***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: This study was conducted to examine the effects of an educational programme on shared decision-making on end-of-life care performance , moral sensitivity and attitude towards shared decision-making among Korean nurses . A quasi-experimental study with a non-equivalent control group pretest-posttest design was used . Forty-one clinical nurses were recruited as participants from two different university hospitals located in Daegu , Korea . Twenty nurses in the control group received no intervention , and 21 nurses in the experimental group received the educational programme on shared decision-making . Data were collected with a question naire covering end-of-life care performance , moral sensitivity and attitude towards shared decision-making . Analysis of the data was done with the chi-square test , t-test and Fisher 's exact test using SPSS/Win 17.0 ( SPSS , Inc. , Chicago , IL , USA ) . The experimental group showed significantly higher scores in moral sensitivity and attitude towards shared decision-making after the intervention compared with the control group . This study suggests that the educational programme on shared decision-making was effective in increasing the moral sensitivity and attitude towards shared decision-making among Korean nurses OBJECTIVE The aim of this study was to explain the role of patient advocacy in the Advance Care Planning ( ACP-ing ) process . Nurses rate prolonging the dying process with inappropriate measures as their most disturbing ethical issue and protecting patients ' rights to be of great concern ( Johnston et al 2002 ) . Paradoxically ethical codes assume nurses have the autonomy to uphold patients ' health-care choices . Advance Directives ( AD ) design ed to improve end-of-life care are poorly taken up and acute hospitals are generally not geared for the few they receive . The Respecting Patient Choices Program ( RPCP ) improves AD utilisation through providing a supportive framework for ACP-ing and primarily equipping nurses as RPC consultants . Assisting patients with this process requires attributes consistent with patient advocacy arising out of nursing 's most basic tenet , the care of others . DESIGN Likert Scales survey administered pre and six months post-intervention to pilot and control groups , with coinciding focus groups . SETTING Selected wards in an acute care public hospital in South Australia . SUBJECTS Nurses on the palliative care , respiratory , renal and colo-rectal pilot wards and the haem-oncology , coronary care , cardiology and neurology/geriatric control wards . INTERVENTION The RPCP during the 2004 - 2005 South Australian pilot of the ( RPCP ) . MAIN OUTCOMES The organisational endorsement of ACP-ing gave nurses the autonomy to be patient advocates with respect to end-of-life care , reconciling clinical practice to their code of ethics and easing distress about prolonging the dying process inappropriately . RESULTS Statistically significant survey results in the post-intervention group showed nurses experienced : encouragement to ensure patients could make informed choices about their end-of-life treatment ( 84 % ) ; the ability to uphold these wishes in practice ( 73 % ) ; and job satisfaction from delivering appropriate end-of-life care ( 67 % ) ; compared to approximately half ( 42 - 55 % ) of respondents in the pre-intervention and control groups . Focus group participants shared that it used to be hard to advocate for patients , but now they could act legitimately and felt ethically comfortable about ensuing end-of-life-care . CONCLUSION Findings suggested patient advocacy , fostered by the supportive RPC environment , effectuates the ACP-ing process . It is recommended that the RPCP should be recognised and developed as integral to promoting quality end-of-life assurance and associated job satisfaction Objective To investigate the impact of advance care planning on end of life care in elderly patients . Design Prospect i ve r and omised controlled trial . Setting Single centre study in a university hospital in Melbourne , Australia . Participants 309 legally competent medical in patients aged 80 or more and followed for six months or until death . Interventions Participants were r and omised to receive usual care or usual care plus facilitated advance care planning . Advance care planning aim ed to assist patients to reflect on their goals , values , and beliefs ; to consider future medical treatment preferences ; to appoint a surrogate ; and to document their wishes . Main outcome measures The primary outcome was whether a patient ’s end of life wishes were known and respected . Other outcomes included patient and family satisfaction with hospital stay and levels of stress , anxiety , and depression in relatives of patients who died . Results 154 of the 309 patients were r and omised to advance care planning  , 125 ( 81 % ) received advance care planning , and 108 ( 84 % ) expressed wishes or appointed a surrogate , or both . Of the 56 patients who died by six months , end of life wishes were much more likely to be known and followed in the intervention group ( 25/29 , 86 % ) compared with the control group ( 8/27 , 30 % ; P<0.001 ) . In the intervention group , family members of patients who died had significantly less stress ( intervention 5 , control 15 ; P<0.001 ) , anxiety ( intervention 0 , control 3 ; P=0.02 ) , and depression ( intervention 0 , control 5 ; P=0.002 ) than those of the control patients . Patient and family satisfaction was higher in the intervention group . Conclusions Advance care planning improves end of life care and patient and family satisfaction and reduces stress , anxiety , and depression in surviving relatives . Trial registration Australian New Zeal and clinical trials registry ACTRN12608000539336 BACKGROUND Advance Care Planning ( ACP ) is a systematic approach to ensure that effective advance directives ( ADs ) are developed and respected . We studied the effects of implementing a regional ACP program in Germany . METHODS In a prospect i ve , inter-regionally controlled trial focusing on nursing homes ( n/hs ) , we compared the number , relevance and validity of new ADs completed in the intervention region versus the control region .  Intervention n/h residents and their families were offered professional facilitation including st and ardized documentation . RESULTS Data from 136 residents of three intervention n/hs were compared with data from 439 residents of 10 control n/hs over a study period of 16.5 months . In the intervention region , 49 ( 36.0 % ) participating residents completed a new AD over the period of the study , compared to 18 ( 4.1 % ) in the control region ; these ADs included 30 ADs by proxy in the intervention region versus 10 in the control region . Proxies were design ated in 94.7 % versus 50.0 % of cases , the AD was signed by a physician in 93.9 % versus 16.7 % , and an emergency order was included in 98.0 % versus 44.4 % . Resuscitation status was addressed in 95.9 % versus 38.9 % of cases ( p<0.01 for all of the differences mentioned above ) . In the intervention region , new ADs were preceded by an average of 2.5 facilitated conversations ( range , 2–5 ) with a mean total duration of 100 minutes ( range , 60–240 minutes ) . CONCLUSION The implementation of an ACP program in German nursing homes led , much more frequently than previously reported , to the creation of advance directives with potential relevance to medical decision-making . Future research should assess the effect of such programs on clinical and structural outcomes 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 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 
    Output:
    
The training programs increased the knowledge , attitudes towards shared decision-making , perceived communication skills , confidence , comfort and experiences concerned with discussing end-of-life ( EOL ) issues .
Patient advocacy , job satisfaction and perceived level of adequate training for EOL care were improved .
The use of ‘ decision aids ’ was rated as acceptable and clinical ly useful .
Conclusions Training for healthcare professionals in ACP has positive effects on their knowledge , attitude and skills .