***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 In implementing the National Strategy of Palliative Care in Spain , there needs to be an evaluation of services , especially of their effectiveness , efficiency , and satisfaction of patients and families . OBJECTIVES To assess the effectiveness of palliative care services ( PCS ) in improving symptom control in Spain . METHODS This multicenter , prospect i ve , quasi-experimental , pre-post intervention study evaluated symptoms , such as pain , breakthrough pain , anorexia , nausea/vomiting , constipation , insomnia , dyspnea at rest and with movement , anxiety , and depression , using patient-reported numeric rating scales on Days 0 , 7 , and 14 after referral to a PCS . RESULTS Of the 318 PCSs included in the National Directory for 2004 , 105 services in the 17 autonomous regions of Spain were able to report 265 eligible ( treatment-naïve ) patients . Nonparticipation by some centers was because of excessive workload or because their patients were not treatment-naïve . Median survival was 42 days . Pain severity and number of crises of breakthrough pain significantly improved , as did other indicators of patient satisfaction . Symptom improvement was independent of type of service ( in acute bed hospitals , medium-term stay facilities , hospital support teams , home care support teams , and outpatient clinics ) . CONCLUSION Our national plan appears to be successful in reducing symptoms irrespective of the type of organization providing the PCS . An area for improvement could be to lessen the workload of individual teams OBJECTIVES --To measure effects on terminally ill cancer patients and their families of coordinating the services available within the NHS and from local authorities and the voluntary sector . DESIGN --R and omised controlled trial . SETTING --Inner London health district . PATIENTS --Cancer patients were routinely notified from 1987 to 1990 . 554 patients expected to survive less than one year entered the trial and were r and omly allocated to a coordination or a control group . INTERVENTION -- All patients received routinely available services . Coordination group patients received the assistance of two nurse coordinators , whose role was to ensure that patients received appropriate and well coordinated services , tailored to their individual needs and circumstances . MAIN OUTCOME MEASURES -- Patients and carers were interviewed at home on entry to the trial and at intervals until death . Interviews after bereavement were also conducted . Outcome measures included the presence and severity of physical symptoms , psychiatric morbidity , use of and satisfaction with services , and carers ' problems . Results from the baseline interview , the interview closest to death , and the interview after bereavement were analysed . RESULTS --Few differences between groups were significant . Coordination group patients were less likely to suffer from vomiting , were more likely to report effective treatment for it , and less likely to be concerned about having an itchy skin . Their carers were more likely to report that in the last week of life the patient had had a cough and had had effective treatment for constipation , and they were less likely to rate the patient 's difficulty swallowing as severe or to report effective treatment for anxiety . Coordination group patients were more likely to have seen a chiropodist and their carers were more likely to contact a specialist nurse in a night time emergency . These carers were less likely to feel angry about the death of the patient . CONCLUSIONS --This coordinating service made little difference to patient or family outcomes , perhaps because the service did not have a budget with which it could obtain services or because the professional skills of the nurse-coordinators may have conflicted with the requirements of the coordinating role Background The Karnofsky Performance Status ( KPS ) is a gold st and ard scale . The Thorne-modified KPS ( TKPS ) focuses on community-based care and has been shown to be more relevant to palliative care setting s than the original KPS . The Australia-modified KPS ( AKPS ) blends KPS and TKPS to accommo date any setting of care . Methods Performance status was measured using all three scales for  palliative care patients enrolled in a r and omized controlled trial in South Australia . Care occurred in a range of setting s. Survival was defined from enrollment to death . Results Ratings were collected at 1600 timepoints for 306 participants . The median score on all scales was 60 . KPS and AKPS agreed in 87 % of ratings ; 79 % of disagreements occurred within 1 level on the 11-level scales . KPS and TKPS agreed in 76 % of ratings ; 85 % of disagreements occurred within one level . AKPS and TKPS agreed in 85 % of ratings ; 87 % of disagreements were within one level . Strongest agreement occurred at the highest levels ( 70–90 ) , with greatest disagreement at lower levels ( ≤40 ) . Kappa coefficients for agreement were KPS-TKPS 0.71 , KPS-AKPS 0.84 , and AKPS-TKPS 0.82 ( all p < 0.001 ) . Spearman correlations with survival were KPS 0.26 , TKPS 0.27 and AKPS 0.26 ( all p < 0.001 ) . AKPS was most predictive of survival at the lower range of the scale . All had longitudinal test-retest validity . Face validity was greatest for the AKPS . Conclusion The AKPS is a useful modification of the KPS that is more appropriate for clinical setting s that include multiple venues of care such as palliative care New Haven , Connecticut , LINDA HUGHES , Department of Adult Nursing , University of Texas School of Nursing , Medical Branch at Galveston , Galveston , Texas , LINDA ROBINSON , University of San Diego , School of Nursing , San Diego , Califomia , BARBARA LEVINE , ISAAC NUAMAH , Center for Advancing Care in Serious Illness , University of Pennsylvania School of Nursing , Philadelphia , Pennsylvania , USA Nursing Interventions for Newly Diagnosed Older Cancer Patients Facing R and omized controlled trials ( RCTs ) in palliative cancer care often experience method ological problems . In this paper we discuss issues of major concern , including recruitment , patient attrition and compliance , arising from an RCT that compared comprehensive palliative care to conventional care .  