***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: We describe training in CBT techniques for 20 palliative care practitioners delivered as 12 days ' equivalent teaching plus skills-building supervision over a six month period . Audiotapes of trainees ' interactions with patients during their usual work were rated using a specially devised ‘ Cognitive First Aid ’ rating scale ( CFARS ) . The CFARS was highly internally consistent ( Cronbach 's Alpha 0.93 ) and inter-rater reliability was high . Trainees showed significant gain in CBT skills competency over six months ( p=0.001 ) . After initial training , half the trainees were r and omised to discontinue supervision ; their measured CBT skill dropped as did their self-reported confidence when reassessed six months later , whereas those who continued in supervision gained further skill and maintained confidence ( p=0.007 ) . Palliative care practitioners can be trained in CBT skills by a simple and brief training course and supportive , skills-building supervision . These skills are compatible with national guidelines on delivery of psychological support to patients at all stages of cancer . Supervision is necessary to ensure maintenance of skills and confidence to use them AIMS To evaluate the effects of a palliative care education programme on the self-reported knowledge and confidence of 72 community nurses . DESIGN a prospect i ve longitudinal postal question naire survey was conducted . FINDINGS seventy-one ( 99 % ) completed a pre-course question naire , 52 ( 72 % ) a question naire at completion of the course , and 37 ( 51 % ) a question naire one year later . Following the programme , more nurses felt that their professional needs were being met well or very well . Confidence in practice showed an increasing trend over time . Desire for education was lower on course completion than at its start . Palliative Care Nursing Quiz scores rose from a pre-course median of 12.5 to 15 at course completion ( P=0.001 ) which was maintained 1 year later . CONCLUSION the education programme was successful in raising st and ards of knowledge , professional development and confidence . Improvement was maintained one year later The effect of a program to train clinicians to support patients making decisions about place of end-of-life care was evaluated . In all , 88 oncology and /or palliative care nursing and allied health providers from three Ontario health networks were r and omly assigned to an education or control condition . Quality of decision support provided to st and ardized patients was measured before and after training , as were participants ’ perceptions about the acceptability of the training program and their intentions to engage in patient decision support . Compared to controls , intervention group members improved the quality of decision support provided and were more likely to address a wider range of decision-making needs . Intervention group members scored higher on a knowledge test of decision support than controls and rated the components as acceptable . Improvements in the quality of decision support can be made by providing training and practical tools such as a patient decision aid OBJECTIVES To determine if an educational program can improve knowledge and attitude among ancillary staff on end-of-life care issues in a long-term care facility . DESIGN A pilot study using a pre- and post-test design prior to and at the completion of an education intervention . SETTING A long-term care facility in suburban Philadelphia that has 150 assisted living beds and 53 nursing home beds . PARTICIPANTS Long-term care ancillary staff including certified nursing assistants ( called " care managers " at this facility ) , social workers , recreational therapists , and food service workers . INTERVENTION The intervention was a novel educational program consisting of five in-service lectures with accompanying take home self- study modules for ancillary staff in long-term care entitled " Dignity in Dementia . " MEASUREMENTS Ancillary staff attitudes and knowledge on end-of-life issues in dementia were assessed with a knowledge and attitude question naire pre- and post-intervention . One-year follow-up question naires were administered to assess long-term maintenance of knowledge and attitude changes . RESULTS Thirty-two ancillary staff completed the pre-intervention question naires . Twenty-nine ancillary staff completed the post-intervention question naires ( 90.6 % ) . There was a significant change in the end-of-life knowledge level of the ancillary staff ( P = .0270 ) . Specifically , there was a significant change in one question dealing with dementia as a terminal disease ( P = .006 ) . There were also significant changes in the average attitude scores of the ancillary staff . ( P = .0242 ) . One-year follow-up revealed that both knowledge and attitude changes were maintained . CONCLUSIONS This pilot project demonstrates that a staff educational program on end-of-life care for dementia residents can improve end-of-life knowledge and attitudes among long-term care ancillary staff and that this improvement can be maintained for up to 1 year . This intervention is easily reproducible in the long-term care setting . This project is an important step in helping improve end-of-life care for dementia residents in long-term care setting s by improving the knowledge and attitudes of their caregivers Prompted by directives from the GMC , ‘ care of the dying ’ is identified as ‘ core curricula ’ for undergraduate medical education . However , there are many technical and interpersonal challenges faced in learning the practice of palliative medicine . Accordingly , the design and delivery of education programmes need to be both carefully considered and evaluated . Using B and ura ’s Social Cognitive Theory as a driver , appropriate methodology for evaluating a novel education programme in palliative medicine was drafted . A pre- and post-survey of an education programme and palliative care placement  for fourth year medical undergraduate students from Liverpool University ( n = 216 ) was completed