***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: OBJECTIVES --To measure effects on terminally ill cancer patients and their families of coordinating the services available within the NHS and from local authorities and the voluntary sector . DESIGN --R and omised controlled trial . SETTING --Inner London health district . PATIENTS --Cancer patients were routinely notified from 1987 to 1990 . 554 patients expected to survive less than one year entered the trial and were r and omly allocated to a coordination or a control group . INTERVENTION -- All patients received routinely available services . Coordination group patients received the assistance of two nurse coordinators , whose role was to ensure that patients received appropriate and well coordinated services , tailored to their individual needs and circumstances . MAIN OUTCOME MEASURES -- Patients and carers were interviewed at home on entry to the trial and at intervals until death . Interviews after bereavement were also conducted . Outcome measures included the presence and severity of physical symptoms , psychiatric morbidity , use of and satisfaction with services , and carers ' problems . Results from the baseline interview , the interview closest to death , and the interview after bereavement were analysed . RESULTS --Few differences between groups were significant . Coordination group patients were less likely to suffer from vomiting , were more likely to report effective treatment for it , and less likely to be concerned about having an itchy skin . Their carers were more likely to report that in the last week of life the patient had had a cough and had had effective treatment for constipation , and they were less likely to rate the patient 's difficulty swallowing as severe or to report effective treatment for anxiety . Coordination group patients were more likely to have seen a chiropodist and their carers were more likely to contact a specialist nurse in a night time emergency . These carers were less likely to feel angry about the death of the patient . CONCLUSIONS --This coordinating service made little difference to patient or family outcomes , perhaps because the service did not have a budget with which it could obtain services or because the professional skills of the nurse-coordinators may have conflicted with the requirements of the coordinating role CONTEXT Upper gastrointestinal cancer is associated with a poor prognosis . The multidimensional problems of incurable patients require close monitoring and frequent support , which can not sufficiently be provided during conventional one to two month follow-up visits to the outpatient clinic . OBJECTIVES To compare nurse-led follow-up at home with conventional medical follow-up in the outpatient clinic for patients with incurable primary or recurrent esophageal , pancreatic , or hepatobiliary cancer . METHODS Patients were r and omized to nurse-led follow-up at home or conventional medical follow-up  in the outpatient clinic . Outcome parameters were quality of life ( QoL ) , patient satisfaction , and health care consumption , measured by different question naires at one and a half and four months after r and omization . As well , cost analyses were done for both follow-up strategies in the first four months . RESULTS In total , 138 patients were r and omized , of which 66 ( 48 % ) were evaluable . At baseline , both groups were similar with respect to clinical and sociodemographic characteristics and health-related QoL. Patients in the nurse-led follow-up group were significantly more satisfied with the visits , whereas QoL and health care consumption within the first four months were comparable between the two groups . Nurse-led follow-up was less expensive than conventional medical follow-up . However , the total costs for the first four months of follow-up in this study were higher in the nurse-led follow-up group because of a higher frequency of visits . CONCLUSION The results suggest that conventional medical follow-up is interchangeable with nurse-led follow-up . A cost utility study is necessary to determine the preferred frequency and duration of the home visits 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 BACKGROUND Little is known about the use of palliative care for out patients who continue to pursue treatment of their underlying disease or whether outpatient palliative medicine consultation teams improve clinical outcomes . METHODS We conducted a year-long controlled trial involving 50 intervention patients and 40 control patients in a general medicine outpatient clinic . Primary care physicians referred patients with advanced congestive heart failure , chronic obstructive pulmonary disease , or cancer who had a prognosis ranging from 1 to 5 years . In the intervention group , the primary care physicians received multiple palliative care team consultations , and patients received advance care planning , psychosocial support , and family caregiver training .  Clinical and health care utilization outcomes were assessed at 6 and 12 months . RESULTS Groups were similar at baseline . Similar numbers of patients died during the study year ( P = .63 ) . After the intervention , intervention group patients had less dyspnea ( P = .01 ) and anxiety ( P = .05 ) and improved sleep quality ( P = .05 ) and spiritual well-being ( P = .007 ) , but no change in pain ( P = .41 ) , depression ( P = .28 ) , quality of life ( P = .43 ) , or satisfaction with care ( P = .26 ) . Few patients received recommended analgesic or antidepressant medications . Intervention patients had decreased primary care ( P = .03 ) and urgent care visits ( P = .04 ) without an increase in emergency department visits , specialty clinic visits , hospitalizations , or number of days in the hospital . There were no differences in charges ( P = .80 ) . CONCLUSIONS Consultation by a palliative medicine team led to improved patient outcomes in dyspnea , anxiety , and spiritual well-being , but failed to improve pain or depression .  