***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 purpose of this study was to determine which of two educational interventions delivered in Spanish would influence Latino elders '  attitudes toward and comfort with end-of-life planning in comparison with a control group receiving only st and ard information routinely provided . Using a posttest-only control group design , elders receiving home care services who agreed to participate were r and omly assigned to one of three groups : Conversación A ; Conversación B , with culturally relevant material added ; and a control group . A one-way multivariate analysis of variance was conducted to determine the effect on the two dependent variables : attitudes toward end-of-life planning and comfort with end-of-life planning . Significant differences were found among the three groups on both outcome measures . Attitudes toward advance planning scores were significantly higher for both intervention groups compared with the control group . Although both intervention groups had higher comfort scores than the control group , only the Conversación A score was statistically different from that of the control group . The results of this study indicate that it may be possible to positively influence both attitudes toward and comfort with end-of-life planning among older Latinos receiving home care , through the use of a one-to-one protocol that is delivered in Spanish CONTEXT Latinos experience significant health disparities at the end of life compared with non-Latinos . OBJECTIVES To determine the feasibility of a patient navigator intervention to improve palliative care outcomes for Latino adults with serious illness . METHODS This was a pilot r and omized controlled trial that included 64 Latino adults with life-limiting illness r and omized to an intervention or a control group . All participants received a packet of linguistically matched material s on palliative care . In addition , intervention participants received up to five home visits from the bilingual , bicultural patient navigator . Visits focused on addressing barriers to palliative care through education , activation , and culturally tailored messaging . Outcomes included feasibility and advance care planning rates , documentation of pain management discussion s in the medical record , and hospice utilization . RESULTS Of the 32 patients r and omized to the intervention arm , 81 % had at least one home visit ( range 1 - 5 ) with the patient navigator . Overall , advance care planning was higher in the intervention group ( 47 % [ n = 15 ] vs. 25 % [ n = 8 ] , P = 0.06 ) , and 79 % of intervention participants had a discussion about pain management documented in their medical record vs. 54 % of control patients ( P = 0.05 ) . Hospice enrollment between the two groups ( n = 18 decedents ) was similar ( n = 7 intervention vs. n = 6 control ) ; length of stay in the intervention group was 36.4 ± 51.6 vs. 19.7 ± 33.6 days for control patients ( P = 0.39 ) . CONCLUSION A culturally tailored patient navigator intervention was feasible and suggests improved palliative care outcomes for Latinos facing advanced medical illness , justifying a fully powered r and omized controlled trial Objective To isolate the effect of spoken language from financial barriers to care , we examined the relation of language to use of preventive services in a system with universal access . Design Cross-sectional survey . Setting Household population of women living in Ontario , Canada , in 1990 . Participants Subjects were 22,448 women completing the 1990 Ontario Health Survey , a population -based r and om sample of households . Measurements and Main Results We defined language as the language spoken in the home and assessed self-reported receipt of breast examination , mammogram and Pap testing . We used logistic regression to calculate odds ratios for each service adjusting for potential sources of confounding : socioeconomic characteristics , contact with the health care system , and measures reflecting culture . Ten percent of the women spoke a  non-English language at home ( 4 % French . 6 % other ) . After adjustment , compared with English speakers , French-speaking women were significantly less likely to receive breast exams or mammography , and other language speakers were less likely to receive Pap testing . Conclusions Women whose main spoken language was not English were less likely to receive important preventive services . Improving communication with patients with limited English may enhance participation in screening programs OBJECTIVE To determine whether an advance directive re design ed to meet most adults ' literacy needs ( fifth grade reading level with graphics ) was more useful for advance care planning than a st and ard form ( > 12th grade level ) . METHODS We enrolled 205 English and Spanish-speaking