***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: CONTEXT Breathlessness is a distressing symptom in advanced disease . Underst and ing its patterns , burden , and palliative care ( PC ) needs over time is important to improve patients ' quality of life . OBJECTIVES To describe and compare the courses of refractory breathlessness , functional status , distress , and PC needs in patients with advanced chronic obstructive pulmonary disease ( COPD ) or lung cancer ( LC ) over time . METHODS This was a cohort study of patients with COPD ( Stage III/IV ) or LC . Data were assessed monthly with up to 12 telephone interviews , using the modified Borg Scale , Karnofsky Performance Status Scale , Distress Thermometer  , and  Palliative care Outcome Scale  as outcomes measures . Descriptive analysis compared all outcomes between COPD and LC at baseline and over time ( forward from study entry and backward from death ) . RESULTS A total of 82 patients ( 50 COPD and 32 LC ) , mean ( SD ) age of 67.2 ( 7.8 ) , and 36 % female were included ( 8 COPD and 23 LC deceased ) . The patients with COPD perceived higher levels of breathlessness and distress at lower functional status steadily over time . The LC patients ' breathlessness , distress , and PC needs increased , whereas functional status decreased toward death . The PC needs were similar between disease groups . Breathlessness was negatively correlated with functional status ( COPD = mean r=-0.20 , P=0.012 ; LC = mean r=-0.277 , P=0.029 ) and positively correlated with PC needs in COPD patients ( mean r=0.343 , P<0.001 ) . Death was significantly predicted by diagnosis ( LC : hazard ratio=7.84 , P<0.001 ) and functional status ( 10 % decline : hazard ratio=1.52 , P=0.001 ) . CONCLUSION The PC needs of patients with advanced COPD are comparable with LC patients , and breathlessness severity and distress are even higher . The care for COPD patients requires further improvement to address symptom burden and PC needs Background Many HIV/AIDS patients experience pain often due to advanced HIV/AIDS infection and side effects of treatment . In sub-Saharan Africa , pain management for people with HIV/AIDS is suboptimal . With survival extended as a direct consequence of improved access to antiretroviral therapy , the prevalence of HIV/AIDS related pain is increasing . As most care is provided at home , the management of pain requires patient and family involvement . Pain education is an important aspect in the management of pain in HIV/AIDS patients . Studies of the effectiveness of pain education interventions for people with HIV/AIDS have been conducted almost exclusively in western countries . Methods / design A r and omised controlled trial is being conducted at the HIV and palliative care clinics of two public hospitals in Malawi . To be eligible , patient participants must have a diagnosis of HIV/AIDS ( stage III or IV ) . Carer participants must be the individual most involved in the patient ’s unpaid care . Eligible participants are r and omised to either : ( 1 ) a 30-minute face-to-face educational intervention covering pain assessment and management , augmented by a leaflet and follow-up telephone call at two weeks ; or ( 2 ) usual care . Those allocated to the usual care group receive the educational intervention after follow-up assessment s have been conducted ( wait-list control group ) . The primary outcome is pain severity measured by the Brief Pain Inventory . Secondary outcomes are pain interference , patient knowledge of pain management , patient quality of life , carer knowledge of pain management , caregiver motivation and carer quality of life . Follow-up assessment s are conducted eight weeks after r and omisation by palliative care nurses blind to allocation . Discussion This r and omised controlled trial conducted in sub-Saharan Africa among people living with HIV/AIDS and their carers will assess whether a pain education intervention is effective in reducing pain and improving pain management , quality of life and carer motivation . Trial registration Current Controlled Trials IS RCT N72861423 A high burden of pain , symptoms and other multidimensional problems persist alongside HIV treatment . WHO policy indicates palliative care as essential throughout the disease course . This study aim ed to determine whether palliative care delivered from within an existing HIV outpatient setting improves control of pain and symptoms compared to st and ard care . A prospect i ve , longitudinal controlled design compared patient outcomes at an outpatient facility that introduced  palliative care training to clinicians and stocked essential palliative care drugs , to outcomes of a cohort of patients at a similar HIV care facility with no palliative care , in Tanzania . Inclusion criteria were clinical ly significant pain or symptoms . Patients were followed from baseline fortnightly