***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: Background A commonly reported problem with the conduct of multicentre r and omised controlled trials ( RCTs ) is that recruitment is often slower or more difficult than expected , with many trials failing to reach their planned sample size within the timescale and funding originally envisaged . The aim of this study was to explore factors that may have been associated with good and poor recruitment in a cohort of multicentre trials funded by two public bodies : the UK Medical Research Council ( MRC ) and the Health Technology Assessment ( HTA ) Programme . Methods The cohort of trials was identified from the administrative data bases held by the two funding bodies . 114 trials that recruited participants between 1994 and 2002 met the inclusion criteria . The full scientific applications and subsequent trial reports su bmi tted by the trial teams to the funders provided the principal data sources . Associations between trial characteristics and recruitment success were tested using the Chi-squared test , or Fisher 's exact test where appropriate . Results Less than a third ( 31 % ) of the trials achieved their original recruitment target and half ( 53 % ) were awarded an extension . The proportion achieving targets did not appear to improve over time . The overall start to recruitment was delayed in 47 ( 41 % ) trials and early recruitment problems were identified in 77 ( 63 % ) trials . The inter-relationship between trial features and recruitment success was complex . A variety of strategies were employed to try to increase recruitment , but their success could not be assessed . Conclusion Recruitment problems are complex and challenging . Many of the trials in the cohort experienced recruitment difficulties . Trials often required extended recruitment periods ( sometimes supported by additional funds ) . While this is of continuing concern , success in addressing the trial question may be more important than recruitment alone R and omized controlled trials ( RCTs ) in palliative cancer care often experience method ological problems . In this paper we discuss issues of major concern , including recruitment , patient attrition and compliance , arising from an RCT that compared comprehensive palliative care to conventional care .  The main criteria for trial entry were incurable malignant disease and a survival expectancy of between 2 and 9 months . Patients '  health-related quality of life ( HRQL ) , self-assessed by multi-item question naires , was a defined endpoint . The planned number of patients was successfully recruited , although the patients were referred late in the course of their disease so that follow-up tended to be short . Compliance in completing HRQL question naires was good up to 1 month before the patient 's death ; but in the final weeks it was found to drop substantially . Based on our experience , recommendations are given for those planning similar research . Procedures for improving patient recruitment are suggested , stressing the need for local data management , repeated information to referral sources , extensive screening for potentially eligible patients and simple referral routines . Precise inclusion criteria , including prognostic factors other than physicians ' estimates of life expectancy , should be used to ensure a sufficient follow-up period . For HRQL assessment , multi-item question naires can achieve excellent compliance up to 1 month before patients ' death , but in order to evaluate the very final weeks of life we recommend the use of simpler methods 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 CONTEXT Latinos experience significant health disparities at the end of life compared with non-Latinos . OBJECTIVES To determine the feasibility of a patient navigator intervention to improve palliative care outcomes for Latino adults with serious illness . METHODS This was a pilot r and omized controlled trial that included 64 Latino adults with life-limiting illness r and omized to an intervention or a control group . All participants received a packet of linguistically matched material s on palliative care . In addition , intervention participants received up to five home visits from the bilingual , bicultural patient navigator . Visits focused on addressing barriers to palliative care through education , activation , and culturally tailored messaging . Outcomes included feasibility and advance care planning rates , documentation of pain management discussion s in the medical record , and hospice utilization . RESULTS Of the 32 patients r and omized to the intervention arm , 81 % had at least one home visit ( range 1 - 5 ) with the patient navigator . Overall , advance care planning was higher in the intervention group ( 47 % [ n = 15 ] vs. 25 % [ n = 8 ] , P = 0.06 ) , and 79 % of intervention participants had a discussion about pain management documented in their medical record vs. 54 % of control patients ( P = 0.05 ) . Hospice enrollment between the two groups ( n = 18 decedents ) was similar ( n = 7 intervention vs. n = 6 control ) ; length of stay in the intervention group was 36.4 ± 51.6 vs. 19.7 ± 33.6 days for control patients ( P = 0.39 ) . CONCLUSION A culturally tailored patient navigator intervention was feasible and suggests improved palliative care outcomes for Latinos facing advanced medical illness , justifying a fully powered r and omized controlled trial BACKGROUND Venous thromboembolism is common in cancer patients and requires anticoagulation with low-molecular-weight heparin ( LMWH ) . Current data recommend LMWH for anticoagulation as far as 6 months , yet guidelines recommend LMWH beyond 6 months in patients who have ongoing or active cancer . This recommendation , based on expert consensus , has not been evaluated in a clinical study . OBJECTIVES ( 1 ) To identify the most clinical ly and cost-effective length of anticoagulation with LMWH in the treatment of cancer-associated thrombosis ( CAT ) ; ( 2 ) to identify practicalities of conducting a full r and omised controlled trial ( RCT ) with regard to recruitment , retention and outcome measurement ; and ( 3 ) to explore the barriers for progressing to a full RCT . DESIGN The Anticoagulation with Low-molecular-weight heparin In the treatment of Cancer-Associated Thrombosis ( ALICAT ) trial is a r and omised , multicentre , feasibility mixed- methods study with three components : ( 1 ) a RCT comparing ongoing LMWH treatment for CAT with cessation of LMWH at 6 months ' treatment ( current licensed practice ) in patients with locally advanced or metastatic cancer , consulted in three clinical setting s ( haematology out patients , oncology out patients and primary care ) ; ( 2 ) a nested qualitative study , including focus groups with clinicians to investigate attitudes for recruiting to the study and identify the challenges of progressing to a full RCT , and semistructured interviews with patients and relatives to explore their attitudes towards participating in the study , and potential barriers and concerns to participation ; and ( 3 ) a UK-wide survey exercise to develop a classification and enumeration system for the CAT models and pathways of care . SETTING A haematology out patients department , an oncology out patients department and primary care . PARTICIPANTS Patients with ongoing active or metastatic cancer who have received 6 months of LMWH for CAT .  