***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 
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    Input: CONTEXT Palliative care is being advocated for noncancer patients but needs evidence of effectiveness and cost-effectiveness . OBJECTIVE We evaluated the cost-effectiveness of a new palliative care service for people with multiple sclerosis ( MS ) . METHODS We used a r and omized fast-track Phase II controlled trial . Patients in South East London who were severely affected by MS were referred by clinicians to the trial . After baseline interview , patients were r and omly allocated to either a multiprofessional palliative care team ( PCT ) immediately ( fast track ) or the control care group who continued best usual care for three months and then were offered the PCT . Data were collected at baseline , 6 , 12 , 18 , and 26 weeks on use of services , patient symptoms , other outcomes , and caregiver burden . RESULTS Fifty-two patients were r and omized : 25 fast track and 21 control patients completed the trial . There was a high level of disability , and mean Exp and ed Disability Status Scale score was 7.7 ( median 8 , st and ard deviation 1.0 ) . At 12 weeks , caregiver burden was 4.47 points lower ( 95 % confidence interval [ CI ] : 1.05 - 7.89 ) in the fast track compared to the control group . Mean service costs , including inpatient care and informal care , over the 0 - 12-week follow-up were pound1,789 lower for the fast-track group ( bootstrapped 95 % CI : - pound5,224 to pound1,902 ) . There was a trend toward lower community costs in the fast-track group and no differences in costs to informal caregivers . CONCLUSIONS The trial suggests that short-term palliative care for people severely affected by MS and their caregivers will be cost-effective and warrants further study . The fast-track trial design could be used to assess this The aim of this study was to assess the  Palliative care Outcome Scale ( POS ) for terminally ill nursing home ( NH ) patients in the Netherl and s. Methods : A prospect i ve observational study of patients with a life-expectancy of six weeks or less in 16 Dutch NHs . NH staff rated the patient characteristics and measured palliative care with the POS , including items on physical , psychosocial , informational , spiritual and practical aspects . Results : POS nonscores ( not applicable ; unknown ) were mainly found in the psychosocial and spiritual domains , particularly in patients with dementia . Mean scores for non-demented patients and patients with dementia were favourable for the majority of the POS items . Conclusion : According to the NH staff , fairly good quality care was provided , but the psychosocial and spiritual aspects of care need to be addressed more in the last days of the dying NH patient 's life . The results indicate that the POS is an appropriate instrument to assess not only cancer patients , but also non-cancer and ( moderately ) severely demented patients Multiple sclerosis results in both physical and psychological disability but some patients have needs that are not adequately met by existing services . Our objective was to explore whether a new palliative care service improved outcomes for people severely affected by multiple sclerosis . A delayed intervention r and omized controlled trial was undertaken with multiple sclerosis patients deemed by staff to have palliative care needs . The intervention was a multiprofessional palliative care team assessment and follow-up . The intervention group was offered the team immediately ( fast track , FI ) ; the control group continued best st and ard care and then offered the team after 3 months ( st and ard intervention , SI ) . The main outcome measures were : patient reported issues using the Palliative Care Outcome Scale and Multiple Sclerosis Impact Scale at 12 weeks and caregiver burden using the Zarit Burden Inventory .  Sixty-nine people were referred to the service ; 52 consented or were eligible to be r and omized ( 26 to the FI and 26 to the SI groups ) . At 12 weeks people in the FI group had an improvement ( mean change —1.0 ) in the total score of 5 key symptoms whereas there was deterioration in the SI group ( mean change 1.1 , F = 4.75 , p = 0.035 ) . There was no difference in the change in general Palliative Care Outcome Scale or Multiple Sclerosis Impact Scale scores . There was an improvement in caregiver burden in the FI group and a deterioration in the SI group ( F = 7.60 , p = 0.013 ) . Involvement with the palliative care service appeared to positively affect some key symptoms and reduced informal caregiver burden Introduction Lung cancer is a disease of high symptom burden , major psychosocial impact and poor prognosis . Although diagnosis is individual , each patient operates within a social context . Patient perception of family ’s or friends ’ concern may affirm the presence of