using a composite question naire containing ; i )  Self-efficacy in Palliative Care Scale ( SEPC ) and ii )  Thanatophobia Scale . Both scales have shown reliability and validity within the sample population . Additionally , a r and omly selected Focus Group was conducted to provide qualitative information on the students ’ experience . A total of 139 pre- and post- question naires ( 64 % ) were completed . Analysis identified significant improvements in perceived efficacy ( SEPC Communication t = −16.41 , P < 0.001 ; SEPC Patient Management t = −22.31 , P < 0.001 ; SEPC Multidisciplinary Teamwork t = −15.56 , P < 0.001 ) . Significant improvements in thanatophobia were also recorded ( z = −7.51 , P < 0.001 ) although some interesting anomalies were noted . This study demonstrates that considered and appropriately structured clinical education has been shown to significantly improve  students ’ belief in their ability to practice palliative medicine and to improve their attitude towards care . In accordance with the study ’s theoretical driver , it is reasonable to propose that the engaged active learning will have a positive effect on the future care of dying patients Purpose High- quality palliative care requires physicians who communicate effectively , yet many do not receive adequate training . Leading efforts to demonstrate the effectiveness of such training have involved time-intensive programs that included primarily attending physicians , which have been conducted outside of the United States . The goal was to evaluate the effect of a short course to improve residents ' communication skills delivering bad news and eliciting patients ' preferences for end-of-life care . Method This prospect i ve trial enrolled internal medicine residents at Duke University Medical Center from 1999 to 2001 . The course consisted of small-group teaching with lecture , discussion , and role-play . The outcome measure was observed communication skills delivering bad news and eliciting patients ' preferences for end-of-life treatment , assessed via audio-recorded st and ardized patient encounters before and after receiving the intervention . Results Thirty-seven residents received the intervention and 19 were in the control group . Residents attending the course demonstrated statistically significant increases in their overall skill ratings in the delivery of bad news , with improvement in the specific areas of information giving and responding to emotional cues . Although cumulative scores for discussion s about patient preferences for treatment did not increase , residents demonstrated enhanced specific skills including discussing probability , presenting clinical scenarios , and asking about prior experience with end-of-life decision making . Conclusion A relatively short , intensive course can improve the end-of-life communication skills of U.S. medical residents The aim of this controlled study was to evaluate a 1-year learner-centred educational project in end-of-life care for home care staff in a rural district of Sweden . Another rural district in the same region served as a control area . A 20-item question naire measuring attitudes towards end-of-life care was design ed , and the Hospital Anxiety and Depression ( HAD ) scale was used to measure mental well being . Increased agreement to 18 of 20 attitude statements was seen in the education group , while 2 of 20 items showed a decreased agreement in the control group . Test retest reliability of the 20-item question naire was good ( r = 0.92 ) . The total HAD score decreased from 8.3 pretest to 5.3 post-test in the education group ( 95 % CI=2.1– 3.7 ; P<0.001 ) , and was 6.8 for both years in the control group . Our study shows that a comprehensive educational programme not only improved attitudes towards end-of-life care , but also the mental well being of the home care staff AIM This paper is a report of part of an evaluation of the impact of a national palliative care education and support programme on the knowledge and confidence of members of district nursing teams . BACKGROUND District nursing teams are the mainstay of ' h and s on ' provision of care at home . In recognition of their central role , the English Department of Health commissioned a national palliative care education programme as post registration education had been limited . METHODS The evaluation , conducted between 2002 and 2004 , had a mixed methods design . In the summative component , 1280 nurses were r and omly selected from eight cancer networks to receive postal question naires 1 year apart , before and after the educational intervention .  Changes in scores were calculated and a multiple regression analysis undertaken to identify predictors of improvement in confidence in competence and knowledge . The formative component involved qualitative interviews with a sub- sample of 39 district nurses participating in the programme . FINDINGS Nurses who responded in both years ( 374/32 % ) were included in the analysis . There was a small statistically significant increase in confidence in palliative care competency and knowledge after participation in the educational programmes . Nurses without district nursing qualifications and who had never worked in specialist palliative care had the largest improvements in scores . Qualitative data supported these findings . CONCLUSION The findings suggest that the education programme led to improvements in self-reported district nursing confidence in palliative care competencies and knowledge ; it is likely that the baseline level of palliative care confidence in competency and knowledge has as a result been raised nationally 
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Level of prior experience and availability of practice reinforcement influenced learning .
Participative and interactive learning strategies were predominantly used along with discussion of case scenarios .
Conclusions : Classroom-based education and training is useful for enhancing professionals ’ skills and perceived preparedness for delivering end-of-life care but should be reinforced by actual practice experience