until week 10 using vali date d self-report outcome measures . For the primary pain outcome , the required sample size of 120 patients was recruited . Odds of reporting pain reduced significantly more at intervention site ( OR=0.60 , 95 % CI 0.50–0.72 ) than at control ( OR=0.85 , 95 % CI 0.80–0.90 ) , p=0.001 . For secondary outcomes , longitudinal analysis revealed significant difference in slope between intervention and control , respectively : Medical Outcomes Study -HIV ( MOS-HIV ) physical score 1.46 vs. 0.54 , p=0.002 ; MOS-HIV mental health 1.13 vs. 0.26 , p=0.006 ; and POS total score 0.84 vs. 0.18 , p=0.001 . Neither baseline CD4 nor antiretroviral therapy ( ART ) use was associated with outcome scores . These data are the first to report outcomes evaluating integrated HIV outpatient palliative care in the presence of ART . The data offer substantive evidence to underpin the existing WHO clinical guidance that states an essential role for palliative care alongside HIV treatment , regardless of prognosis Background SAIATU is a program of specially trained in-home social assistance and companionship which , since February 2011 , has provided support to end-of-life patients , enabling the delivery of better clinical care by healthcare professionals in Osakidetza ( Basque Health Service ) , in Guipúzcoa ( Autonomous Community of the Basque Country).In January 2012 , a retrospective observational study was carried out , with the aim of describing the characteristics of the service and determining if the new social service and the associated socio-health co-ordination had produced any effect on the use of healthcare re sources by end-of-life patients .The results of a comparison of a cohort of cases and controls demonstrated evidence that the program could reduce the use of hospital re sources and promote the continuation of living at home , increasing the home-based activity of primary care professionals . The objective of this study is to analyse whether a program of social intervention in palliative care ( SAIATU ) results in a reduction in the consumption of healthcare re sources and cost by end-of-life patients and promotes a shift towards a more community-based model of care . Method / design Comparative prospect i ve cohort study , with r and omised selection of patients , which will systematic ally measure patient characteristics and their consumption of re sources in the last 30 days of life , with and without the intervention of a social support team trained to provide in-home end-of-life care . For a sample of approximately 150 patients , data regarding the consumption of public healthcare re sources , SAIATU activity , home hospitalisation teams , and palliative care will be recorded . Such data will also include information dealing with the socio-demographic and clinical characteristics of the patients and attending carers , as well as particular characteristics of patient outcomes ( Karnofsky Index ) , and of the outcomes of palliative care received ( Palliative Outcome Scale).Ethical approval for the study was given by the Clinical Research Ethics Committee of Euskadi ( CREC-C ) on 10 Dec 2012 . Discussion The results of this prospect i ve study will assist in verifying or disproving the hypothesis that the in-home social care offered by SAIATU improves the efficiency of healthcare re source usage by these patients ( quality of life , symptom control).This project represents a dramatic advance with respect to other studies conducted to date , and demonstrates how , through the provision of personnel trained to provide social care for patients in the advanced stages of illness , and through strengthening the co-ordination of such social services with existing healthcare system re sources , the result ing holistic structure obtains cost savings within the health system and improves the efficiency of the system as a whole Background Patients with HIV/AIDS on Antiretroviral Therapy ( ART ) suffer from physical , psychological and spiritual problems . Despite international policy explicitly stating that a multidimensional approach such as palliative care should be delivered throughout the disease trajectory and alongside treatment , the effectiveness of this approach has not been tested in ART-experienced population s. Methods / design This mixed methods study uses a R and omised Controlled Trial ( RCT ) to test the null hypothesis that receipt of palliative care in addition to st and ard HIV care does not affect pain compared to st and ard care alone . An additional qualitative component will explore the mechanism of action and participant experience . The sample size is design ed to detect a statistically significant decrease in reported pain , determined by a two tailed test and a p value of ≤0.05 . Recruited patients will be adults on ART for more than one month , who report significant pain or symptoms which have lasted