***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 problem of cancer-related pain afflicts millions of people annually . The study described here was aim ed at improving cancer patients '  pain control through a planned patient education program . A r and omized clinical trial with a Solomon Four-Group design was used to assess the effectiveness of a patient education intervention consisting of nurse counseling and printed material s.  The sample included 230 cancer patients . One month later , patients in the experimental group were more likely to have taken their pain medicine on the correct schedule and to have taken the correct dosage . The experimental group also was significantly less likely to report stopping the medicine when they felt better . In addition , they were significantly less worried about tolerance and addiction to pain medicines . Forty-four percent of the experimental group compared to 24 % of the control group reported no or mild pain at the posttest The purpose of this r and omized , controlled , home care intervention was to test the effectiveness of two nurse-targeted , e-mail-based interventions to increase home care nurses ' adherence to pain assessment and management guidelines , and to improve patient outcomes . Nurses from a large urban non-profit home care organization were assigned to usual care or one of two interventions upon identification of an eligible cancer patient with pain . The basic intervention consisted of a patient-specific , one-time e-mail reminder highlighting six pain-specific clinical recommendations . The augmented intervention supplemented the initial e-mail reminder with provider prompts , patient education material , and clinical nurse specialist outreach .  Over 300 nurses were r and omized and outcomes of 673 of their patients were review ed . Data collection involved clinical record abstract ion of nurse care practice s and patient interviews completed approximately 45 days after start of care . The intervention had limited effect on nurse-documented care practice s but patient outcomes were positively influenced . Patients in the augmented group improved significantly over the control group in ratings of pain intensity at its worst , whereas patients in the basic group had better ratings of pain intensity on average . Other outcomes measures were also positively influenced but did not reach statistical significance . Our findings suggest that although reminders have some role in improving cancer pain management , a more intensive approach is needed for a generalized nursing workforce with limited recent exposure to state-of-the-art pain management practice The purpose of this r and omized controlled study was to assess the effects of a structured pain education program on the pain experience of hospitalized cancer patients . Eligible cancer pain patients were r and omly assigned to either an  experimental group ( receiving pain education 10–15 min per day for 5 days , n=15 ) or a st and ard care control group ( n=15 ) . The effects of the intervention on six pain-related variables were evaluated using three instruments . Pain intensity , pain interference with daily life , negative beliefs about opioids , beliefs about endurance of pain , pain catastrophizing ( an individual ’s tendency to focus on and exaggerate the threat value of painful stimuli and negatively evaluate his or her own ability to deal with pain ) , and sense of control over pain were evaluated by the Brief Pain Inventory — Short Form Taiwanese version ( BPI-T ) , Pain and Opioid Analgesic Beliefs Scale — Cancer ( POABS-CA ) , and the Catastrophizing subscale and the sense of control over pain measure from the Coping Strategies Question naire ( CSQ ) . The results indicated that , after completing treatment , patients who had received  structured pain education  had significantly less pain intensity on average , negative pain beliefs regarding opioids , pain endurance beliefs , and pain catastrophizing than patients in the control group . In addition , patients in the pain education group showed a significant increase in their sense of control over pain . These preliminary results strongly suggest that structured pain education can effectively improve the pain experience of hospitalized cancer patients and should be further implemented clinical ly The persistence of negative attitudes towards cancer pain and its treatment suggests there is scope for identifying more effective pain education strategies . This r and omized controlled trial involving 189 ambulatory cancer patients evaluated an educational intervention that aim ed to optimize patients ' ability to manage pain . One week post-intervention , patients receiving the pain management intervention ( PMI ) had a significantly greater increase in self-reported pain knowledge , perceived control over pain , and number of pain treatments recommended . Intervention group patients also demonstrated a greater reduction in willingness to tolerate pain , concerns about addiction and side effects , being a " good " patient , and tolerance to pain relieving medication . The results suggest that targeted educational interventions that utilize individualized instructional techniques may alter cancer patient attitudes , which can potentially act as barriers to effective pain management PURPOSE Minority patients with cancer experience worse control of their pain than do their white counterparts . This disparity may , in part , reflect more miscommunication between minority patients and