***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: Background Family caregivers in palliative care have a need for knowledge and support from health professionals , result ing in the need for educational and supportive interventions . However , research has mainly focused on the experiences of family caregivers taking part in interventions . To gain an increased underst and ing of complex interventions , it is necessary to integrate the perspectives of health professionals and family caregivers . Hence , the aim of this study is to explore the perspectives of health professionals and family caregivers of delivering and participating in a psycho-educational intervention in palliative home care . Methods A psycho-educational intervention was design ed for family caregivers based on a theoretical framework describing family caregiver ’s need for knowing , being and doing . The intervention was delivered over three sessions , each of which included a presentation by healthcare professionals from an intervention manual . An interpretive descriptive design was chosen and data were collected through focus group discussion s with health professionals and individual interviews with family caregivers . Data were analysed using framework analysis . Results From the perspectives of both health professionals and family caregivers , the delivering and participating in the intervention was a positive experience . Although the content was not always adjusted to the family caregivers ’ individual situation , it was perceived as valuable . Consistently , the intervention was regarded as something that could make family caregivers better prepared for caregiving . Health professionals found that the work with the intervention dem and ed time and engagement from them and that the manual needed to be adjusted to suit group characteristics , but the experience of delivering the intervention was still something that gave them satisfaction and contributed to them finding insights into their work . Conclusions The theoretical framework used in this study seems appropriate to use for the design of interventions to support family caregivers . In the perspectives of health professionals and family caregivers , the psycho-educational intervention had important benefits and there was congruence between the two groups in that it provided reward and support . In order for health professionals to carry out psycho-educational interventions , they may be in need of support and supervision as well as securing appropriate time and re sources in their everyday work Background Symptom distress in patients toward the end of life can change rapidly . Family caregivers have the potential to help patients manage those symptoms , as well as their own stress , if they are equipped with the proper re sources . Electronic health ( eHealth ) systems may be able to provide those re sources . Very sick patients may not be able to use such systems themselves to report their symptoms but family caregivers could . Objective The aim of this paper was to assess the effects on cancer patient  symptom distress of an eHealth system that alerts clinicians to significant changes in the patient ’s symptoms , as reported by a family caregiver . Methods A pooled analysis from two r and omized clinical trials ( NCT00214162 and NCT00365963 ) compared outcomes at 12 months for two unblinded groups : a control group ( Comprehensive Health Enhancement Support System [CHESS]-Only ) that gave caregivers access to CHESS , an online support system , and an experimental group ( CHESS+CR [ Clinician Report ] ) , which also had CHESS but with a CR that automatically alerted clinicians if symptoms exceeded a predetermined threshold of severity . Participants were dyads ( n=235 ) of patients with advanced lung , breast , or prostate cancer and their respective family caregivers from 5 oncology clinics in the United States of America . The proportion of improved patient threshold symptoms was compared between groups using area-under-the-curve analysis and binomial proportion tests . The proportion of threshold symptoms out of all reported symptoms was also examined . Results When severe caregiver-reported symptoms were shared with clinicians , the symptoms were more likely to be subsequently reported as improved than when the symptoms were not shared with clinicians ( P<.001 ) . Fewer symptom reports were completed in the group of caregivers whose reports went to clinicians than in the CHESS-Only group ( P<.001 ) , perhaps because caregivers , knowing their reports might be sent to a doctor , feared they might be bothering the clinician . Conclusions This study suggests that an eHealth system design ed for caregivers that alerts clinicians to worrisome changes in patient health status may lead to reduced patient distress . Trial Registration Clinical trials.gov NCT00214162 ; https:// clinical trials.gov/ct2/show/NCT00214162 ( Archived by WebCite at http://www.webcitation.org/6nmgdGfuD ) and Clinical trials.gov NCT00365963 ; https:// clinical trials.gov/ct2/show/NCT00365963 ( Archived by WebCite at http://www.webcitation.org/6nmh0U8VP Background Being a family carer to a patient nearing the end of their life is a challenging and confronting experience . Studies show that caregiving can have negative consequences on the health of family carers including fatigue , sleep problems , depression , anxiety and burnout . One of the goals of palliative care is to provide psychosocial support to patients and families facing terminal illness . A systematic review of interventions for family carers of cancer and palliative care patients conducted at the start of this millennium demonstrated that there was a dearth of rigorous inquiry on this topic and consequently limited knowledge regarding the types of interventions likely to be effective in meeting the complex needs of family carers . We wanted to discern whether or not the evidence base to support family carers has improved . Furthermore , undertaking this review was acknowledged as one of the priorities for the International Palliative Care Family Carer Research Collaboration http://www.centreforpallcare.org . Methods A systematic review was undertaken in order to identify developments in family carer support that have occurred over the last decade . The focus of the review was on interventions that targeted improvements in the psychosocial support of family carers of palliative care patients . Studies were grade d to assess their quality . Results A total of fourteen studies met the inclusion criteria . The focus of interventions included  psycho-education , psychosocial support , carer coping , symptom management , sleep promotion and family meetings .  Five studies were r and omised controlled trials , three of which met the criteria for the highest quality evidence . There were two prospect i ve studies , five pre-test/post-test projects and two qualitative studies . Conclusions The systematic review identified a slight increase in the quality and quantity of psychosocial interventions conducted for family carers in the last decade . More rigorous intervention research is required in order to meet the supportive care needs of family carers of palliative care patients Background A key component of palliative care is support for family caregivers . Although some family caregivers identify positive aspects , the impact is typically burdensome ; they are prone to physical and psychological morbidity , financial disadvantage and social isolation . Outcomes of systematic review s have highlighted the importance of investment in  family caregiver intervention research . Purpose To provide an overview of the development , evaluation and outcomes arising from of a programme of research ( The Melbourne Family Support Program ( FSP ) ) , which focused on reducing the psychosocial burden of family caregivers . Methods Developmental work involved a systematic literature review ; focus groups with family caregivers and health professionals ; and identification of a conceptual framework . Following a pilot r and omised controlled trial ( RCT ) , a programme of psychoeducational intervention studies was developed and tested ; one via RCT , the others via prepost test . Results Four psychoeducational interventions , incorporating one-to-one and group format delivery , conducted in both the home and inpatient hospital/hospice were evaluated . Statistically significant outcomes included improvements in family caregivers ’ preparedness , competence , positive emotions , more favourable levels of psychological wellbeing and a reduction in unmet needs . Internationally endorsed guidelines for the psychosocial support of family caregivers were produced and several re sources were constructed . Fifteen publications in international peer- review ed journals have arisen from this programme . Conclusions The interventions and re sources from the Melbourne FSP provide several evidence d-based and clinical ly relevant approaches that focus on reducing the psychosocial burden of the caregiving role . In several instances , however , more rigorous method ological testing is advocated OBJECTIVE To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes . MATERIAL S AND METHODS Engaging and Motivating Patients Online With Enhanced Re sources for Diabetes was a 12-month parallel r and omized controlled trial of 415 patients with type 2 diabetes with baseline glycosylated hemoglobin ( A1C ) values ≥7.5 % from primary care sites sharing an electronic health record . The intervention included : ( 1 ) wirelessly uploaded home glucometer readings with graphical feedback ; ( 2 ) comprehensive patient-specific diabetes summary status report ; ( 3 ) nutrition and exercise logs ; ( 4 ) insulin record ; ( 5 ) online messaging with the patient 's health team ; ( 6 ) nurse care manager and dietitian providing advice and medication management ; and ( 7 ) personalized text and video educational ' nuggets ' dispensed electronically by the care team . A1C was the primary outcome variable . RESULTS Compared with usual care ( UC , n=189 ) , patients in the intervention ( INT , n=193 ) group had significantly reduced A1C at 6 months ( -1.32 % INT vs -0.66 % UC ; p<0.001 ) . At 12 months , the differences were not significant ( -1.14 % INT vs -0.95 % UC ; p=0.133 ) . In post hoc analysis , significantly more INT patients had improved diabetes control ( > 0.5 % reduction in A1C ) than UC patients at 12 months ( 69.9 ( 95 % CI 63.2 to 76.5 ) vs 55.4 ( 95 % CI 48.4 to 62.5 ) ; p=0.006 ) . CONCLUSIONS A nurse-led , multidisciplinary health team can manage a population of diabetic patients in an online disease management program . INT patients achieved greater decreases in A1C at 6 months than UC patients , but the differences were not sustained at 12 months . More INT than UC patients achieved improvement in A1C ( > 0.5 % decrease ) . Trial registered in clinical trials.gov : # NCT00542204 
    Output:
    
Conclusions We engaged with service users and professionals to develop an evidence -based website addressing the agreed core information needs of non-professional carers who wish to provide palliative care to a friend or relative