***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: OBJECTIVE Previous studies regarding patients ' end of life ( EOL ) preparation have focused mainly on practical tasks , such as advance directives . In this study , we investigate the relational and personal aspects of EOL preparation , using a patient-completed question naire , and examine associations with clinician-patient communication ( CPC ) and other variables . METHODS Patients with advanced cancer but with good performance status were recruited from 24 medical oncology clinics , to participate in a cluster-r and omised controlled trial of early palliative care intervention . Measures included the Quality of Life at the End of Life preparation for EOL subscale , and measures of CPC , functional status , comorbidity , spiritual well-being and symptom severity . Using chi-squared tests , t-tests and multivariate regression analyses , we examined the variables associated with preparation for EOL . We also examined the frequency distributions of individual EOL preparation items and used logistic regression to examine their associations with adequacy of CPC . RESULTS In the 469 patients , characteristics associated with better EOL preparation were better CPC , older age , living alone , less symptom burden and better spiritual well-being . Thirty-one per cent agreed that they worried ' quite a bit ' or ' completely ' about their family 's preparation to cope with the future , and 27 % agreed that they would be a burden to their family . All preparation items except regrets about life were associated with adequacy of communication . CONCLUSIONS A substantial minority of patients with advanced cancer but with good performance status are concerned about EOL preparation , particularly in relation to their families . Better CPC may help patients prepare not only practically but also personally and socially in relation to the dying process and the welfare of their families Objective : To assess the effectiveness of nurse led follow up in the management of patients with lung cancer . Design : R and omised controlled trial . Setting : Specialist cancer hospital and three cancer units in southeastern Engl and Participants : 203 patients with lung cancer who had completed their initial treatment and were expected to survive for at least 3 months . Intervention : Nurse led follow up of out patients compared with conventional medical follow up . Outcome measures : Quality of life , patients ' satisfaction , general practitioners ' satisfaction , survival , symptom-free survival , progression-free survival , use of re sources , and comparison of costs . Results : Patient acceptability of nurse led follow up was high : 75 % ( 203/271 ) of eligible patients consented to participate . Patients who received the intervention had less severe dyspnoea at 3 months ( P=0.03 ) and had better scores for emotional functioning ( P=0.03 ) and less peripheral neuropathy ( P=0.05 ) at 12 months . Intervention group patients scored significantly better in most satisfaction subscales at 3 , 6 , and 12 months ( P<0.01 for all subscales at 3 months ) . No significant differences in general practitioners ' overall satisfaction were seen between the two groups . No differences were seen in survival or rates of objective progression , although nurses recorded progression of symptoms sooner than doctors ( P=0.01 ) . Intervention patients were more likely to die at home rather than in a hospital or hospice ( P=0.04 ) , attended fewer consultations with a hospital doctor during the first 3 months ( P=0.004 ) , had fewer radiographs during the first 6 months ( P=0.04 ) , and had more radiotherapy within the first 3 months ( P=0.01 ) . No other differences were seen between the two groups in terms of the use of re sources . Conclusion : Nurse led follow up was acceptable to lung cancer patients and general practitioners and led to positive outcomes CONTEXT Upper gastrointestinal cancer is associated with a poor prognosis . The multidimensional problems of incurable patients require close monitoring and frequent support , which can not sufficiently be provided during conventional one to two month follow-up visits to the outpatient clinic . OBJECTIVES To compare nurse-led follow-up at home with conventional medical follow-up in the outpatient clinic for patients with incurable primary or recurrent esophageal , pancreatic , or hepatobiliary cancer . METHODS Patients were r and omized to nurse-led follow-up at home or conventional medical follow-up  in the outpatient clinic . Outcome parameters were quality of life ( QoL ) , patient satisfaction , and health care consumption , measured by different question naires at one and a half and four months after r and omization . As well , cost analyses were done for both follow-up strategies in the first four months . RESULTS In total , 138 patients were r and omized , of which 66 ( 48 % ) were evaluable . At baseline , both groups were similar with respect to clinical and sociodemographic characteristics and health-related QoL. Patients in the nurse-led follow-up group were significantly more satisfied with the visits , whereas QoL and health care consumption within the first four months were comparable between the two groups . Nurse-led follow-up was less expensive than conventional medical follow-up . However , the total costs for the first four months of follow-up in this study were higher in the nurse-led follow-up group because of a higher frequency of visits . CONCLUSION The results suggest that conventional medical follow-up is interchangeable with nurse-led follow-up . A cost utility study is necessary to determine the preferred frequency and duration of the home visits Background Most cancer patients still die in hospital , mainly in medical wards . Many studies in different countries have shown the poor quality of end-of-life care delivery in hospitals . The Program " Liverpool Care Pathway for the dying patient " ( LCP ) , developed in the UK to transfer the hospice model of care into hospitals and other care setting s , is a complex intervention to improve the quality of end-of-life care . The results from qualitative and quantitative studies suggest that the LCP Program can improve significantly the quality of end-of-life care delivery in hospitals , but no r and omised trial has been conducted till now . Methods and design This is a r and omized cluster trial , stratified by regions and matched for assessment period . Pairs of eligible medical wards from different hospitals will be r and omized to receive the LCP-I Program or no intervention until the end of the trial . The LCP-I Program will be implemented by a Palliative Care Unit . The assessment of the end-points will