their physicians . Therefore , we examined whether patient coaching could reduce disparities in pain control in a secondary analysis of a r and omized controlled trial . METHODS Sixty-seven English-speaking adult cancer out patients , including 15 minorities , with moderate pain over the prior 2 weeks were r and omly assigned to the experimental ( N = 34 ) or control group ( N = 33 ) . Experimental patients received a 20-minute individualized education and coaching session to increase knowledge of pain self-management , to redress personal misconceptions about pain treatment , and to rehearse an individually scripted patient-physician dialog about pain control . The control group received st and ardized information on controlling pain . Data on average pain ( 0 - 10 scale ) were collected at enrollment and 2-week follow-up . RESULTS At enrollment , minority patients had significantly more pain than their white counterparts ( 6.0 vs 5.0 , P = 0.05 ) . At follow-up , minorities in the control group continued to have more pain ( 6.4 vs 4.7 , P = 0.01 ) , whereas in the experimental group , disparities were eliminated ( 4.0 vs 4.3 , P = 0.71 ) . The effect of the intervention on reducing disparities was significant ( P = 0.04 ) . CONCLUSIONS Patient coaching offers promise as a means of reducing racial/ethnic disparities in pain control . Larger studies are needed to vali date these findings and to explore possible mechanisms The purpose of this r and omized controlled community trial is to evaluate the effects of a community intervention utilizing opinion leaders and educational strategies on the cancer pain management knowledge , attitudes , and the practice s of physicians and nurses , and cancer pain reported by patients . Six Minnesota communities participated in the study . The three communities r and omized to the intervention received educational programs over 15 months . The clinical community opinion leaders participated in a minifellowship , developed community task forces , and interacted with their peers . This strategy was reinforced with community outreach programs , clinical practice guidelines , educational material s , and media events . The primary study end point was patients ' pain intensity score . Comparing intervention to control communities , pain prevalence declined slightly , pain management index improved slightly , pain intensity scores increased slightly , patient and family attitude scores did not change , and physicians ' and nurses ' knowledge and attitude scores improved slightly . None of these changes , however , reached statistical significance . Participation in at least one intervention program improved physicians ' and nurses ' knowledge and attitude scores that approached statistical significance . Our results suggest that community opinion leaders combined with other educational programs may improve cancer pain management , but this strategy requires further study . The results suggest that more intense intervention application may be effective . Effective strategies to improve cancer pain management remain elusive PURPOSE / OBJECTIVES To demonstrate the effects of a program , directed at homecare nurses , of structured educational interventions on the management of pain and opioid-related side effects in homecare patients with cancer . DESIGN A longitudinal multilevel , r and omized , controlled clinical trial . SETTING Midwestern region in the United States . SAMPLE 202 nurses caring for patients with cancer recruited from homecare agencies . METHODS The two-tiered educational program focused on basic and advanced pain management strategies , particularly in the area of pharmacologic options and assertive communication skills . Instruments used were the Nurses ' Knowledge and Attitudes Survey Regarding Pain , the barriers question naire , perception of control over pain , and a demographic question naire . MAIN RESEARCH VARIABLES Knowledge and attitudes about pain management , barriers to pain management , and perception of control over pain . FINDINGS Nurses in the intervention group had a significant increase in their knowledge , a more positive attitude about pain management , fewer perceived barriers to pain management , and an increase in perceived control over pain compared to the nurses who did not receive the intervention . CONCLUSIONS The educational program Power Over Pain has beneficial effects for homecare nurses caring for patients with cancer pain . IMPLICATION S FOR NURSING A need exists for homecare nurses to gain more insight into pain management strategies and enhance their advocacy skills to improve pain management for patients with cancer treated in the home Abstract Previously , we demonstrated , in a r and omized clinical trial , the effectiveness of a psychoeducational intervention to decrease pain intensity scores and increase patients ’ knowledge of cancer pain management with a sample of oncology patients with pain from bone metastasis . In the present study , we evaluated for changes in mood states ( measured using the Profile of Mood States ) , quality of life ( QOL ; measured using the Medical Outcomes Study Short Form‐36 ( SF‐36 ) ) , and pain ’s level of interference with function ( measured using the Brief Pain Inventory ( BPI ) ) from baseline to the end of the intervention first between the  intervention and the st and ard care groups and then within the intervention group based on the patients ’ level of response to the intervention ( i.e. , patients were classified as non‐responders , partial responders , or responders ) . No differences were found in any of these outcome measures between patients in the st and ard care and intervention groups . However , when patients in the intervention group were categorized using a responder analysis approach , significant differences in the various outcome measures were found among the three respondent groups . Differences in the physical and mental component summary scores on the SF‐36 and the interference items on the BPI , among the three respondent groups , were not only statistically significant but also clinical ly significant . The use of responder analysis in analgesic trials may help to identify unique subgroups of patients and lead to the development of more effective psychoeducational interventions Objectives To evaluate the risk of bias tool , introduced by the Cochrane Collaboration for assessing the internal validity of r and omised trials , for inter-rater agreement , concurrent validity compared with the Jadad scale and Schulz approach to allocation concealment , and the relation between risk of bias and effect estimates . Design Cross sectional study . Study sample 163 trials in children . Main outcome measures Inter-rater agreement between review ers assessing trials using the risk of bias tool ( weighted κ ) , time to apply the risk of bias tool compared with other approaches to quality assessment ( paired t test ) , degree of correlation for overall risk compared with overall quality scores ( Kendall ’s τ statistic ) , and magnitude of effect estimates for studies classified as being at high , unclear , or low risk of bias ( metaregression ) . Results Inter-rater agreement on individual domains of the risk of bias tool ranged from slight ( κ=0.13 ) to substantial ( κ=0.74 ) . The mean time to complete the risk of bias tool was significantly longer than for the Jadad scale and Schulz approach , individually or combined ( 8.8 minutes ( SD 2.2 ) per study v 2.0 ( SD 0.8 ) , P<0.001 ) . There was low correlation between risk of bias overall compared with the Jadad scores ( P=0.395 ) and Schulz approach ( P=0.064 ) . Effect sizes differed between studies assessed as being at high or unclear risk of bias ( 0.52 ) compared with those at low risk ( 0.23 ) . Conclusions Inter-rater agreement varied across domains of the risk of bias tool . Generally , agreement was poorer for those items that required more judgment . There was low correlation between assessment s of overall risk of bias and two common approaches to quality assessment : the Jadad scale and Schulz approach to allocation concealment . Overall risk of bias as assessed by the risk of bias tool differentiated effect estimates , with more conservative estimates for studies at low risk The Minnesota Cancer Pain Project ( MCPP ) is a community-based research project to test various innovative education strategies for improving  cancer pain management ( CPM ) in Minnesota . The main hypothesis is that community-based , multidisciplinary and integrated education programs can improve CPM and change knowledge , attitudes , and behaviors regarding CPM in cancer patients , their families , and community physicians and nurses . The specific aim of the MCPP is to demonstrate effective methods to improve CPM in communities . The MCPP design is a r and omized trial with before- and after-intervention assessment s of cancer pain and CPM knowledge , attitudes , and behaviors among cancer patients and their families , physicians , and nurses . The unit of r and omization and study is the community , with six Minnesota communities participating in the MCPP . This paper describes the hypotheses , design , methods , and education strategies of the MCPP . Baseline data from the participating communities and the cancer patient sample are reported The purpose of this study was to determine if continued access to information following a baseline pain education program would increase knowledge and positive beliefs about cancer pain management , thus result ing in improved pain control during a 6-month follow-up period . Patients with cancer-related pain and their primary caregivers received a brief pain education program , and were then r and omized into one of three information groups : a ) usual care , b ) pain hot line , and c ) weekly provider-initiated follow-up calls for 1 month post-education .  Sixty-four patients and their primary caregivers were recruited . Both patients and caregivers showed an improvement in knowledge and beliefs after the baseline pain education program . Continued access to pain information with either the pain hot line or provider-initiated weekly follow-up calls did not affect long-term outcomes of pain intensity , interference because of pain , adequacy of analgesics used , or pain relief . In addition , long-term outcomes did not differ between patients who had improvement and those who showed decline in knowledge and beliefs pre-post education . These findings suggest that a brief pain education program can improve knowledge and beliefs of both patient and primary caregiver . Continued access to pain related information using either a patient- or provider-initiated format did not affect 
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In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade .
Of interest , no agreement between the two tools was evident in their final grade assigned to each study .
Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs .
Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain .