***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: Goals of the workMany cancer patients experience unmet needs and elevated levels of anxiety and depression . This paper describes a volunteer-delivered intervention to reduce the psychosocial needs of cancer patients and presents findings from a feasibility study of this intervention . Material s and methods The telephone-based intervention , called the Pathfinder Program , involves the assignment of volunteers to patients  to assist them in addressing their needs as identified in question naires . Fifty-two patients with colorectal cancer were involved in the feasibility study , with 18 in the intervention . Sixty-two percent of the sample was male and the mean age was 64 years . Patients ’ needs were assessed using The Supportive Care Needs Survey , a colorectal cancer symptom checklist , and the Hospital Anxiety and Depression Scale . All patients completed baseline question naires ( Time 1 ) and 47 completed Time 2 question naires 3 months later . Main results The most common needs were fear of the cancer spreading and returning , concerns about the worries of others , gas or wind , changes in weight , and bowel problems such as diarrhea , constipation , and pain . A statistically significant Time 1 to Time 2 decrease in supportive care needs and depression was found for the intervention group . Conclusions The Pathfinder Program has been found to be feasible , acceptable for patients , and has the potential to reduce needs and depression . A larger , r and omized controlled trial is needed to determine the impact of this program on colorectal symptoms and anxiety PURPOSE Although patient-reported cancer symptoms and quality -of-life issues ( SQLIs ) have been promoted as essential to a comprehensive assessment , efficient and efficacious methods have not been widely tested in clinical setting s. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment -Cancer ( ESRA-C ) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits . Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians . PATIENTS AND METHODS This r and omized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center .  Patient-reported SQLIs  were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit ( n = 327 ) ; in the control group , no summary was provided ( n = 333 ) . SQLIs were scored for level of severity or distress . One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI . We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians . RESULTS The likelihood of SQLIs being discussed differed by r and omized group and depended on whether an SQLI was first reported as problematic ( P = .032 ) . Clinic visits were similar with regard to duration between groups , and clinicians reported the summary as useful . CONCLUSION The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US r and omized clinical trial Objectives To evaluate the impact of a mobile phone-based , remote monitoring , advanced symptom management system ( ASyMS © ) on the incidence , severity and distress of six chemotherapy-related symptoms ( nausea , vomiting , fatigue , mucositis , h and –foot syndrome and diarrhoea ) in patients with lung , breast or colorectal cancer . Design A two group ( intervention and control ) by five time points ( baseline , pre-cycle 2 , pre-cycle 3 , pre-cycle 4 and pre-cycle 5 ) r and omised controlled trial . Setting Seven clinical sites in the UK ; five specialist cancer centres and two local district hospitals . Participants One hundred and twelve people with breast , lung or colorectal cancer receiving outpatient chemotherapy . Interventions A mobile phone-based , remote monitoring , advanced symptom management system (ASyMS © ).Main outcome measures Chemotherapy-related morbidity of six common chemotherapy-related symptoms ( nausea , vomiting , fatigue , mucositis , h and –foot syndrome and diarrhoea ) . Results There were significantly higher reports of fatigue in the control group compared to the intervention group ( odds ratio = 2.29 , 95%CI = 1.04 to 5.05 , P = 0.040 ) and reports of h and –foot syndrome were on average lower in the control group ( odds ratio control/intervention = 0.39 , 95%CI = 0.17 to 0.92 , P = 0.031 ) . Conclusion The study demonstrates that ASyMS © can support the management of symptoms in patients with lung , breast and colorectal cancer receiving chemotherapy Systematic review s provide the best evidence on the effectiveness of healthcare interventions including quality improvement strategies . The methods of systematic review of individual patient r and omised trials of healthcare interventions are well developed . We discuss method ological and practice issues that need to be considered when undertaking systematic review s of quality improvement strategies including developing a review protocol , identifying and screening evidence sources , quality assessment and data abstract ion , analytical methods , reporting systematic review s , and appraising systematic review s. This paper builds on our experiences within the Cochrane Effective Practice and Organisation of Care ( EPOC ) review group The potential benefits of health-related quality of life ( HRQL ) assessment in oncology clinical practice include better