be performed for all cancer deaths occurred in the six months after the end of the LCP-I implementation in the experimental wards and , in the same period of time , in the matched control wards . The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families , assessed using the Global Scale of the Italian version of the Toolkit " After-death Bereaved Family Member Interview " . Discussion This study can be interpreted as a Phase III trial according to the Medical Research Council Framework . In this study , the effectiveness of a fully defined intervention is assessed by comparing the distribution of the endpoints in the experimental and in the control arm . Research IDRFPS-2006 - 6 - 341619Trial registration Clinical Trials.gov Identifier : OBJECTIVE To document outcomes of a r and omized trial of the PhoenixCare demonstration program of palliative care and coordinated care/case management for seriously chronically ill individuals who simultaneously received active treatment from managed care organizations ( MCOs ) . DESIGN Patients , continuously enrolled between July 1999 , and March 2001 , were r and omly assigned to the PhoenixCare program  or a control group receiving usual MCO care . SETTING Hospice of the Valley , Phoenix , Arizona . PARTICIPANTS Participants were 192 patients with chronic obstructive pulmonary disease ( COPD ) or chronic heart failure ( CHF ) , who had an estimated 2-year life expectancy . INTERVENTION Intensive home-based case management provided by registered nurse casemanagers , in coordination with patients ' existing source of medical care , comprised the intervention . Program foci included disease and symptom management , patient self-management of illness and knowledge of illness-related re sources , preparation for end-of life , physical and mental functioning , and utilization of medical services . OUTCOME MEASURES Outcomes , assessed every 3 months by telephone interview , included measures related to all program foci ; the SF-36 was used to evaluate physical and mental functioning ; emergency department visits exemplified medical service utilization . RESULTS Compared to controls , PhoenixCare patients exhibited significantly better outcomes on self-management of illness , awareness of illness-related re sources , and legal preparation for end of life . They reported lower symptom distress , greater vitality , better physical functioning and higher self-rated health than r and omized controls . Emergency department utilization was equivalent across groups . Patients with COPD showed stronger responsiveness to the intervention . CONCLUSION A novel model of patient care that combined greatly enhanced palliative carefocused case management with ongoing MCO-based treatment was associated with improved functioning of chronically severely ill patients in the last years of life CONTEXT Although home-based health care has grown over the past decade , its effectiveness remains controversial . A prior trial of Veterans Affairs ( VA ) Team-Managed Home-Based Primary Care ( TM/HBPC ) found favorable outcomes , but the replicability of the model and generalizability of the findings are unknown . OBJECTIVES To assess the impact of TM/HBPC on functional status , health-related quality of life ( HR-QoL ) , satisfaction with care , and cost of care . DESIGN AND SETTING Multisite r and omized controlled trial conducted from October 1994 to September 1998 in 16 VA medical centers with HBPC programs . PARTICIPANTS A total of 1966 patients with a mean age of 70 years who had 2 or more activities of daily living impairments or a terminal illness , congestive heart failure ( CHF ) , or chronic obstructive pulmonary disease ( COPD ) .  Intervention Home-based primary care ( n=981 ) , including a primary care manager , 24-hour contact for patients , prior approval of hospital readmissions , and HBPC team participation in discharge planning , vs customary VA and private sector care ( n=985 ) . MAIN OUTCOME MEASURES Patient functional status , patient and caregiver HR-QoL and satisfaction , caregiver burden , hospital readmissions , and costs over 12 months . RESULTS Functional status as assessed by the Barthel Index did not differ for terminal ( P=.40 ) or nonterminal ( those with severe disability or who had CHF or COPD ) ( P=.17 ) patients by treatment group . Significant improvements were seen in terminal TM/HBPC patients in HR-QoL scales of emotional role function , social function , bodily pain , mental health , vitality , and general health . Team-Managed HBPC nonterminal patients had significant increases of 5 to 10 points in 5 of 6 satisfaction with care scales . The caregivers of terminal patients in the TM/HBPC group improved significantly in HR-QoL measures except for vitality and general health . Caregivers of nonterminal patients improved significantly in QoL measures and reported reduced caregiver burden ( P=.008 ) . Team-Managed HBPC patients with severe disability experienced a 22 % relative decrease ( 0.7 readmissions/patient for TM/HBPC group vs 0.9 readmissions/patient for control group ) in hospital readmissions ( P=.03 ) at 6 months that was not sustained at 12 months . Total mean per person costs were 6.8 % higher in the TM/HBPC group at 6 months ( $ 19190 vs $ 17971 ) and 12.1 % higher at 12 months ( $ 31401 vs $ 28008 ) . CONCLUSIONS The TM/HBPC intervention improved most HR-QoL measures among terminally ill patients and satisfaction among non-terminally ill patients . It improved caregiver HR-QoL , satisfaction with care , and caregiver burden and reduced hospital readmissions at 6 months , but it did not substitute for other forms of care . The higher costs of TM/HBPC should be weighed against these benefits 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 PURPOSE Several guidelines on the treatment of cancer-related fatigue recommend optimizing treatment of accompanying symptoms . However , evidence for this recommendation from r and omized clinical trials is lacking . We investigated whether monitoring and protocol ized treatment of physical symptoms alleviates fatigue . PATIENTS AND METHO 
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Strategies under ‘ treatment design ’ aim ed to ensure equivalent treatment dose between and within intervention and control groups , and delivery of necessary ingredients .
Use of treatment manuals and implementation checklists aim ed to aid ‘ delivery of treatment ’ .
Research teams aim ed to improve ‘ receipt of treatment ’ by transmitting clear information and verifying underst and ing , while improving ‘ enactment of treatment skills ’ by review ing and reinforcing prior content .
Conclusion : Implementation fidelity in palliative care is under-recognised .