INTERVENTIONS Ongoing LMWH treatment for CAT versus cessation of LMWH at 6 months ' treatment in patients with locally advanced or metastatic cancer . MAIN OUTCOME MEASURES ( i  ) The number of eligible patients over 12 months ; ( ii ) the number of recruited patients over 12 months ( target recruitment rate of 30 % of eligible patients ) ; and ( iii ) the proportion of r and omised participants with recurrent venous thromboembolisms ( VTEs ) during follow-up . RESULTS Following several delays in setting up the RCT component of the study , 5 out of 32 eligible patients consented to be r and omised to the RCT suggesting progression to a full RCT was not feasible . Reasons for non-consenting were primarily based on a fixed preference for continuing or discontinuing treatment after 6 months of anticoagulation , and a fear of r and omisation to their non-preferred option . Views were largely influenced by patients ' initial experience of CAT . Focus groups with clinicians revealed that they would be reticent to recruit to such a study as they had fixed views of best management despite the lack of evidence . Patient pathway modelling suggested that there is a broad heterogeneity of practice with respect to CAT management and co-ordination , with no consensus on which specialty should best manage such cases . CONCLUSIONS The results of the RCT reflect recruitment from the oncology site only and provide no recruitment data from haematology centres . However , it is unlikely that these other sites would have access to more eligible patients . The management of cancer-associated thrombosis beyond 6 months will remain a clinical challenge . As it is unlikely that a prospect i ve study will successfully recruit , other strategies to accrue relevant data are necessary . Currently the LONGHEVA ( Long-term treatment for cancer patients with deep-venous thrombosis or pulmonary embolism ) registry is in development to prospect ively evaluate this important and common clinical scenario . STUDY REGISTRATION This study is registered as clinical trials.gov number NCT01817257 and International St and ard R and omised Controlled Trial Number ( IS RCT N ) 37913976 . FUNDING DETAILS Funding for the ALICAT trial was provided by the Health Technology Assessment programme ( 10/145/01 ) in response to a themed funding call . The study was design ed in accordance with the initial funding brief and feedback from the review process CONTEXT The h and held fan is an inexpensive and safe way to provide facial airflow , which may reduce the sensation of chronic refractory breathlessness , a frequently encountered symptom . OBJECTIVES To test the feasibility of developing an adequately powered , multicenter , multinational r and omized controlled trial comparing the efficacy of a h and held fan and exercise advice with advice alone in increasing activity in people with chronic refractory breathlessness from a variety of medical conditions , measuring recruitment rates ; data quality ; and potential primary outcome measures . METHODS This was a Phase II , multisite , international , parallel , nonblinded , mixed- methods r and omized controlled trial . Participants were central ly r and omized to fan or control . All received breathlessness self-management/exercise advice and were followed up weekly for four weeks . Participants /carers were invited to participate in a semistructured interview at the study 's conclusion . RESULTS Ninety-seven people were screened , 49 r and omized ( mean age 68 years ; 49 % men ) , and 43 completed the study .  Site recruitment varied from 0.25 to 3.3/month and screening : r and omization from 1.1:1 to 8.5:1 . There were few missing data except for the Chronic Obstructive Pulmonary Disease Self-Efficacy Scale ( two-thirds of data missing ) . No harms were observed . Three interview themes included 1 ) a fan is a helpful self-management strategy , 2 ) a fan aids recovery , and 3 ) a symptom control trial was welcome . CONCLUSION A definitive , multisite trial to study the use of the h and held fan as part of self-management of chronic refractory breathlessness is feasible . Participants found the fan useful . However , the value of information for changing practice or policy is unlikely to justify the expense of such a trial , given perceived benefits , the minimal costs , and an absence of harms demonstrated in this study Abstract Objective : To evaluate a palliative care home support team based on an inpatient unit . Design : R and omised controlled trial with waiting list . Patients in the study group received the service immediately , those in the control group received it after one month . Main comparison point was at one month . Setting - A city of 300 000 people with a publicly funded home care service and about 200 general practitioners , most of whom provide home care . Main outcome measures : Pain and nausea levels were measured at entry to trial and at one month , as were quality of life for patients and care givers ' health . Results : Because of early deaths , problems with recruitment , and a low compliance rate for completion of question naires , the required sample size was not attained . Conclusion : In design ing evaluations of palliative care services , investigators should be prepared to deal with the following issues : attrition due to early death , opposition to r and omisation by patients and referral sources , ethical problems raised by r and omisation of dying patients , the appropriate timing of comparison points , and difficulties of collecting data from sick or exhausted patients and care givers . Investigators may choose to evaluate a service from various perspectives using different methods : controlled trials , qualitative studies , surveys , and audits . R and omised trials may prove to be impracticable for evaluation of palliative care Objective The aim of the study was to investigate how doctors considered and experienced the concept of equipoise while recruiting patients to r and omized controlled tri 
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Careful messaging and the use of scripts/role play ( Promotion ) were recommended .
The need for intensive re sources and gatekeeping by professionals were barriers while having research staff on-site and lead clinician support ( Working with Partners ) was advocated .
The findings of this review are applicable to all palliative care research and not just r and omised controlled trials