detection of problems , enhanced disease and treatment monitoring and improved care . However , few empirical studies have investigated the effects of incorporating such assessment s into routine clinical care . Recent r and omized studies have reported improved detection of and communication about patients ' concerns , but few have found effects on patient HRQL or satisfaction . This study examined whether offering interpretive assistance of HRQL results would improve these patient outcomes . Two hundred and thirteen participants with metastatic breast , lung or colorectal cancer were r and omly assigned to one of three conditions : usual care ; HRQL assessment or HRQL assessment followed by a structured interview and discussion . Interviews about patients ' assessment responses were conducted by a research nurse , who then presented HRQL information to the treating nurse . HRQL and treatment satisfaction outcomes were assessed at 3 and 6 months . No significant differences were found between study conditions in HRQL or satisfaction . Results suggest that routine HRQL assessment , even with description of results , is insufficient to improve patient HRQL and satisfaction . It is suggested that positive effects may require supplementing assessment results with specific suggestions for clinical management changes Background In clinical and research practice linked to prostate cancer treatment , frequent monitoring of patient health-related quality of life ( HRQOL ) is essential . Practical and analytic limitations of paper question naire data capture may be overcome with the use of self-administered personal digital assistant ( PDA ) data collection . The objective of this study was to assess the reliability , validity , and feasibility of using PDA in place of paper versions of the International Prostate Symptom Score ( IPSS ) , the Patient Oriented Prostate Cancer Utility Survey ( PORPUS ) , and the International Index of Erectile Function-5 ( IIEF-5 ) in a prostate cancer clinic setting . Methods 152 participants were r and omly assigned to one of three conditions : 1 ) paper followed by PDA survey ; 2 ) PDA followed by paper survey ; or 3 ) PDA followed by PDA survey . Evaluation included an assessment of data quality ( internal consistency , test-retest reliability , response correlation , completeness of data ) , and feasibility ( participation rates , time to completion , preference and difficultly/ease of using PDA ) . Results Internal consistency was similar for both PDA and paper applications . Test-retest reliability was confirmed for PDA repeated administration . Data from paper and PDA question naires were strongly correlated . Lower missed item rates were found in PDA administration . 82.8 % of participants preferred using the PDA or had no preference . Mean difficulty/ease ratings indicated that participants found the PDA easy to use . Age did not significantly correlate with preference or difficulty . Conclusion The results confirm the adaptability of the IPSS , IIEF-5 , and the PORPUS to PDA administration . Similarly , the findings of this study support the feasibility of using PDA technology for HRQOL serial data capture in the prostate cancer patient population This r and omized controlled trial investigated the effect of reporting physical symptoms by using a systematic symptom monitoring instrument , the Symptom Monitor , on symptom prevalence and severity among patients with cancer in the palliative phase . The overall objective was to achieve symptom relief through systematic and regular symptom reporting by patients themselves . One hundred forty-six patients with cancer in the palliative phase were r and omized to either the intervention group ( n = 69 with Symptom Monitor ) or the control group ( n = 77 without Symptom Monitor ) . Ten physical symptoms with regard to prevalence and severity were monitored . After 2 months , the prevalence of symptoms was lower in the intervention group compared to the control group ( prevalent differences 2.1 - 24.3 % ) for 9 out of 10 symptoms ( except coughing ) . The intervention group scored a statistically significantly lower prevalence in constipation and vomiting ( prevalence differences 24.3 % and 18.0 % , respectively ) . In four symptoms ( fatigue , lack of appetite , shortness of breath , and nausea ) , the intervention group had a lower , although not statistically significant , severity score ( median differences 0.5 - 1 ) . In four symptoms ( pain , coughing , sleeplessness , and diarrhea ) , the severity score was the same in both groups ( medians 2 - 4 ) . In two symptoms ( constipation and vomiting ) , the severity score was lower in the control group ( median differences -1 and -2 ) . A comparison between the study groups on improved , deteriorated , or steady-state cases showed that the severity score had deteriorated less for 8 out of 10 symptoms in a larger proportion of patients in the intervention group . Although statistical significance was not reached , the prevalence as well as severity of symptoms in the palliative phase of cancer can be influenced by using the Symptom Monitor Purpose This r and omized controlled clinical trial examined the usefulness of including an assessment of health-related