support or may drive personal anxiety . Perceived worry may impact on freedom to discuss illness or symptoms within the support network . The vali date d palliative outcome scale quantifies physical and psychosocial needs . It also evaluates anxiety felt and anxiety perceived in the support network . This study examined lung cancer patients ’ symptoms , performance status , their supportive care needs and their perception of family’s/friends ’ anxiety . Goals of workThe aim of this study was to evaluate lung cancer patients ’ anxiety , physical symptoms , performance status and their perception of anxiety within their support network . Patients and methods The study was a prospect i ve observational evaluation of 170 lung cancer out- patients using an adapted palliative outcome scale question naire . Comparison was made between patients perceiving high anxiety within their support network and those who perceiving low anxiety . Main results Perceived familial and self-rated personal anxiety both increased as function declined ( p < 0.001 ; p = 0.001 ) . Increased perceived worry was associated with increased physical symptoms [ dyspnoea ( p < 0.001 ) , cough ( p = 0.001 ) , haemoptysis ( p = 0.009 ) ] , low self-esteem ( p = 0.004 ) and feeling lack of worth ( p = 0.035 ) . Perception of increased worry did not influence whether patients felt able to share their feelings ( p = 0.362 ) . Conclusions As physical function declines and symptoms increase , patients are more worried themselves and perceive increased anxiety within their support network . However , this circle of anxiety did not impair the perception that feelings could be shared within the support network Goals We aim ed to evaluate the palliative care quality for terminal cancer patients as a reference for prospect i ve service improvements . Patients and methods A prospect i ve study was conducted to analyze the quality audit data collected from 1,476 sample s in one medical center ’s palliative care unit . Lai ’s modified version of the support team assessment schedule was utilized for 2-year data collection , applying 17 categories of audit criteria rated on a scale of 0 to 4 ( 0—no symptoms , 4—significant symptoms ) . The quality audit criteria were scored weekly for 2 weeks following patient admission . Results Average scores of quality audit criteria from admission to week 2 were 10.05 , 8.85 , and 8.49 , respectively , with statistical differences noted weekly . Efficacy of palliative care was most evident 2 weeks after hospitalization . Factors with statistically significant differences between admission and week 1 included : pain control , constipation , vomiting , anorexia , other symptom control , patient anxiety , self awareness and preparation of patient for illness , self awareness and preparation of family for illness , and satisfaction of patient ’s spiritual belief and life philosophy . Factors with statistically significant differences between weeks 1 and 2 included : pain control , other symptom control , self awareness and preparation of family for illness , and satisfaction of patient ’s spiritual belief and life philosophy . Conclusions Patients in hospice care received adequate symptom relief . Total quality audit scores declined progressively over the 2 weeks following patient admission , indicating efficacy of palliative care quality Background Palliative care has been proposed for progressive non-cancer conditions but there have been few evaluations of service developments . We analysed recruitment , compliance and follow-up data of a fast track ( or wait list control ) r and omised controlled trial of a new palliative care service – a design not previously used to assess palliative care . Methods / Design An innovative palliative care service ( comprising a consultant in palliative medicine , a clinical nurse specialist , an administrator and a psychosocial worker ) was delivered to people severely affected by multiple sclerosis ( MS ) , and their carers , in southeast London . Our design followed the MRC Framework for the Evaluation of Complex Interventions . In phase II we conducted r and omised controlled trial , of immediate referral to the service ( fast-track ) versus a 12-week wait ( st and ard best practice ) . Main outcome measures were : compliance ( the extent the trial protocol was adhered to ) , recruitment ( target 50 patients ) , attrition and missing data rates ; trial outcomes were Palliative Care Outcome Scale and MS Impact Scale . Results 69 patients were referred , 52 entered the trial ( 26 r and omised to each arm ) , 5 refused consent and 12 were excluded from the trial for other reasons , usually illness or urgent needs , achieving our target numbers . 