The main criteria for trial entry were incurable malignant disease and a survival expectancy of between 2 and 9 months . Patients '  health-related quality of life ( HRQL ) , self-assessed by multi-item question naires , was a defined endpoint . The planned number of patients was successfully recruited , although the patients were referred late in the course of their disease so that follow-up tended to be short . Compliance in completing HRQL question naires was good up to 1 month before the patient 's death ; but in the final weeks it was found to drop substantially . Based on our experience , recommendations are given for those planning similar research . Procedures for improving patient recruitment are suggested , stressing the need for local data management , repeated information to referral sources , extensive screening for potentially eligible patients and simple referral routines . Precise inclusion criteria , including prognostic factors other than physicians ' estimates of life expectancy , should be used to ensure a sufficient follow-up period . For HRQL assessment , multi-item question naires can achieve excellent compliance up to 1 month before patients ' death , but in order to evaluate the very final weeks of life we recommend the use of simpler methods 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 R and omized controlled clinical trials are conducted to determine whether differences of clinical importance exist between selected treatment regimens . When statistical analysis of the study data finds a P value greater than 5 % , it is convention to deem the assessed difference nonsignificant . Just because convention dictates that such study findings be termed nonsignificant , or negative , however , it does not necessarily follow that the study found nothing of clinical importance . Subject sample s used in controlled trials tend to be too small . The studies therefore lack the necessary power to detect real , and clinical ly worthwhile , differences in treatment . Freiman et al. found that only 30 % of a sample of 71 trials published in the New Engl and Journal of Medicine in 1978 - 79 with a P value greater than 10 % were large enough to have a 90 % chance of detecting even a 50 % difference in the effectiveness of the treatments being compared , and they found no improvement in a similar sample of trials published in 1988 . It is therefore wrong and unwise to interpret so many negative trials as providing evidence of the ineffectiveness of new treatments . One must instead seriously question whether the absence of evidence is a valid justification for inaction . Efforts must be made to look for quantification of an association rather than just a P value , especially when the risks under investigation are small . The authors cite a recent trial comparing octreotide and sclerotherapy in patients with variceal bleeding  , as well as the overview of clinical trials evaluating fibrinolytic treatment for preventing reinfa rct ion after acute myocardial infa rct ion as examples In a prospect i ve controlled study , patients with incurable cancer and an estimated prognosis of three months to one year were allocated to two patient groups for evaluation of supportive interventions . One group , called " intensive , " received home visits by a nurse practitioner acting as an extension of a multidisciplinary team ; the other , termed " nonintensive , " did not receive such visits . Both patient groups were periodically evaluated in their homes by an observer and by self-ratings , to measure changes in quality of life as their disease progressed . Several method ologic problems were identified , which have implication s for future research . Pain problems later in the course of cancer seem to be predictable in those patients with higher scores on the Cornell Medical Index M-R scales ( greater emotional disturbance ) and on the Rotter Locus of Control ( I-E ) scale ( expectation of more external control of self ) . The study also found that the home visiting nurse practitioners , specially trained in pain treatment , improved pain control in the " intensive " group of patients over the last 90 days of life , when pain was an increasingly major problem . Such nurses can significantly improve the quality of life for patients dying outside of institutions Background Due to the growing number of elderly with advanced chronic conditions , healthcare services will come under increasing pressure . Teleconsultation is an innovative approach to deliver quality of care for palliative patients at home . Quantitative studies assessing the effect of teleconsultation on clinical outcomes are scarce . The aim of this present study is to investigate the effectiveness of teleconsultation in complex palliative homecare . Methods / Design During a 2-year recruitment period , GPs are invited to participate in this cluster r and omized controlled trial . When a GP refers an eligible patient for the study , the GP is r and omized to the intervention group or the control group . Patients in the intervention group have a weekly teleconsultation with a nurse practitioner and /or a physician of the palliative consultation team . The nurse practitioner , in cooperation with the palliative care specialist of the palliative consultation team , advises the GP on treatment policy of the patient . The primary outcome of patient symptom burden is assessed at baseline and weekly using the Edmonton Symptom Assessment Scale ( ESAS ) and at baseline and every four weeks using the Hospital Anxiety and Depression Scale ( HADS ) . Secondary outcomes are self-perceived burden from informal care ( EDIZ ) , patient experienced continuity of medical care ( NCQ ) , patient and caregiver satisfaction with the teleconsultation ( PSQ ) , the experienced problems and needs in palliative care ( PNPC-sv ) and the number of hospital admissions . Discussion This is one of the first r and omized controlled trials in palliative telecare . Our data will verify whether telemedicine positively affects palliative homecare . Trial registration The Netherl and s National Trial Register Objective To evaluate the costs and cost-effectiveness of home-care assistance ( HCA ) as an alternative to hospital-based care only for patients with AIDS ( PWA ) . Design A 6-month prospect i ve study . Use of re sources by a control group of PWA receiving ordinary hospital-based care ( OC group )  was compared with that by a r and om group of PWA who , in addition to hospital care , were also receiving home care ( HC group ) . Setting Home- and hospital-based care for PWA in Vicenza , Italy . Patients HC group selection 
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Authors ' conclusions The results provide clear and reliable evidence that home palliative care increases the chance of dying at home and reduces symptom burden in particular for patients with cancer , without impacting on caregiver grief .
This justifies providing home palliative care for patients who wish to die at home .
On the basis of 23 studies including 37,561 patients and 4042 family caregivers , we found that when someone with an advanced illness gets home palliative care  , their chances of dying at home more than double .
Home palliative care services also help reduce the symptom burden people may experience as a result of advanced illness , without increasing grief for family caregivers after the patient dies .