patients , aged > /=50 years from an urban , general medicine clinic . We r and omized participants to review either form . Main outcomes included acceptability and usefulness in advance care planning . Participants then review ed the alternate form ; we assessed form preference and six-month completion rates . RESULTS Forty percent of enrolled participants had limited literacy . Compared to the st and ard form , the re design ed form was rated higher for acceptability and usefulness in care planning , P</=0.03 , particularly for limited literacy participants ( P for interaction < /=0.07 ) . The re design ed form was preferred by 73 % of participants . More participants r and omized to the re design ed form completed an advance directive at six months ( 19 % vs. 8 % , P=0.03 ) ; of these , 95 % completed the re design ed form . CONCLUSIONS The re design ed advance directive was rated more acceptable and useful for advance care planning and was preferred over a st and ard form . It also result ed in higher six-month completion rates . PRACTICE IMPLICATION S An advance directive re design ed to meet most adults ' literacy needs may better enable patients to engage in advance care planning Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Older Latinos with serious medical conditions such as cancer and other chronic diseases lack information about advance care planning ( ACP ) . ACP Intervention ( ACP-I Plan ) was design ed for informational and communication needs of older Latinos to improve communication and advance directives ( ADs ) . OBJECTIVE To determine the feasibility of implementing ACP-I Plan among seriously ill , older Latinos ( ≥50 years ) in Southern New Mexico with one or more chronic diseases ( e.g. , cancer , heart disease , renal/liver failure , stroke , hypertension , diabetes , chronic obstructive pulmonary disease , and HIV/AIDS ) . DESIGN We conducted a prospect i ve , pretest/post-test , two-group , r and omized , community-based pilot trial by using mixed data collection methods . SETTING /SUBJECTS Older Latino/Hispanic participants were recruited from community-based setting s in Southern New Mexico . METHODS All participants received ACP education , whereas the intervention group added : ( 1 ) emotional support addressing psychological distress ; and ( 2 ) systems navigation for re source access , all of which included interactive ACP treatment decisional support and involved motivational interview ( MI ) methods . Purposive sampling was guided by a sociocultural framework to recruit Latino participants from community-based setting s in Southern New Mexico . Feasibility of sample recruitment , implementation , and retention was assessed by examining the following : recruitment strategies , trial enrollment , retention rates , duration of MI counseling , type of visit ( home vs. telephone ) , and satisfaction with the program . RESULTS We contacted 104 patients , enrolled 74 r and omized to usual care 39 ( UC ) and treatment 35 ( TX ) groups . Six dropped out before the post-test survey , three from TX before the post-test survey because of sickness ( n = 1 ) or could not be located ( n = 2 ) , and the same happened for UC . Completion rates were 91.4 % UC and 92.3 % TX groups . All participants were Latino/Hispanic , born in the United States ( 48 % ) or Mexico ( 51.4 % ) on average in the United States for 25 years ; majority were female , 76.5 % ; 48.6 % preferred Spanish ; and 31.4 % had less than sixth- grade education . Qualitative data indicate satisfaction with the ACP-I Plan intervention . CONCLUSIONS Based on enrollment and intervention completion rates , time to completion tests , and feedback from qualitative post- study , follow-up interviews , the ACP-I Plan was demonstrated to be feasible and perceived as extremely helpful BACKGROUND Previous studies have shown that minority population s have low rates of documented advance directives and express preferences for more life-prolonging interventions at the end of life . We sought to determine the impact of Latino ethnicity on patients ' self-report of having an advance directive discussion and having a completed advance directive in the medical record at an index hospitalization for serious medical illness . METHODS This was a prospect i ve observational cohort study of 458 adults admitted to the general medical services of a safety net hospital , an academic medical center , and a Veterans ' Affairs ( VA ) hospital . Patients were asked if they had discussed advance directives , and we review ed medical records for documented advance directives . RESULTS Overall , 45 % of patients reported having had a  discussion about advance directives  ( 29 % of Latinos compared with 54 % of Caucasians , p=0.0002 ) and 24 % of patients had a completed advance directive in their medical record ( 25 % Latinos and 26 % of Caucasians , p = not significant [ ns ] ) . Using logistic regression modeling and adjusting for socioeconomic status ( SES ) , education level , and language spoken , Latinos ( odds ratio [ OR ] 0.42 , confidence interval [ CI ] 0.24 - 0.75 ) were less likely to report having advance directive discussion s compared with Caucasians ( referent ) . However , modeling of a completed advance directive in the medical record showed no significant difference between Latinos ( OR 1.44 , CI 0.73 - 2.85 ) and Caucasians ( referent ) . CONCLUSIONS The unexpected discrepancy we found highlights the need for more effective communication in advance care planning that includes education that is culturally sensitive and accessible to persons with low health literacy Importance Advance care planning improves the receipt of medical care aligned with patients ’ values ; however , it remains suboptimal among diverse patient population s. To mitigate literacy , cultural , and language barriers to advance care planning , easy-to-read advance directives and a patient-directed , online advance care planning program called PREPARE For Your Care ( PREPARE ) were created in English and Spanish . Objective To compare the efficacy of PREPARE plus an easy-to-read advance directive with an advance directive alone to increase advance care planning documentation and patient-reported engagement . Design , Setting , and Participants A comparative efficacy r and omized clinical trial was conducted from February 1 , 2014 , to November 30 , 2017 , at 4 safety-net , primary -care clinics in San Francisco among 986 English-speaking or Spanish-speaking primary care patients 55 years or older with 2 or more chronic or serious illnesses . Interventions Participants were r and omized to PREPARE plus an easy-to-read advance directive ( PREPARE arm ) or the advance directive alone . There were no clinician-level or system-level interventions . Staff were blinded for all follow-up measurements . Main Outcomes and Measures The primary outcome was documentation of new advance care planning ( ie , legal forms and /or documented discussion s ) at 15 months . Patient-reported outcomes included advance care planning engagement at baseline , 1 week , 3 months , 6 months , and 12 months using vali date d surveys . Intention-to-treat analyses were performed using mixed-effects logistic and linear regression , controlling for time , health literacy , and baseline advance care planning , clustering by physician , and stratifying by language . Results Among the 986 participants ( 603 women and 383 men ) , the mean ( SD ) age was 63.3 ( 6.4 ) years , 387 of 975 ( 39.7 % ) had limited health literacy , and 445 ( 45.1 % ) were Spanish speaking . No participant characteristic differed between the 2 groups , and retention was 85.9 % ( 832 of 969 ) among survivors . Compared with the advance directive alone , PREPARE result ed in a higher rate of advance care planning documentation ( unadjusted , 43.0 % [ 207 of 481 ] vs 33.1 % [ 167 of 505 ] ; P < .001 ; adjusted , 43.0 % vs 32.0 % ; P < .001 ) and higher self-reported increased advance care planning engagement scores ( 98.1 % vs 89.5 % ; P < .001 ) . Results remained significant among English speakers and Spanish speakers . Conclusions and Relevance The patient-facing PREPARE program and an easy-to-read advance directive , without clinician-level or system-level interventions , increased documentation of advance care planning and patient-reported engagement , with statistically higher gains for PREPARE vs advance directive alone . These tools may mitigate literacy and language barriers to advance care planning , allow patients to begin planning on their own , and could substantially improve the process for diverse English-speaking and Spanish-speaking population s. Trial Registration Clinical Trials.gov identifiers : NCT01990235 and Importance Strategies to increase access to palliative care , particularly for racial/ethnic minorities , must maximize primary palliative care and community-based models to meet the ever-growing need in a culturally sensitive and congruent manner . Objective To investigate if a culturally tailored patient navigator intervention can improve palliative care outcomes for Latino adults with advanced cancer . Design , Setting , and Participants The Apoyo con Cariño ( Support With Caring ) r and omized clinical trial was conducted from July 2012 to March 2016 . The setting was clinics across the state of Colorado , including 
    Output:
    
Interventions used trained personnel , video images , web-based programs , and written material s. Interventions were associated with increased advance directive completion and decreased preferences for some life-prolonging treatments .
Interventions were deemed to be feasible and acceptable .
Few interventions exist to improve end-of-life care for patients with LEP .