25/26 fast track and 21/26 st and ard best practice patients completed the trial , result ing in 217/225 ( 96 % ) of possible interviews completed , 87 % of which took place in the patient 's home . Main reasons for failure to interview and /or attrition were death or illness . There were three deaths in the st and ard best practice group and one in the fast-track group during the trial . At baseline there were no differences between groups . Missing data for individual question naire items were small ( median 0 , mean 1–5 items out of 56 + items per interview ) , not associated with any patient or carer characteristics or with individual question naires , but were associated with interviewer . Conclusion This is the first time a fast track ( or wait list ) r and omised trial has been reported in palliative care . We found it achieved good recruitment and is a feasible method to evaluate palliative care services when patients are expected to live longer than 3–6 months . Home interviews are needed for a trial of this kind ; interviewers need careful recruitment , training and supervision ; and there should be careful separation from the clinical service of the control patients to prevent accidental contamination . Trial Registration Clinical Trials . Gov Abstract Background The care of palliative patients challenges the health care system in both quantity and quality . Especially the role of primary care givers needs to be strengthened to provide them with the knowledge and the confidence of applying an appropriate end-of-life care to palliative patients . To improve health care services for palliative patients in primary care , interested physicians in and around Heidelberg , Germany , are enabled to participate in the community-based program ' Palliative Medical Initiative North Baden ( PAMINO ) ' to improve their knowledge in dealing with palliative patients . The impact of this program on patients ' health and quality of life remains to be evaluated . Methods / Design The evaluation of PAMINO is a non-r and omized , controlled study . Out of the group of primary care physicians who took part in the PAMINO program , a sample of 45 physicians and their palliative patients will be compared to a sample of palliative patients of 45 physicians who did not take part in the program . Every four weeks for 6 months or until death , patients , physicians , and the patients ' family caregivers in both groups answer questions to therapy strategies , quality of life ( QLQ-C15-PAL , POS ) , pain ( VAS ) , and burden for family caregivers ( BSFC ) . The inclusion of physicians and patients in the study starts in March 2007 . Discussion Although participating physicians value the increase in knowledge they receive from PAMINO , the effects on patients remain unclear . If the evaluation reveals a clear benefit for patients ' quality of life , a larger-scale implementation of the program is considered . Trial registration : The study was registered at ‘ current controlled trials ( CCT ) ’ , registration number : IS RCT N78021852 The preferences of advanced cancer patients and the impact of cancer management on relatives remain partly unknown . We present the preliminary results of a prospect i ve study evaluating  quality of care ( QC ) , quality of life ( QoL )  and  family impact ( FI ) in advanced cancer patients treated at home or in hospital , depending on their own choice . QC is evaluated using  STAS question naire , and  QoL  and symptom  control using  EORTC QLQ-C30 , Spielberger question naire  and  VAS for pain evaluation . FI is evaluated using  GHQ28  and semi-structured interviews conducted at days 0 , 15 , 30 , then monthly until death . Intermediate analysis of 52 patients ( 100 expected ) of whom 63 % had chosen home care , 26 % in-hospital care . Actual assignment is home care : 56 % , in-hospital care : 44 % . Place of death is home : 15 % , hospital : 85 % . In the QC study , the two symptoms most frequently rated by nurses are anxiety and pain , in either group . Patient information and communication are also similar in both groups . The QoL and symptom study shows that patients also rate pain as frequent ( 84 % ) but moderate ( mean VAS score 2.5/10 ) . However , the most frequent symptom is fatigue ( 100 % ) . Anxiety is rated higher at hospital , as well as FI ( anxiety , insomnia , social dysfunction and global score ) . Palliative care research is sometimes difficult but feasible . In this study , most patients prefer home care .  Anxiety and FI seem lower at home . However , re-hospitalisations just before death are frequent and death generally occurs in hospital As part of a large multicentre study on palliative care units in Italy , carried out between 1 January and 30 June 1995 , we describe the place , circumstances and ‘ quality of death ’ of patients admitted to home palliative care . Data presented refer 
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Overall , they seem to be well accepted tools for outcome measurement in palliative care , both in clinical care and research