for more than two weeks ( as measured by the African Palliative Care Association ( APCA ) African Palliative Outcome Scale ( POS ) ) . The intervention under trial is palliative care delivered by an existing HIV facility nurse trained to a set st and ard . Following an initial pilot the study will be delivered in two African countries , using two parallel independent Phase III clinical RCTs . Qualitative data will be collected from semi structured interviews and documentation from clinical encounters , to explore the experience of receiving palliative care in this context . Discussion The data provided by this study will provide evidence to inform the improvement of outcomes for people living with HIV and on ART in Africa . Clinical Trials.gov Identifier : Background : Although communicating effectively with patients receiving palliative care can be difficult , it may contribute to maintaining or enhancing patients ’ quality of life . Little is known about the effect of training general practitioners in palliative care – specific communication . We hypothesized that palliative care patients of general practitioners exposed to the ‘ Availability , Current issues and Anticipation ’ communication training programme  would report better outcomes than patients of control general practitioners . Aim : To evaluate the effectiveness of the Availability , Current issues and Anticipation training programme for general practitioners on patient-reported outcomes . Design : In a controlled trial , general practitioners followed the Availability , Current issues and Anticipation programme or were part of the control group .  Patients receiving palliative care of participating general practitioners completed the  Palliative Care Outcome Scale , the European Organisation for Research and Treatment of Cancer Quality of Life  Question naire Core 15 Palliative , the Rest & Peace Scale , the Patient Satisfaction Question naire – III and the Availability , Current issues and Anticipation Scale  , at baseline and 12 months follow-up . We analysed differences between groups using linear mixed models . Trial registration : IS RCT N56722368 . Setting / participants : General practitioners who attended a 2-year Palliative Care Training Course in the Netherl and s. Results : Question naire data were available for 145 patients ( 89 in intervention and 56 in control group ) . We found no significant differences over time between the intervention and control groups in any of the five outcome measures . Ceiling effects were observed for the Rest & Peace Scale , Patient Satisfaction Question naire – III and Availability , Current issues and Anticipation Scale . Conclusion : General practitioner participation in the Availability , Current issues and Anticipation training programme did not have a measurable effect on any of the outcomes investigated . Patients reported high levels of satisfaction with general practitioner care , regardless of group assignment . Future research might focus on general practitioners without special interest in palliative care CONTEXT Most patient-reported outcome measurement tools in multiple sclerosis ( MS ) are geared toward less severely affected patients . Palliative care outcome measures have not been vali date d in patients with MS . OBJECTIVES To assess the psychometric properties of the  Core-Palliative Care Outcome Scale ( Core-POS ) and POS-MS-Symptoms ( POS-MS-S ) in patients severely affected by MS . METHODS Secondary analyses were conducted on data from a Phase II trial of palliative care in MS . Patients completed assessment s using the following five scales : Core-POS , POS-MS-S , the Multiple Sclerosis Impact Scale , the United Kingdom Neurological Disability Scale , and the Exp and ed Disability Status Scale . Data quality , scaling assumptions , acceptability , internal consistency , and construct validity of the Core-POS and POS-MS-S were determined using st and ard psychometric methods . RESULTS The 46 participants had a mean ±SD age of 52.8 ±10.6 years . The mean Exp and ed Disability Status Scale score was 7.9 ± 1.2 . Missing data were low ( 0 and 0.2 % for the Core-POS and POS-MS-S , respectively ) , and floor and ceiling effects were absent . Internal consistency was good ( Cronbach 's alpha for the Core-POS and POS-MS-S were 0.72 [ 95 % CI 0.56 - 0.84 ] and 0.81 [ 95 % CI 0.72 - 0.89 ] , respectively ) . Construct validity was consistent with a priori hypotheses 17 of 20 times . CONCLUSION Psychometric analyses confirm that the Core-POS and POS-MS-S are acceptable , reliable , and valid in patients severely affected by MS OBJECTIVES In Germany since 2007 patients with advanced life-limiting 
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There has been increasing use of these measures within non-cancer patient groups .
CONCLUSION The POS and STAS are now used in a wide variety of setting s and countries .