Palliative care for seriously ill out patients can be effective , but barriers to implementation must be explored BACKGROUND To identify factors influencing place of death among home palliative care patients with advanced cancer , focusing on the timing of referrals from hospital to home care setting s. METHODS A cross-sectional nationwide question naire survey was conducted on home palliative care patients at 1000 r and omly selected home care agencies in Japan . A total of 568 responses were analyzed ( effective response rate , 69 % ) . RESULTS Multivariate logistic regression analysis revealed that ( i ) predischarge health care supports in hospital ( e.g. early referral 8 days or more before discharge ; clear explanation by hospital staffs to patients and families regarding discharge to live and die at home ) and ( ii ) postdischarge health care supports after transferring home care ( e.g. signing a 24-h support insurance contract of network between primary physician and nurse as a home palliative care team ; primary nurse consultation with primary physician > 3 times during the first week after discharge ) have an effect on place of death among home palliative care patients . CONCLUSION An early and carefully coordinated referral support system for smooth discharge by hospital staffs as well as intensive and highly qualified support just after discharge by the home care team would help to increase the number of patients who could die at home CONTEXT Although home-based health care has grown over the past decade , its effectiveness remains controversial . A prior trial of Veterans Affairs ( VA ) Team-Managed Home-Based Primary Care ( TM/HBPC ) found favorable outcomes , but the replicability of the model and generalizability of the findings are unknown . OBJECTIVES To assess the impact of TM/HBPC on functional status , health-related quality of life ( HR-QoL ) , satisfaction with care , and cost of care . DESIGN AND SETTING Multisite r and omized controlled trial conducted from October 1994 to September 1998 in 16 VA medical centers with HBPC programs . PARTICIPANTS A total of 1966 patients with a mean age of 70 years who had 2 or more activities of daily living impairments or a terminal illness , congestive heart failure ( CHF ) , or chronic obstructive pulmonary disease ( COPD ) .  Intervention Home-based primary care ( n=981 ) , including a primary care manager , 24-hour contact for patients , prior approval of hospital readmissions , and HBPC team participation in discharge planning , vs customary VA and private sector care ( n=985 ) . MAIN OUTCOME MEASURES Patient functional status , patient and caregiver HR-QoL and satisfaction , caregiver burden , hospital readmissions , and costs over 12 months . RESULTS Functional status as assessed by the Barthel Index did not differ for terminal ( P=.40 ) or nonterminal ( those with severe disability or who had CHF or COPD ) ( P=.17 ) patients by treatment group . Significant improvements were seen in terminal TM/HBPC patients in HR-QoL scales of emotional role function , social function , bodily pain , mental health , vitality , and general health . Team-Managed HBPC nonterminal patients had significant increases of 5 to 10 points in 5 of 6 satisfaction with care scales . The caregivers of terminal patients in the TM/HBPC group improved significantly in HR-QoL measures except for vitality and general health . Caregivers of nonterminal patients improved significantly in QoL measures and reported reduced caregiver burden ( P=.008 ) . Team-Managed HBPC patients with severe disability experienced a 22 % relative decrease ( 0.7 readmissions/patient for TM/HBPC group vs 0.9 readmissions/patient for control group ) in hospital readmissions ( P=.03 ) at 6 months that was not sustained at 12 months . Total mean per person costs were 6.8 % higher in the TM/HBPC group at 6 months ( $ 19190 vs $ 17971 ) and 12.1 % higher at 12 months ( $ 31401 vs $ 28008 ) . CONCLUSIONS The TM/HBPC intervention improved most HR-QoL measures among terminally ill patients and satisfaction among non-terminally ill patients . It improved caregiver HR-QoL , satisfaction with care , and caregiver burden and reduced hospital readmissions at 6 months , but it did not substitute for other forms of care . The higher costs of TM/HBPC should be weighed against these benefits 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 
    Output:
    
RESULTS Advantages to palliative care include improvement in certain symptoms such as depression , improved patient quality of life , reduced aggressive care at the end of life , increased advanced directives , reduced hospital length of stay and hospitalizations , improved caregiver burden and better maintenance of caregiver quality of life and reduction in the medical cost of care as well as patient and family satisfaction .
There are r and omized trials which demonstrate that symptoms and quality of life are not improved , and re source utilization and costs are not different from " usual " care .
CONCLUSIONS Multiple studies have demonstrated several benefits to early outpatient palliative care for patients with newly diagnosed metastatic cancer .