***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: PURPOSE To examine the effect of weekly completion of a patient-held  quality -of-life ( QOL ) diary in routine oncology practice for palliative care patients . PATIENTS AND METHODS In a pragmatic r and omized controlled trial , 115 patients with inoperable lung cancer were r and omly assigned to receive either st and ard care or a structured QOL diary ( European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 and the related lung cancer module LC13 ) that they completed at home each week for 16 weeks . Patients were encouraged to share the QOL information with health professionals involved in their care . Changes in QOL over time ( measured by the Functional Assessment of Cancer Therapy-Lung question naire and the Palliative Care Quality of Life Index ) , discussion of patient problems , and satisfaction with communication and general care were assessed at baseline and at 2 and 4 months after baseline . RESULTS Analysis of QOL indicated a small but consistent difference between patients in the diary group and the st and ard care group . The diary group had a poorer QOL in many domains . Two different QOL summary scores ( total and overall QOL ) indicated a statistically significant between-group difference . No effects were found in relation to satisfaction with care , communication , or the discussion of patient problems . CONCLUSION The regular completion of a QOL question naire without appropriate feedback to health care professionals and without the provision of appropriate support may have a negative impact on inoperable lung cancer patients . Further research should focus on identifying features such as feedback loops that are required for the successful and meaningful use of QOL question naires in routine patient care BACKGROUND Patients with advanced cancer receiving palliative care often experience severe physical and psychosocial symptoms . However , there are limited re sources for psychological and emotional support . Expressive writing has shown decreased anxiety level in young and healthy people suffering from a number of stressors . OBJECTIVE The purpose of this study was to determine the feasibility of expressive writing in patients receiving palliative care and the most suitable outcomes of expressive writing in this patient population . DESIGN In this pilot study , patients were r and omly assigned to either the expressive writing group ( EW ) or the neutral writing group ( NW ) . Anxiety level before and after the writing session was compared between the two groups . Writing material s were content analyzed using st and ard qualitative research methods . RESULTS A total of 24 patients ( 12 in EW and 12 in NW ) were enrolled in the study between October 2006 and January 2007 . Although the majority of patients ( 83%-100 % ) were able to complete all baseline assessment s , poor adherence was observed during the follow-ups . Only 8 % of patients completed the 2-week study . There was no significant difference in the State-Trait Anxiety Inventory ( STAI ) State-Anxiety scores at baseline , before and after each writing session between the EW and NW groups . DISCUSSION Our rapid accrual suggests that palliative care patients are interested in participating in studies such as expressive writing . The high level of adherence to the baseline assessment s indicates that these assessment s were not particularly difficult for our patients to complete . Future studies may need to include patients with better performance status , better patient education , means of emotional expression ( i.e. , audio recording , telephone interview ) and improved adherence . CONCLUSION We conclude that clinical trials of expressive writing in the palliative care setting are not feasible unless they undergo major modification in methods compared to those previous reported in other patient population . Our findings will hopefully assist research ers considering similar studies In addition to modern medicinal therapy , many cancer patients in Taiwan are treated regularly with herbal medicines or prescribed a traditional herbal diet . In this paper , the effect of a Taiwanese traditional herbal diet ( TTHD ) on pain  in terminal cancer patients was investigated . A total of 2,466 patients diagnosed with a variety of cancers were included . The most common patient-reported symptoms included troublesome pain ( 79.2 % ) , weakness ( 69.0 % ) , anorexia ( 46.4 % ) , fever ( 36.5 % ) , dyspnea ( 31.1 % ) , and leg edema ( 30.9 % ) . The 2,466 terminal cancer patients included in the study were r and omly divided into three groups . The TTHD group ( n=1044 ; 42.3 % ) were given the TTHD consisting of analgesic herbs ( paeony root : licorice root=1:1 ) and a Taiwanese tonic vegetable soup ( Lilii bulbus , Nelumbo seed , and Jujube fruit ) . The remaining patients were divided into a reference group , given the regular hospital diet , ( n=909 , 36.9 % ) and a control group , given the Taiwanese tonic vegetable soup without analgesic herbs , ( n=513 , 20.8 % ) . All patients maintained their assigned diets for one week . A verbal numerical scale was used to assess pain . Results revealed that the patients given TTHD reported enhanced pain relief ( p<0.05 ) compared to the reference and control groups . We found that TTHD could alleviate the pain among terminal cancer patients thereby supporting the supposition that Eastern and Western medicines can be effectively co-administered to enhance terminal patient 's quality of life . Further research is warranted BACKGROUND Few patients with end-stage dementia are enrolled in hospice care . A palliative care approach would nonetheless seem to be appropriate in various care setting s , including the acute care hospital . METHODS We conducted a r and omized controlled trial of palliative care in patients with advanced dementia ( Functional Assessment Staging Tool [ FAST ] stage 6d-7f ) who were hospitalized with acute illness . Intervention patients received recommendations by a palliative care team with the goal of enhancing patient comfort ; control patients received usual care without these recommendations . RESULTS Among 99 patients enrolled over 3 years , groups were comparable at baseline in terms of gender , age , race , dementia stage , and advance directive status . Outcomes were similar in terms of mean number of hospitalizations , average length of stay , and mortality . Intervention patients were more likely than control patients to receive a palliative care plan  ( 23 % versus 4 % ; p = 0.008 ) , usually on discharge , and more decisions were made to forgo certain medical treatments but the numbers were small . Fewer patients in the intervention group received intravenous therapy  throughout the admission ( 66 % vs. 81 % , p = 0.025 ) . Overall , additional interventions included  daily phlebotomy  for at least half of the admission ( 41 % ) ,  systemic antibiotics  ( 75 % ) , and  new feeding tubes  ( 44 % ) . Including tubes present at the time of r and omization , a total of 69 % received long-term enteral feeding . CONCLUSION It was difficult for a palliative care research team to influence the care of advanced dementia patients in the acute hospital setting . When patients have advanced dementia , there may be unique barriers , including perceived prognostic uncertainty , difficulty assessing comfort level , and perceptions about tube feeding . There must be a reexamination of treatment approaches for this severely impaired group of patients . Further study should attempt to identify patients prior to the need for acute hospitalization so goals can be established when there is less urgency to make life and death decisions 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 Palliative care is now considered an essential part of end-of-life care , yet little research examines the efficacy of interventions addressing the psychological treatment of dying patients . Forgiveness therapy has been shown to be effective in improving psychological well-being and may provide a valuable addition to a terminal cancer patient 's overall treatment plan . This study experimentally tested the effectiveness of a four-week forgiveness therapy in improving the quality of life of elderly terminally ill cancer patients . Participants ( n=20 ) were r and omly assigned to a forgiveness therapy group or to a  wait-list control group , which received forgiveness therapy in the second four-week period . All participants completed instruments measuring forgiveness , hope , quality of life , and anger at pre-test , post-test 1 , and post-test 2 . The forgiveness therapy group showed greater improvement than the control group , with one-tailed t-tests , on all measures . After receiving forgiveness therapy , participants in both forgiveness treatment conditions demonstrated significant improvements on all measures . The aggregated effect size was large . The four-week forgiveness therapy demonstrated psychological benefits for elderly terminally ill cancer patients and thus may be an appropriate addition to the treatment plan for terminal cancer patients Most seriously ill Americans live at home under the care of their primary physician and with the support of family caregivers . To reduce costs while simultaneously improving the quality of patient care , insurers have increasingly turned to the concept of case management . While case management is targeted to individuals with life-threatening illnesses , palliative care assessment and interventions are typically not included in the management protocol s. An academic/care management/health plan partnership between Mount Sinai School of Medicine , Franklin Health , a care management organization , and South Carolina Blue Cross Blue Shield , was formed in 1998 to test the utility of integration of case management with formal palliative care assessment , feedback and recommendations to treating physicians , and ongoing support for implementation of a palliative care plan . The goal of the project was to ensure identification and optimal care of seriously ill patients ' complex needs , while facilitating doctor-patient continuity , improving patient/family/physician communication , providing assistance with decision-making , ensuring quality care at home , and promoting efficient use of health care re sources . Care management nurses were r and omly assigned to a control ( usual care ) group or to the intervention ( palliative care ) group . Intervention nurses were trained in formal palliative care assessment and interventions , supported by treatment protocol s and communication strategies with treating physicians . Measurements included symptom burden , prescribing practice s , advance care planning status , satisfaction , and health care utilization . These results are pending completion of study run-out and analysis . Preliminary programmatic results indicate that combining palliative care with the case management approach is a logical , feasible , and effective strategy to improve the care of seriously ill patients living in the community . Franklin Health has offered the program to their entire client base because they feel that the integration of palliative care into their case management program improved the st and ard of patient care . Blue Cross Blue Shield of South Carolina has also chosen to sustain this enhanced model of care management for seriously ill patients BACKGROUND Significant palliative care intervention has focused on physical pain and symptom control ; yet less empirical evidence supports efforts to address the psychosocial and spiritual dimensions of experience . OBJECTIVE To evaluate the impact of an intervention ( Outlook ) that promotes discussion s of end-of-life preparation and completion on health outcomes in dying persons , including pain and symptoms , physical function , emotional function ( anxiety and depression ) , spiritual well-being , and quality of life at the end of life . DESIGN A three-arm pilot r and omized control trial . Subjects were recruited from inpatient and outpatient hospital , palliative care , and hospice setting s. Intervention subjects met with a facilitator three times and discussed issues related to life review , forgiveness , and heritage and legacy . Attention control subjects met with a facilitator three times and listened to a nonguided relaxation CD . True control subjects received no intervention . MEASUREMENTS Pre outcomes and post outcomes included the Memorial Symptom Assessment Scale , QUAL-E , Rosow-Breslau ADL Scale , Profile of Mood States anxiety sub-scale , the CESD short version , and the Daily Spiritual Experience Scale . RESULTS Eighty-two hospice eligible patients enrolled in the study ; 38 were women , 35 were African American . Participants ' primary diagnoses included cancer ( 48 ) , heart disease ( 5 ) lung disease ( 10 ) , and other ( 19 ) Ages ranged from 28 - 96 . Participants in the active discussion intervention showed improvements in functional status , anxiety , depression , and preparation for end of life . CONCLUSIONS The Outlook intervention was acceptable to patients from a variety of educational and ethnic background s and offers a brief , manualized , intervention for emotional and spiritual concerns BACKGROUND Cognitive behaviour therapy ( CBT ) has been shown to reduce 
    Output:
    
We conclude that published RCTs have no clear definitions of their palliative care patients and illustrate the diversity of this patient , the lack of consensus concerning the attributes of illnesses needing palliation and the ambiguous use of the adjective ‘ palliative ’ .