quality of life ( HRQL ) in the routine clinical care of lung-transplant patients . We hypothesized that the inclusion of HRQL in routine clinical care would improve patient – clinician communication , affect clinical management , and improve patients ’ HRQL . Methods At the outpatient clinic , University of Alberta Hospital , patients were r and omly assigned to intervention ( completion of Health Utilities Index Mark 2 ( HUI2 ) and Mark 3 ( HUI3 ) on touch-screen computer with feedback to clinicians ) and control group ( completion of HUI2 and HUI3 on touch-screen computer without feedback ) . Feedback involved a graphical representation included in patients ’ chart . All clinical encounters were audio-taped . Changes in clinical management ( medication changes , number of referrals and test ordered ) were summed to produce an overall management composite . At the end of every visit , patients completed the EQ-5D . Results Two hundred and thirteen patients were r and omized ( 108 to intervention and 105 to control groups ) . There were statistically significant differences between the groups in mean number of issues discussed per encounter ( P = 0.003 ; Cohen ’s d = 0.03 ) and mean management composite score ( P = 0.001 ; Cohen ’s d = 0.41 ) . EQ-5D index was not statistically significant different between the groups ( P = 0.48 ) . Conclusions We detected very small effects on patient – clinician communication and small effects on patient management , without detecting improvement in patient outcome Many of us believe there are major benefits to be gained by using  patient-reported outcomes  ( PROs ) in routine clinical practice . However , demonstrating tangible benefits has frequently proved elusive . Although r and omised clinical trials ( RCTs ) have become accepted as the st and ard for comparing alternative forms of clinical interventions , when evaluating the effectiveness of PROs there are a number of challenges both in terms of study design and the subsequent analysis . Despite this , to date , of those investigators who have used RCTs , relatively few have used anything other than simple two-group r and omisation and comparisons . Most of these trials have also failed to demonstrate convincing benefits to patient outcomes . We suggest that the use of PROs may result in modest yet important improvements to patient outcomes , and that these benefits may be obscured in conventional individual patient trials because of contamination effects . The advantages of alternative design s such as cross-over studies and in particular cluster-r and omised trials are illustrated PURPOSE Regularly collecting patient-reported outcomes ( PROs ) of health-related quality of life with feedback to oncologists may assist in eliciting and monitoring patients ' problems during cancer treatment . This study examined how PRO feedback had an impact on patient-physician communication over time to gain a better underst and ing of how it may influence patient care . PATIENTS AND METHODS Exploratory analyses were performed on a data set from a previous study . Patients were r and omly assigned to intervention ( regular completion of European Organisation for Research and Treatment of Cancer Quality of Life Question naire-Core 30 and Hospital Anxiety and Depression Scale with feedback to oncologists ) , attention-control ( completion of same question naires without feedback ) , and control ( st and ard care ) arms . The content of consultation audio recordings between 28 oncologists and 198 patients over four consecutive visits ( 792 consultations ) was analyzed . Mixed-effects models and multivariate regressions were used to examine the longitudinal impact of the intervention on patient-physician communication , dynamics of patient-physician interaction , and the association between PROs and the content of clinic discussion . RESULTS Patients in the intervention arm discussed more symptoms over time compared with patients in the attention-control ( P = .008 ) and control ( P = .04 ) arms . No study arm effect was observed for function discussion s. Discussion topics were predominantly raised by patients /relatives , regardless of arm allocation . Clinic discussion s were associated with severity of patient-reported symptoms but not with patient-reported functional concerns . CONCLUSION A positive longitudinal impact of the intervention on symptom discussion 
    Output:
    
Results The 27 identified studies showed strong evidence that the well-implemented PROs improved patient-provider communication and patient satisfaction .
There was also growing evidence that it improved the monitoring of treatment response and the detection of unrecognised problems .
However , there was a weak or non-existent evidence -base regarding the impact on changes to patient management and improved health outcomes , changes to patient health behaviour , the effectiveness of quality improvement of organisations , and on transparency , accountability , public reporting activities , and performance of the health care system .
Conclusions Despite the existence of significant gaps in the evidence -base , there is growing evidence in support of routine PRO collection in enabling better and patient-centred care in cancer setting