***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 To evaluate the effect of a video decision support tool on the preferences for future medical care in older people if they develop advanced dementia , and the stability of those preferences after six weeks . Design R and omised controlled trial conducted between 1 September 2007 and 30 May 2008 . Setting Four primary care clinics ( two geriatric and two adult medicine ) affiliated with three academic medical centres in Boston . Participants Convenience sample of 200 older people ( ≥65 years ) living in the community with previously scheduled appointments at one of the clinics . Mean age was 75 and 58 % were women . Intervention Verbal narrative alone ( n=106 ) or with a video decision support tool ( n=94 ) . Main outcome measures Preferred goal of care : life prolonging care ( cardiopulmonary resuscitation , mechanical ventilation ) , limited care ( admission to hospital , antibiotics , but not cardiopulmonary resuscitation ) , or comfort care ( treatment only to relieve symptoms ) . Preferences after six weeks . The principal category for analysis was the difference in proportions of participants in each group who preferred comfort care . Results Among participants receiving the verbal narrative alone , 68 ( 64 % ) chose comfort care , 20 ( 19 % ) chose limited care , 15 ( 14 % ) chose life prolonging care , and three ( 3 % ) were uncertain . In the video group , 81 ( 86 % ) chose comfort care , eight ( 9 % ) chose limited care , four ( 4 % ) chose life prolonging care , and one ( 1 % ) was uncertain ( χ2=13.0 , df=3 , P=0.003 ) . Among all participants the factors associated with a greater likelihood of opting for comfort care were being a college graduate or higher , good or better health status , greater health literacy , white race , and r and omisation to the video arm . In multivariable analysis , participants in the video group were more likely to prefer comfort care than those in the verbal group ( adjusted odds ratio 3.9 , 95 % confidence interval 1.8 to 8.6 ) . Participants were re-interviewed after six weeks . Among the 94/106 ( 89 % ) participants re-interviewed in the verbal group , 27 ( 29 % ) changed their preferences ( κ=0.35 ) . Among the 84/94 ( 89 % ) participants re-interviewed in the video group , five ( 6 % ) changed their preferences ( κ=0.79 ) ( P<0.001 for difference ) . Conclusion Older people who view a video depiction of a patient with advanced dementia after hearing a verbal description of the condition are more likely to opt for comfort as their goal of care compared with those who solely listen to a verbal description . They also have more stable preferences over time . Trial registration Clinical trials.gov NCT00704886 OBJECTIVE To examine factors associated with family satisfaction with end-of-life care in the Study to Underst and Prognoses and Preferences for Outcomes and Risks of Treatments ( SUPPORT ) . DESIGN A prospect i ve cohort study with patients r and omized to either usual care or an intervention that included clinical nurse specialists to assist in symptom control and facilitation of communication and decision-making . SETTING Five teaching hospitals in the United States . PARTICIPANTS Family members and other surrogate respondents for 767 seriously ill hospitalized adults who died . MEASUREMENTS Eight question naire items regarding satisfaction with the patient 's medical care expressed as two scores , one measuring satisfaction with patient comfort and the other measuring satisfaction with communication and decision-making . RESULTS Sixteen percent of respondents reported dissatisfaction with patient comfort and 30 % reported dissatisfaction with communication and decision-making . Factors found to be significantly associated with satisfaction with communication and decision-making were hospital site , whether death occurred during the index hospitalization ( adjusted odds ratio ( AOR ) 2.2 , 95 % CI , 1.3 - 3.9 ) , and for patients who died following discharge , whether the patient received the SUPPORT intervention ( AOR 2.0 , 1.2 - 3.2 ) . For satisfaction with comfort , male surrogates reported less satisfaction ( 0.6 , 0.4 - 1.0 ) , surrogates who reported patients ' preferences were followed moderately to not at all had less satisfaction ( 0.2 , 0.1 - 0.4 ) , and surrogates who reported the patient 's illness had greater effect on family finances had less satisfaction ( 0.4 , 0.2 - 0.8 ) . CONCLUSIONS Satisfaction scores suggest the need for improvement in end-of-life care , especially in communication and decision making . Further research is needed to underst and how factors affect satisfaction with end-of-life care . An intervention like that used in SUPPORT may help family members The purpose of this study was to describe the life-sustaining treatment preferences of  dialysis patients and to compare the acceptability of two generic and a disease-specific advance directive ( AD ) . Of 532 potentially eligible hemodialysis patients , 95 ( 17.9 % ) participated in the study . These patients completed two generic ( the Centre for Bioethics Living Will and the Medical Directive ) and one disease-specific ( the Dialysis Living Will ) AD in a r and omized cross-over trial . Treatment preferences were measured by using the Centre for Bioethics Living Will . Acceptability of the AD was measured by using a 13-item advance directive acceptability question naire ( ADAQ ) for each AD , and the  advance directive choice question naire ( ADCQ ) to elicit participants ' preferred AD . Twenty-five percent of the participants wanted to continue dialysis in case of severe stroke , 19 % in severe dementia , and 14 % in permanent coma . Averaged across treatments , proportions of participants wanting treatment in various health states were : current health ( 86 % ) , mild stroke ( 84 % ) , moderate stroke ( 60 % ) , severe stroke ( 21 % ) , mild dementia ( 78 % ) , moderate dementia ( 51 % ) , severe dementia ( 14 % ) , terminal illness ( 41 % ) , and permanent coma ( 10 % ) . Averaged across health states , proportions of participants wanting various types of treatment were :  dialysis  ( 58 % ) ,  antibiotics  ( 53 % ) , transfusion ( 53 % ) , surgery ( 48 % ) ,  cardiopulmonary resuscitation ( 48 % ) , respirator ( 47 % ) , and tube feeding ( 41 % ) . Mean ADAQ scores were : Dialysis Living Will , 71 % ; Centre for Bioethics Living Will , 70 % ; and Medical Directive , 60 % ( F = 8.27 , P < 0.001 ( repeat measures analysis of variance ) ; the Dialysis Living Will and Centre for Bioethics Living Will scored significantly higher than the Medical Directive ) . The proportion of participants who said they would choose to complete each AD was : Dialysis Living Will , 28 % ; Centre for Bioethics Living Will , 38 % ; Medical Directive , 31 % ; and unsure , 3 % ( chi 2 = 1.465 , df = 2 , P = 0.48 ) . In conclusion , twenty-five percent or less of hemodialysis patients want to continue dialysis  in three specific health states : severe stroke , severe dementia , and permanent coma . Health states and illness severity , far more than treatment descriptions , influence preferences . Dialysis patients should be offered a generic AD , and some generic AD are more acceptable than others . Only a minority of dialysis patients will complete any AD , but the completion of written AD forms is only one element in the process of advance care planning BACKGROUND A large discrepancy exists between the wishes of dying patients and their actual end-of-life care . However , retrospective clinical experience suggests that early advance care planning ( ACP ) can markedly reduce this discrepancy . This article describes a r and omized trial to evaluate the short-term clinical utility of early ACP . We also assessed the feasibility of performing a larger prospect i ve study to document long-term outcomes . METHODS Ambulatory geriatric patients ( N = 61 ) were r and omized to either a  control group , which received only a Massachusetts Health Care Proxy form to complete , or an intervention group , in which each patient and health care agent discussed ACP with a trained nurse facilitator . The benefits and burdens of life-sustaining treatments were discussed , and patient goals and preferences for these treatments were documented . RESULTS Two-month follow-up revealed that the intervention achieved higher congruence between agents and patients in their underst and ing of patients ' end-of-life care preferences , with 76 % ( 19/25 ) in complete agreement vs 55 % ( 12/22 ) of the controls ( effect size [ ES ] = -0.43 ) . There was also a greater increase in patient knowledge about ACP in the intervention group ( ES = 0.22 ) . Intervention patients became less willing to undergo life-sustaining treatments  for a new serious medical problem ( ES = -0.25 ) , more willing to undergo such treatments for an incurable progressive disease ( ES = 0.24 ) , and less willing to tolerate poor health states ( ES = -0.78 ) . Practical insights were gained about how to conduct a larger study more effectively . CONCLUSION A facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient 's wishes for both patient and agent 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 BACKGROUND Patients with severe COPD or chronic heart failure ( CHF ) are often confronted with decisions concerning life-sustaining treatments . The aim of this prospect i ve , observational study was to assess life-sustaining treatment preferences , advance care planning , and the quality of end-of-life care communication  in Dutch out patients with clinical ly stable but severe COPD or CHF . METHODS The following outcomes were assessed in out patients with severe COPD ( n = 105 ) or CHF ( n = 80 ) :  life-sustaining treatment preferences ( CPR and mechanical ventilation ; Willingness to Accept Life-sustaining Treatment instrument ) , advance care planning , and quality of end-of-life care communication  ( Quality of Communication question naire ) . RESULTS Most patients asserted that in their current health status , they would prefer  CPR  ( COPD , 70.5 % ; CHF , 62.5 % ) and /or  mechanical ventilation  ( COPD , 70.5 % ; CHF , 66.3 % ) . Patients ' treatment preferences were influenced by burden of treatment , outcome of treatment , and likelihood of outcome . Advance directives were discussed with the physician specialist by 5.9 % of patients with COPD and 3.9 % of patients with CHF . Patients rated quality of patient-physician end-of-life care communication as poor . Physicians rarely discussed prognosis , dying , and palliative care . CONCLUSIONS Despite the fact that patients are able to indicate their preferences regarding life-sustaining treatments , based on burden of treatment , outcome of treatment , and likelihood of outcome , these preferences are rarely discussed with their physician specialist . This study shows a need for advance care planning , taking into account the burden of treatment , outcome of treatment , and likelihood of outcome , in patients with severe COPD or CHF . Finally , the quality of patient-physician end-of-life care communication needs to improve BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The 
    Output:
    
RESULTS Interventions focusing on advance directives as well as interventions that also included communication about end-of-life care  increased the completion of advance directives and the occurrence of end-of-life care discussion s between patients and healthcare professionals .
In addition , interventions that also included  communication about ACP  , improved concordance between preferences for care and delivered care and may improve other outcomes , such as quality of communication .