***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: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to  FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of home-based transitional palliative care for patients with end-stage heart failure ( ESHF ) after hospital discharge . Methods This was a r and omised controlled trial conducted in three hospitals in Hong Kong . The recruited subjects were patients with ESHF who had been discharged home from hospitals and referred for palliative service , and who met the specified inclusion criteria . The interventions consisted of weekly home visits/telephone calls in the first 4 weeks then monthly follow-up , provided by a nurse case manager supported by a multidisciplinary team . The primary outcome measures were any readmission and count of readmissions within 4 and 12 weeks after index discharge , compared using χ2 tests and Poisson regression , respectively . Secondarily , change in symptoms over time between control and intervention groups were evaluated using generalised estimating equation analyses of data collected using the Edmonton Symptom Assessment Scale ( ESAS ) . Results The intervention group ( n=43 ) had a significantly lower readmission rate than the control group ( n=41 ) at 12 weeks ( intervention 33.6 % vs control 61.0 % χ2=6.8 , p=0.009 ) . The mean number ( SE ) of readmissions for the intervention and control groups was , respectively , 0.42 ( 0.10 ) and 1.10 ( 0.16 ) and the difference was significant ( p=0.001 ) . The relative risk ( CI ) for 12-week readmissions for the intervention group was 0.55 ( 0.35 to 0.88 ) . There was no significant difference in readmissions between groups at 4 weeks . However , when compared with the control group , the intervention group experienced significantly higher clinical improvement in depression ( 45.9 % vs 16.1 % , p<0.05 ) , dyspnoea ( 62.2 % vs 29.0 % , p<0.05 ) and total ESAS score ( 73.0 % vs 41.4 % , p<0.05 ) at 4 weeks . There were significant differences between groups in changes over time in quality of life ( QOL ) measured by McGill QOL ( p<0.05 ) and chronic HF ( p<0.01 ) question naires . Conclusions This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF . Trial registration number HKCTR-1562 ; Results Importance Palliative care considerations are typically introduced late in the disease trajectory of patients with advanced heart failure ( HF ) , and access to specialty-level palliative care may be limited . Objective To determine if early initiation of goals of care conversations by a palliative care – trained social worker would improve prognostic underst and ing , elicit advanced care preferences , and influence care plans for high-risk patients discharged after HF hospitalization . Design , Setting , and Participants This prospect i ve , r and omized clinical trial of a social worker – led palliative care intervention vs usual care analyzed  patients recently hospitalized for management of acute HF who had risk factors for poor prognosis . Analyses were conducted by intention to treat . Interventions Key components of the social worker – led intervention included a structured evaluation of  prognostic underst  and ing , end-of-life preferences , symptom burden , and quality of life with routine review by a palliative care physician ; communication of this information to treating clinicians ; and longitudinal follow-up in the ambulatory setting . Main Outcomes and Measures Percentage of patients with physician-level documentation of advanced care preferences and the degree of alignment between patient and cardiologist expectations of prognosis at 6 months . Results The study population ( N = 50 ) had a mean ( SD ) age of 72 ( 11 ) years and had a mean ( SD ) left ventricular ejection fraction of 0.33 ( 13 ) . Of 50 patients , 41 ( 82 % ) had been hospitalized more than once for HF management within 12 months of enrollment . At enrollment , treating physicians anticipated death within a year for 32 patients ( 64 % ) , but 42 patients ( 84 % ) predicted their life expectancy to be longer than 5 years . At 6 months , more patients in the intervention group than in the control group had physician-level documentation of advanced care preferences in the electronic health record ( 17 [ 65 % ] vs 8 [ 33 % ] ; & khgr;2 = 5.1 ; P = .02 ) . Surviving patients allocated to intervention were also more likely to revise their baseline prognostic assessment in a direction consistent with the physician ’s assessment ( 15 [ 94 % ] vs 4 [ 26 % ] ; & khgr;2 = 14.7 ; P < .001 ) . Among the 31 survivors at 6 months , there was no measured difference between groups in depression , anxiety , or quality -of-life scores . Conclusions and Relevance Patients at high risk for mortality from HF frequently overestimate their life expectancy . Without an adverse impact on quality of life , prognostic underst and ing and patient-physician communication regarding goals of care may be enhanced by a focused , social worker – led palliative care intervention that begins in the hospital and continues in the outpatient setting . Trial Registration clinical trials.gov Identifier : NCT02805712 OBJECTIVE To document outcomes of a r and omized trial of the PhoenixCare demonstration program of palliative care and coordinated care/case management for seriously chronically ill individuals who simultaneously received active treatment from managed care organizations ( MCOs ) . DESIGN Patients , continuously enrolled between July 1999 , and March 2001 , were r and omly assigned to the PhoenixCare program  or a control group receiving usual MCO care . SETTING Hospice of the Valley , Phoenix , Arizona . PARTICIPANTS Participants were 192 patients with chronic obstructive pulmonary disease ( COPD ) or chronic heart failure ( CHF ) , who had an estimated 2-year life expectancy . INTERVENTION Intensive home-based case management provided by registered nurse casemanagers , in coordination with patients ' existing source of medical care , comprised the intervention . Program foci included disease and symptom management , patient self-management of illness and knowledge of illness-related re sources , preparation for end-of life , physical and mental functioning , and utilization of medical services . OUTCOME MEASURES Outcomes , assessed every 3 months by telephone interview , included measures related to all program foci ; the SF-36 was used to evaluate physical and mental functioning ; emergency department visits exemplified medical service utilization . RESULTS Compared to controls , PhoenixCare patients exhibited significantly better outcomes on self-management of illness , awareness of illness-related re sources , and legal preparation for end of life . They reported lower symptom distress , greater vitality , better physical functioning and higher self-rated health than r and omized controls . Emergency department utilization was equivalent across groups . Patients with COPD showed stronger responsiveness to the intervention . CONCLUSION A novel model of patient care that combined greatly enhanced palliative carefocused case management with ongoing MCO-based treatment was associated with improved functioning of chronically severely ill patients in the last years of life 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 Heart failure ( HF ) is associated with a high symptom burden and reduced quality of life ( QOL ) . Models integrating palliative care ( PC ) into HF care have been proposed , but limited research is available on the outcomes of such models . OBJECTIVE Our aim was to assess if  inpatient PC for HF patients is associated with improvements in symptom burden , depressive symptoms , QOL , or differential use of services . METHODS Patients hospitalized with acute HF were r and omized to receive a PC consult  with follow-up as determined by provider or st and ard care . Two hundred thirty-two patients ( 116 intervention/116 control ) from a large tertiary-care urban hospital were recruited over a 10-month period . Primary outcomes were symptom burden , depressive symptoms , and QOL measured at baseline , 1 , and 3 months . Secondary outcomes included advance care planning ( ACP ) , inpatient 30-day readmission , hospice use , and death . RESULTS Improvements were greater at both 1 and 3 months in the intervention group for primary outcome summary measures after adjusting for age , gender , and marital status differences between study groups . QOL scores increased by 12.92 points in the intervention and 8 points in the control group at 1 month ( difference+4.92 , p<0.001 ) . Improvement in symptom burden was 8.39 in the intervention group and 4.7 in the control group at 1 month ( + 3.69 , p<0.001 ) . ACP was the only secondary outcome associated with the intervention ( hazard ratio [ HR ] 2.87 , p=0.033 ) . CONCLUSION An inpatient PC model  for patients with acute HF is associated with short-term improvement in symptom burden , QOL , and 
    Output:
    
There was no clear adverse impact on mortality .
Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival .