “ What do oncology nurses need to increase their ability to assist patients with ADs  ? ” was asked of a r and om sample of Oncology Nursing Society members . The Knowledge , Attitudinal , Experiential Survey  on  Advance Directives instrument was used to survey a r and om sample of oncology nurses in four states : California , Illinois , New York , and Texas . Of the 900 nurses who responded to the survey , 677 ( 75 % ) wrote responses to the open-ended question . Grounded theory was used to analyze data to establish and saturate categories . The four topics discussed most often by the nurses were time , education , support , and the nurse ’s role . Nurses also wrote about philosophical issues related to dying , end-of-life issues , and ADs , as well as institutional issues that have an impact on the assistance they can give patients completing ADs . In addition , the category “ communicating ” was frequently discussed by nurses . The importance of communication was a thread woven throughout their responses Purpose Advance directives ( AD ) are becoming increasingly widespread . We examine the prevalence of AD and the factors associated with AD  in tumor patients during radiotherapy .  Methods A st and ardized question naire was h and ed out to all tumor patients on 9 r and om days with an interval of at least 12 weeks . The data were analyzed in a bivariate and multivariate way . Results Of 1,208 question naires , 658 were completed and returned ( 54.5 % ) . Of respondents , 23.6 % had already signed an AD , 53.3 % thought they were likely to sign an AD , 9.0 % did not want to sign an AD , and 4.9 % were not familiar with advance directives . Patients who have signed an AD and those who are likely to sign one think that ADs facilitate the physician ’s decision-making process ( 97.7 % cf . 94.5 % ) and that they ease the burden on relatives ( 98.5 % cf . 98.8 % ) . Regardless of an AD having been signed , every second respondent was of the opinion that AD facilitates consultations rather than serving as a directive ( 55.1 % cf . 57.3 % ) . Patients likely to sign an AD are significantly younger compared to those unlikely to do so and have suffered from their tumor disease for a shorter period of time . Conclusions Of advance directives is widely accepted among the tumor patients surveyed . Advanced directives are not exclusively seen as instruments for surrogate decision making , but also as mediums to improve communication . Training of physicians and additional offers for patients could increase the actual number of ADs and perhaps improve physicians and relatives underst and ing of patients needs and wishes Abstract This study evaluated whether measures of psychological well-being , including coping style , are associated with advance care planning ( ACP ) . Data were from the Hematology Communications Study ( HEMA-COMM ) , a prospect i ve observational study of physician – patient communication in patients with hematologic malignancies . ACP was defined as having a living will , having a health care proxy , discussing life support with family or friends and discussing life support with a doctor or nurse . A total of 293 patients participated : only 45 ( 15 % ) had all the elements of ACP ; 215 ( 73 % ) had at least one element of ACP , while 33 ( 11 % ) did not engage in ACP . In multivariate analysis , specific coping styles but not other measures of psychosocial well-being were associated with having written ACP . Verbal ACP was associated with patient-reported health and physician estimate of life expectancy . Our study suggests that tailoring ACP discussion s to a patient 's coping style may increase engagement in ACP PURPOSE Patients with 
    Output:
    
The complex social and emotional environments within which EOL planning is initiated and actioned are not sufficiently embedded within st and ardized ACP .