***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: OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization & NA ; St and ard guidelines for cancer pain treatment routinely recommend training patients to reduce barriers to pain relief , use medications appropriately , and communicate their pain‐related needs . Methods are needed to reduce professional time required while achieving sustained intervention effectiveness . In a multisite , r and omized controlled trial , this study tested a pain training method versus a nutrition control . At six oncology clinics , physicians ( N = 22 ) and nurses ( N = 23 ) enrolled patients ( N = 93 ) who were over 18 years of age , with cancer diagnoses , pain , and a life expectancy of at least 6 months .  Pain training and control interventions were matched for material s and method . Patients watched a video followed by about 20 min of manual‐st and ardized training with an oncology nurse focused on review ing the printed material and adapted to individual concerns of patients . A follow‐up phone call after 72 h addressed individualized treatment content and pain communication . Assessment s at baseline , one , three , and 6 months included barriers , the Brief Pain Inventory , opioid use , and physician and nurse ratings of their patients ’ pain . Trained versus control patients reported reduced barriers to pain relief ( P < .001 ) , lower usual pain ( P = .03 ) , and greater opioid use ( P < .001 ) . No pain training patients reported severe pain ( > 6 on a 0–10 scale ) at 1‐month outcomes ( P = .03 ) . Physician and nurse ratings were closer to patients ’ ratings of pain for trained versus nutrition groups ( P = .04 and < .001 , respectively ) . Training efficacy was not modified by patient characteristics . Using video and print material s , with brief individualized training , effectively improved pain management over time for cancer patients of varying diagnostic and demographic groups 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 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 / OBJECTIVES To evaluate use of a CD-ROM titled Completing a Life among patients diagnosed with serious illnesses for comfort level with content and ease of computer use . DESIGN A prospect i ve pilot study collected a convenience sample of 50 people diagnosed with life-limiting illnesses during a six-month period . SETTING The hematology/oncology department of a large healthcare system located in a metropolitan area in the midwestern United States . SAMPLE Convenience sample of 50 patients diagnosed with life-limiting illnesses . Of the patients enrolled ( age range = 38 - 93 years ) , 72 % were female , 68 % were Caucasian , 50 % were diagnosed with breast cancer or nonsolid tumors , and 40 % were newly diagnosed . METHODS Subjects viewed the CD-ROM and completed pre- and post-intervention surveys . MAIN RESEARCH VARIABLES Comfort level with educational media , comfort level of information viewed , and areas of CD-ROM viewed compared to age and stage of illness . FINDINGS Ninety percent of patients reported that they were somewhat or very comfortable with the CD-ROM  as a learning tool , and ease of use was rated at 98 % . Patients ' comfort level with the material increased from 76 % to 90 % after they viewed the CD-ROM . CONCLUSIONS The pilot study suggests that the Completing a Life CD-ROM can be used with patients facing serious or life-limiting illnesses as an additional re source tool for information . IMPLICATION S FOR NURSING Nurses typically provide the bulk of educational material for their patients . With limited re sources available regarding management of life-limiting illnesses , this re source may provide an excellent addition to re sources currently available PURPOSE / OBJECTIVES To assess the effect of an educational homecare program on pain relief in patients with advanced cancer . DESIGN Quasi-experimental ( pretest post-test , nonequivalent group ) . SETTING Four community-based primary care centers providing social and healthcare services in the Quebec City region of Canada . SAMPLE 80 homecare patients with advanced cancer who were free of cognitive impairment , who presented with pain or were taking analgesics to relieve pain , and who had a life expectancy of six weeks or longer . METHODS The educational intervention included information regarding pain assessment and monitoring using a daily pain diary and the provision of specific recommendations in case of loss of pain control . Pain intensity data  were collected prior to the intervention , and re assessment s were made two and four weeks later . Data on beliefs were collected at baseline and two weeks . All data were collected by personal interviews . MAIN RESEARCH VARIABLES Patients beliefs about the use of opioids ; average and maximum pain intensities . FINDINGS Patients beliefs regarding the use of opioids were modified successfully following the educational intervention . Average pain was unaffected in the control group and was reduced significantly in patients who received the educational program . The reduction remained after controlling for patients initial beliefs . Maximum pain decreased significantly over time in both the experimental and control groups . CONCLUSIONS An educational intervention can be effective in improving the monitoring and relief of pain in patients with cancer living at home . IMPLICATION S FOR NURSING Homecare nurses can be trained to effectively administer the educational program during their regular homecare visits OBJECTIVES To examine whether peer support and illness representation mediate the link between family support , self-management and well-being . METHOD Fifty-two adolescents ( 12 - 18 years old ) with Type I diabetes were recruited and followed over 6 months , completing assessment s of self-management , well-being , and social support . RESULTS Perceived impact of diabetes and supportive family and friends were prospect ively predictive of participants ' well-being measures . Although support from family and friends was predictive of better dietary self-care , this relationship was mediated by personal model beliefs . In particular , beliefs about the effectiveness of the diabetes treatment regimen to control diabetes was predictive of better dietary self-care . CONCLUSIONS Both friends and family are important to support adolescents as they live with and manage their diabetes . Personal models of diabetes are important determinants of both dietary self-care and well-being . In addition , personal models may serve to mediate the relationship between social support and dietary behavior Lung cancer represents a major public health problem worldwide ( ISD 2000 ) with approximately 80 % of patients presenting with locally advanced or metastatic disease . Treatment is essentially palliative ; therefore , symptom management is important . This paper describes the findings from a prospect i ve study of fatigue in newly diagnosed patients with non-small cell lung cancer . Fifty-three patients undergoing radical or high-dose palliative radiotherapy for Stage I , II and III disease were recruited to the study . Patients completed a structured health diary  throughout radiotherapy and for up to 1 month post-treatment . Tape-recorded interviews were conducted with a sub- sample ( n=11 ) to explore the nature of fatigue . Complete data sets were available on 46 patients . Consistent with current literature , the study findings demonstrated the progressive nature of this symptom throughout treatment ; however , the levels of distress reported and interference with daily living were not found to be as overwhelming in this group of patients as the literature thus far suggests PURPOSE / OBJECTIVES To evaluate the effectiveness of a psychoeducational program ( i.e. , PRO-SELF Pain Control Program ) compared to st and ard care in increasing patients '  knowledge regarding  cancer pain management .  DESIGN R and omized clinical trial . SETTING Seven outpatient setting s in northern California . SAMPLE 174 out patients with cancer and pain from bone metastasis . METHODS Following r and omization into either the PRO-SELF or st and ard care group , patients completed the Pain Experience Scale ( PES ) prior to and at the completion of the intervention . MAIN RESEARCH VARIABLES Total and individual item scores on the PES . FINDINGS Total PES knowledge scores increased significantly in the PRO-SELF group ( 21 % ) compared to the st and ard care group ( 0.5 % ) . Significant improvements in knowledge scores for patients in the PRO-SELF group were found on five of the nine PES items when compared to baseline scores . CONCLUSIONS The PRO-SELF Pain Control Program was an effective approach to increase patients '  knowledge of cancer pain management . IMPLICATION S FOR NURSING The use of a structured paper- and -pencil question naire , such as the PES , as part of a psychoeducational intervention provides an effective foundation for patient education in cancer pain management . Oncology nurses can use patients ' responses to this type of question naire to individualize the teaching and to spend more time on the identified knowledge deficits . This individualized approach to education about pain management may save staff time and improve patient outcomes CONTEXT For patients with chronic disease , there is growing interest in " self-management " programs that emphasize the patients ' central role in managing their illness . A recent r and omized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases . OBJECTIVE To evaluate outcomes of a chronic disease self-management program in a real-world " setting . STUDY DESIGN Before-after cohort study . PATIENTS AND SETTING Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study , 489 had complete baseline and follow-up data . INTERVENTION The Chronic Disease Self-Management Program is a 7-week , small-group intervention attended by people with different chronic conditions . It is taught largely by peer instructors from a highly structured manual . The program is based on self-efficacy theory and emphasizes problem solving , decision making , and confidence building . MAIN OUTCOME MEASURES Health behavior , self-efficacy ( confidence in ability to deal with health problems ) , health status , and health care utilization , assessed at baseline and at 12 months by self-administered question naires . RESULTS At 1 year , participants in the program experienced statistically significant improvements in health behaviors ( exercise , cognitive symptom management , and communication with physicians ) , self-efficacy , and health status ( fatigue , shortness of breath , pain , role function , depression , and health distress ) and had fewer visits to the emergency department ( ED ) ( 0.4 
    Output:
    
Themes identified were ; interventions for end of life care ; self care behaviours used by patients ; factors that prevent patients to self care .
CONCLUSION The nurses ' role in supporting self care for people with advanced cancer is important .
The review identifies various ways nurses can empower patients to self care related to oncology