***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: The Cancer Information Service ( CIS ) of the National Cancer Institute ( NCI ) is a health communications program that disseminates information through two channels : to individuals through a toll-free telephone service and to organizations ( serving primarily underserved population s ) through an outreach program . People call the 1 - 800 - 4-CANCER line to meet a variety of information needs . The information specialists who respond to these calls are prepared to answer questions ranging from cancer prevention to early detection , treatment , and survivorship . In a 1996 r and om sample survey , 2,489 callers were asked why they called , how they valued the information , and what health-related actions they took or decisions they made since their call . Results show the CIS is highly valued by its users , with satisfaction high across gender , age , education , and racial/ethnic groups . While differences in satisfaction were observed by caller type and subject of inquiry , nearly all respondents reported that contact with the CIS increased knowledge , provided reassurance , and influenced decisionmaking and health behavior . Overall , 95 % were satisfied with  CIS information , 98 % trusted the information , 92 % reported an increase in knowledge , 69 % felt reassured , and 73 % said the information helped them to better cope with their concerns . Eight out of 10 callers reported the information they received had a positive impact , with 56 % reporting taking a positive health action . Results demonstrate that health communications programs like the CIS can fill information gaps consumers must bridge to make informed health care decisions and can play an important public health role in motivating people to take actions to reduce risks and /or make decisions that lead to improved health status To test the feasibility and efficacy of a multifaceted model of shared care for men after completion of treatment for prostate cancer Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Background Carers provide extended and often unrecognized support to people with cancer . The aim of this study is to test the hypothesis that excessive carer burden is modifiable through a telephone outcall intervention that includes supportive care , information and referral to appropriate psycho-social services . Secondary aims include estimation of changes in psychological health and quality of life . The study will determine whether the intervention reduces unmet needs among patient dyads . A formal economic program will also be conducted . Methods / Design This study is a single-blind , multi-centre , r and omized controlled trial to determine the efficacy and cost-efficacy of a telephone outcall program among carers of newly diagnosed cancer patients . A total of 230 carer/patient dyads will be recruited into the study ; following written consent , carers will be r and omly allocated to either the outcall intervention program ( n = 115 ) or to a minimal outcall / attention control service ( n = 115 ) . Carer assessment s will occur at baseline , at one and six months post-intervention . The primary outcome is change in carer burden ; the secondary outcomes are change in carer depression , quality of life , health literacy and unmet needs . The trial patients will be assessed at baseline and one month post-intervention to determine depression levels and unmet needs . The economic analysis will include perspectives of both the health care sector and broader society and comprise a cost-consequences analysis where all outcomes will be compared to costs . Discussion This study will contribute to our underst and ing on the potential impact of a telephone outcall program on carer burden and provide new evidence on an approach for improving the wellbeing of carers . Trial registration Australian New Zeal and Clinical Trials RegistryACTRN : 12613000731796 Goal Men diagnosed with prostate cancer experience high decision-related distress  concurrent with cancer-related distress .  Psycho-education , problem solving and decision support were integrated in a novel telephone-delivered supportive care intervention targeting men at diagnosis and assessed for feasibility . Material s and Methods An exploratory single-group pre – post-test design tracked session frequency , duration and content . St and ardised measures assessed decisional conflict , cancer-related distress and decision involvement .  Brief screening measures  for  psychological and decision-related distress  were incorporated into the intervention protocol . Twenty men ( 77 % response ) newly diagnosed with localised prostate cancer received the intervention . Results Men who were undecided about treatment at study entry required more pre-treatment intervention calls ( p < 0.013 ) . Pre-treatment support calls were longer ( M = 40.2 min ) and more complex by comparison to post-treatment calls ( M = 30.9 min ; p < 0.002 ) . Brief screening for decision-related distress correlated with concurrent ( p < 0.008 ) and prospect i ve ( p < 0.046 ) decisional conflict . Decisional conflict and intrusion decreased at post-test ( p < 0.001 ; p < 0.005 ) . Men reported a high level of satisfaction with the support received with benefits identified including anonymity and accessibility . Conclusions In this setting , a tele-based supportive care and decision support intervention for men newly diagnosed with prostate cancer was feasible . The use of brief screening measures as within-intervention clinical tools appears promising Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home . With funding from the Canadian Partnership Against Cancer , a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocol s using a rigorous methodology ( CAN-IMPLEMENT © ) . Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines . Protocol s were vali date d by cancer nurses from across Canada . The aim of this study is to build an effective and sustainable approach for implementing evidence -informed protocol s for nurses to use when providing remote symptom assessment , triage , and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments . Methods A prospect i ve mixed- methods study design will be used . Guided by the Knowledge to Action Framework , the study will involve ( a ) establishing an advisory knowledge user team in each of three targeted setting s ; ( b ) assessing factors influencing nurses ’ use of protocol s using interviews/focus groups and a st and ardized survey instrument ; ( c ) adapting protocol s for local use , ensuring fidelity of the content ; ( d ) selecting intervention strategies to overcome known barriers and implementing the protocol s ; ( e ) conducting think-aloud usability testing ; ( f ) evaluating protocol use and outcomes by conducting an audit of 100 r and omly selected charts at each of the three setting s ; and ( g ) assessing satisfaction with remote support using symptom protocol s and change in nurses ’ barriers to use using survey instruments . The primary outcome is sustained use of the protocol s , defined as use in 75 % of the calls . Descriptive analysis will be conducted for the barriers , use of protocol s , and chart audit outcomes . Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across setting s. Discussion Given the importance of patient safety , patient-centered care , and delivery of quality services , learning how to effectively implement evidence -informed symptom protocol s in oncology healthcare services is essential for ensuring safe , consistent , and effective care for individuals with cancer . This study is likely to have a significant contribution to the delivery of remote oncology services , as well as influence symptom management by patients at home OBJECTIVE There is a paucity of r and omized controlled trials ( RCTs ) to evaluate models of palliative care . Although interventions vary , all have faced a variety of method ological challenges including adequate recruitment , missing data , and contamination of the control group . We describe the ENABLE II intervention , methods , and sample baseline characteristics to increase intervention and method ological transparency , and to describe our solutions to selected method ological issues . METHODS Half of the participants recruited from our rural U.S. comprehensive cancer center and affiliated clinics were r and omly assigned to a phone-based , nurse-led educational , care coordination palliative care intervention model . Intervention services were provided to half of the participants weekly for the first month and then monthly until death , including bereavement follow-up call to the caregiver . The other half of the participants were assigned to care as usual .  Symptoms , quality of life , mood , and functional status were assessed every 3 months until death . RESULTS Baseline data of 279 participants were similar to normative sample s. Solutions to method ological challenges of recruitment , missing data , and " usual care " control group contamination are described . SIGNIFICANCE OF RESULTS It is feasible to overcome many of the method ological challenges to conducting a rigorous palliative care RCT OBJECTIVE The purpose of this study was to investigate the accuracy of oncologists ' recognition of their patients ' supportive care needs and symptoms in breast cancer outpatient consultation in Japan . METHODS The participants included a sample of r and omly selected out patients with breast cancer and two oncologists . The patients responded to vali date d self-administered question naires to assess their supportive care needs and symptoms . The oncologists responded to a question naire in which they indicated their perception of level of the same set of needs or symptoms following consultation . The two data sets were compared statistically . RESULTS Complete data sets were available for 408 patients . Low negative predictive values for the psychological ( 30 % ) and information domain ( 30 % ) indicated that the patients often have psychological and information needs that the oncologists do not appropriately recognize . The sensitivity and specificity of the physicians ' assessment for all physical symptoms except pain were < 40 and > 85 % , respectively , indicating that the physicians could not detect , but could rule out the possibility of a patient experiencing physical symptoms . Borderline/ clinical depression and anxiety were the only two symptoms that the oncologists reported more frequently than the patients did . As a result , the specificity of the physicians ' assessment for the detection of borderline/ clinical depression and anxiety was relatively low ( 74 and 27 % ) . CONCLUSIONS Oncologists ' recognition may not accurately reflect their patients ' supportive care needs and symptoms in usual care . Incorporation of a st and ard assessment system for supportive care needs and symptoms in clinical practice must heighten the oncologists ' awareness of their patients ' these problems PURPOSE / OBJECTIVES To compare the effectiveness of two low-intensity approaches for distressed patients with cancer and caregivers who had called cancer helplines seeking support . Baseline distress was hypothesized as a moderator of intervention effect . DESIGN R and omized trial . SETTING Community-based cancer helplines in Queensl and and New South Wales , Australia . SAMPLE 354 patients with cancer and 336 caregivers . METHODS Participants were r and omized to either a single session of nurse-led self-management intervention or a five-session psychologist cognitive behavioral intervention delivered by telephone . Assessment s were undertaken at baseline ( preintervention ) and at 3 , 6 , and 12 months . MAIN RESEARCH VARIABLES Psychological and cancer-specific distress and post-traumatic growth . FINDINGS No significant moderation by baseline cancer-specific distress was noted . For low-education patients , only the psychologist intervention was associated with a significant drop in distress . For all other participants , distress decreased over time in both arms with small to large effect sizes ( Cohen 's ds = 0.05 - 0.82 ) . Post-traumatic growth increased over time for all participants ( Cohen 's ds = 0.6 - 0.64 ) . CONCLUSIONS Many distressed patients with cancer and their caregivers may benefit significantly from a single session of a nurse psychoeducation intervention that can be delivered remotely by telephone and supported by self-management material s. Research is needed to develop an algorithm that moves beyond the use of distress as the only indicator for referral to specialist psychological services . Survivors and caregivers with low education and low literacy may require more in-depth and targeted support . IMPLICATION S FOR NURSING Brief nurse psychoeducation and stress management for cancer survivors and care 
    Output:
    
The review ed studies indicate that vali date d distress-screening tools are being used via telephone to identify distress , particularly in relation to cancer .
Screening-driven supportive care referrals are also taking place in telephone-based services .
However , not all services use an established referral protocol .
Ongoing rescreening of callers ’ distress is also limited despite it being an important recommendation from psycho-oncology guidelines