***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: We conducted an observational cohort study to determine if hospital-based , reinforcing regulatory and educational interventions could encourage physicians to discuss end-of-life ( EOL ) care with their patients . Specifically , we measured the effect of ( 1 ) administrative prompts to encourage discussion s about EOL care and ( 2 ) a m and atory educational seminar focusing on EOL issues .  Study subjects were patients consecutively admitted to the medicine service who faced an anticipated 3-year mortality rate of at least 50 % . The main study endpoint was the frequency of documented EOL discussion s between physicians and patients . In the inception cohort of 184 patients , physicians discussed EOL care with 64 patients ( 34 . 8 % ) , and in the follow-up cohort of 121 patients , 41 individuals ( 33 . 9 % ) had documented discussion s regarding EOL issues ( P = 0.90 ) . Actual " Do Not Resuscitate"(DNR ) orders were written for 53 patients ( 28.8 % ) in the inception cohort and for 33 persons ( 27.3 % ) in the follow-up cohort ( P = 0.71 ) . We conclude that enhanced , mutually reinforcing regulatory and educational efforts focusing on EOL care proved ineffectual at promoting either discussion s about EOL issues or the use of DNR orders Objective We investigated whether patient-centered communication skills can be taught to residents in Internal Medicine by using a time-limited behaviorally oriented intervention . Method Residents working at the Department of Internal Medicine were r and omly assigned to an intervention group ( IG ; N = 19 ) or a control group ( CG ; N = 23 ) . In addition to 6 hours of st and ard medical education per week , the IG received specific communication training of 22.5 hours duration within a 6-month period . Initially and 10 months later , participants performed interviews with simulated patients . Interviews were rated by blinded raters who used the Maastricht History and Advice Checklist-Revised . Results Compared with the CG , the IG improved substantially in many specific communication skills . Both groups improved in the " amount of medical information identified " and in the ability to " communicate about feasibility of treatment . " Conclusion Patient-centered communication skills such as those presented in this intervention study can be taught . The ability to gain medical information and the readiness to communicate about aspects of medical treatment seem to improve with more professional experience ; however , they also profit from the intervention OBJECTIVES --To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon 's opinion or the patient 's choice . To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery  was associated with their participation in a r and omised clinical trial . DESIGN -- Prospect i ve , multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer . SETTING --12 District general hospitals , three London teaching hospitals , and four private hospitals . PATIENTS --269 Women under 75 with a probable diagnosis of stage I or II breast cancer who were referred to 22 different surgeons . INTERVENTIONS --Surgery and radiotherapy or adjuvant chemotherapy , or both , depending on the individual surgeon 's stated preferences for managing early breast cancer . MAIN OUTCOME MEASURES --Anxiety and depression as assessed by st and ard methods two weeks , three months , and 12 months after surgery . RESULTS --Of the 269 women , 31 were treated by surgeons who favoured mastectomy , 120 by surgeons who favoured breast conservation , and 118 by surgeons who offered a choice of treatment . Sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery , and 43 of these chose  breast conserving surgery . The incidences of anxiety , depression , and sexual dysfunction were high in all treatment groups . There were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy . A significant effect of surgeon type on the incidence of depression was observed , with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons ( p = 0.06 ) . There was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose . Most of the women ( 159/244 ) gave fear of cancer as their primary fear rather than fear of losing a breast . The overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the Cancer Research Campaign breast conservation study . At 12 months 28 % of women who underwent mastectomy in the present study were anxious compared with 26 % in the earlier study , and 27 % of women in the present study who underwent lumpectomy were anxious compared with 31 % in the earlier study . In both the present and earlier study 21 % of women who underwent mastectomy were depressed , and 19 % of women who underwent lumpectomy in the present study were depressed compared with 27 % in the earlier study . ) CONCLUSIONS --There is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy . Women who surrender autonomy for decision making by agreeing to participate in r and omised clinical trials do not experience any different psychological , sexual , or social problems from those women who are treated for breast cancer outside a clinical trial The emotional content of health care professionals – cancer patient communication is often considered as poor and has to be improved by an enhancement of health care professionals empathy . One hundred and fifteen oncology nurses participating in a communication skills training workshop  were assessed at three different periods . Nurses r and omly allocated to a control group arm ( waiting list ) were assessed a first time and then 3 and 6 months later . Nurses allocated to the training group were assessed before training workshop , just after and 3 months later . Each nurse completed a 20-min clinical and simulated interview . Each interview was analysed by three content analysis systems : two computer-supported content analysis of emotional words , the Harvard Third Psychosocial Dictionary and the Martindale Regressive Imagery Dictionary and an observer rating system of utterances emotional depth level , the Cancer Research Campaign Workshop Evaluation Manual . The results show that in clinical interviews there is an increased use of emotional words by health care professionals right after having been trained ( P=0.056 ) : training group subjects use 4.3 ( std : 3.7 ) emotional words per 1000 used before training workshop , and 7.0 ( std : 5.8 ) right after training workshop and 5.9 ( std : 4.3 ) 3 months later compared to control group subjects which use 4.5 ( std : 4.8 ) emotional words at the first assessment point , 4.3 ( std : 4.1 ) at the second and 4.4 ( std : 3.3 ) at the third . The same trend is noticeable for emotional words used by health care professionals in simulated interviews ( P=0.000 ) . The emotional words registry used by health care professionals however remains stable over time in clinical interviews ( P=0.141 ) and is enlarged in simulated interviews ( P=0.041 ) . This increased use of emotional words by trained health care professionals facilitates cancer patient emotion words expressions compared to untrained health care professionals especially 3 months after training ( P=0.005 ) . This study shows that health care professionals empathy may be improved by communication skills training workshop and that this improvement facilitates cancer patients emotions expression BACKGROUND Doctors ' communication with patients is commonly hampered by lack of training in this core skill . This study aim ed to assess the efficacy of an intensive 3-day training course on communication skills in a r and omised controlled trial with a two-by-two factorial design and several outcomes . METHODS 160 oncologists from 34 UK cancer centres were r and omly allocated to four groups : written feedback followed by course ; course alone ; written feedback alone ; and control . At each of two assessment periods , consultations with six to ten consecutive , consenting patients per doctor were videotaped . 2407 patients participated . Outcome measures included objective and subjective ratings made by research ers , doctors , and patients . The primary outcomes were objective improvements after the intervention in key communication skills . Course content included structured feedback , videotape review of consultations , role-play with simulated patients , interactive group demonstrations , and discussion led by a trained facilitator . FINDINGS In Poisson regression analysis of counts of communication behaviours , course attendance significantly improved key outcomes . The estimated effect sizes corresponded to higher rates of use of focused questions ( difference between course attenders [ n=80 ] and non-attenders [ n=80 ] 34 % , p=0.003 ) , focused and open questions ( 27 % , p=0.005 ) , expressions of empathy ( 69 % , p=0.003 ) , and appropriate responses to patients ' cues ( 38 % , p=0.026 ) , and a 24 % lower rate of use of leading questions ( p=0.11 ) . There was little evidence for the effectiveness of written feedback . INTERPRETATION The communication problems of senior doctors working in cancer medicine are not resolved by time and clinical experience . This trial shows that training courses significantly improve key communication skills . More re sources should be allocated to address doctors ' training needs in this vital area Although st and ardized role-playing sessions ( SRPS ) with simulators are increasingly used to assess health care professionals ' ( HCPs ) communication skills ( CS ) and the effectiveness of training workshops ( TWs ) , nothing has been done to date to define the optimal emotional content of SRPS . Three emotionally different SRPS context s-weakly emotional ( WE- ) , moderately emotional ( ME- ) , and highly emotional (HE-SRPS)-were , therefore , tested in order to assess induced CS and sensitivity to TW-related changes . The study included 25 HCPs .  Tape-recorded SRPS , scheduled before and after the TW , were retranscribed , and assessed according to the Cancer Research Campaign Workshop Evaluation Manual ( CRCWEM ) , which provides a rating of form , function and structure for each utterance . Results show that induced CS are different in WE- , ME- , and HE-SRPS , regarding form ( HE-SRPS induced more ' directing ' , ' leading ' or ' multiple ' questions ; WE : 20.7 % ; ME : 19.7 % ; HE : 33.7 % ( p<0.001 ) ) ; function ( HE-SRPS induced more ' inappropriate ' information ; WE : 6 . 5 % ; ME : 8.2 % ; HE : 15.6 % ( p<0.001 ) ) ; and blocking ( HE-SRPS induced more ' blocking ' utterances ; WE : 7.2 % ; ME : 13.8 % ; HE : 30.2 % ( p<0 . 0001 ) ) . Finally , CS changes induced by TWs are the highest in HE-SRPS ( 14.8 % increase of ' open ' questions for the HE- versus 1.0 % for the WE-SRPS ; 11.6 % decrease of ' inappropriate ' information for the HE- versus 3.3 % for the WE-SRPS ; and 17.5 % decrease of ' blocking ' for the HE- versus 2.6 % for the WE-SRPS ) . In conclusion , SRPS , with a HE content , induce more inappropriate CS . Moreover , they are more sensitive to TW effects . SRPS with a HE content should , thus , be recommended for the assessment of TW effectiveness A prospect i ve study of the impact of training  41 hospice nurses in assessment skills  was used to test hypotheses that blocking behaviours would be used more when patients disclosed feelings and used less when nurses perceived that they had satisfactory professional support . Each nurse was asked to assess a patient 's current problems before and after feedback training and 8 months later . Audiotape recordings of these interviews were rated by trained raters . They determined the frequency of nurses ' responses which had the function of blocking patient disclosure and the emotional level of patient disclosure . Before each patient assessment each nurse was interviewed and question naires administered to measure her perceptions of the support she received . Blocking behaviours were most evident when patients disclosed their feelings ( Kendalls r = 0.36 , P < 0.001 ) . In interviews containing most patient disclosure of feeling , blocking was significantly less ( r = -0.24 , P < 0.5 ) when the nurse felt that practical help would be available if needed and when the nurse felt that her direct supervisor was concerned about the nurse 's own welfare ( r = -0.37 , P < 0.005 ) An annual seminar held by the University of Colorado , Department of Pediatrics , is design ed to assist interns to cope more effectively with the emotional strains of caring for dying patients and their families . In the seminar , interns are r and omly divided into four small groups con sisting of six interns , a chief resident , two pediatric faculty members , and a nurse or social worker from an intensive care unit . This paper review s the resident evaluations of the seminar , as well as the results of a question naire which explored attitude formation toward death . Interns felt that the opportunity to discuss death and dying early in their training program helped them gain an underst and ing of their own feelings about death , which enabled them to cope better with the stress involved in caring for dying children . Additional benefits from the seminar included more effective interpersonal communication , the establishment of deeper and more meaningful friendships , and a stronger esprit de corps The usefulness of psychological training programs ( P.T.P. ) in health care setting s devoted to cancer care is beginning to be recognised but their content , form and effectiveness need further investigation 
    Output:
    
No significant differences were found between attendees and non-attendees in use of leading questions .
Both studies investigated differences in summarising , interrupting and checking but found none .
REVIEW ER 'S CONCLUSIONS The training programmes assessed by these trials appear to be effective in improving  cancer care professionals communication skills .
It is not known whether the training would be effective if taught by other educators , nor has any trial compared the efficacy of both programmes