***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 Palliative care planning for nursing home residents with advanced dementia is often suboptimal . This study compared effects of facilitated case conferencing ( FCC ) with usual care ( UC ) on end-of-life care . Methods A two arm parallel cluster r and omised controlled trial was conducted . The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers . In each intervention nursing home ( n = 10 ) , Palliative Care Planning Coordinators ( PCPCs ) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months . The primary outcome was family-rated quality of end-of-life care ( End-of-Life Dementia [ EOLD ] Scales ) . Secondary outcomes included nurse-rated EOLD scales , resident quality of life ( Quality of Life in Late-stage Dementia [ QUALID ] ) and quality of care over the last month of life ( pharmacological/non-pharmacological palliative strategies , hospitalization or inappropriate interventions ) . Results Two-hundred-eighty-six people with advanced dementia took part but only 131 died ( 64 in UC and 67 in FCC which was fewer than anticipated ) , rendering the primary analysis under-powered with no group effect seen in EOLD scales . Significant differences in pharmacological ( P < 0.01 ) and non-pharmacological ( P < 0.05 ) palliative management in last month of life were seen . Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care ( coefficient 2.97 , P < 0.05 ) and lower staff-rated EOLD Comfort Assessment with Dying ( coefficient 4.37 , P < 0.01 ) . Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios , proportion of residents with dementia and staff attitudes . Conclusion FCC facilitates a palliative approach to care . Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness . Trial registration Australian New Zeal and Clinical Trial Registry PURPOSE OF STUDY Dementia affects more than 5 million Americans , and is a leading cause of death . Family members of nursing home ( NH ) residents with advanced dementia report difficulty making decisions about care toward the end of life . As part of a r and omized trial testing an intervention to improve decision making , this qualitative study aim ed to underst and how family decision makers experienced goal -based decision making in advance of the death of their relative . DESIGN AND METHODS This qualitative study was conducted as part of the goals of care clinical trial . Study participants ( n = 16 ) were family decision makers in North Carolina whose relative with advanced dementia died after participating in the goals of care intervention . Semi-structured interviews were analyzed using a qualitative description approach . RESULTS Family members ' experience of decision making and death differed based on the presence or absence of trusting relationships with NH staff . Family members who reported trust described a positive end-of-life experience and less need for prescribed goals of care discussion s. In the absence of trust , family members reported that goals of care discussion s were ignored by staff or created confusion . IMPLICATION S Among family members of persons who recently died from dementia in NHs , expressions of trust in staff were strongly related to perceptions of decision making about goals of care . Although goals of care discussion s may potentially promote communication to earn trust , the presence of pre-existing trust ultimately influenced the decision making and end-of-life experiences of residents and families Background : In dementia care , a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity ; advance care planning can support such carers in the decision-making of care goals . However , given the relative importance of advance care planning in dementia care , the prevalence of advance care planning in dementia care is poor . Aim : To evaluate the effectiveness of advance care planning with family carers in dementia care homes . Design : Paired cluster r and omized controlled trial . The intervention comprised a trained facilitator , family education , family meetings , documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff . Setting / participants : A total of 24 nursing homes with a dementia nursing category located in Northern Irel and , United Kingdom . Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussion s. Results : The primary outcome was family carer uncertainty in decision-making about the care of the resident ( Decisional Conflict Scale ) . There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group ( −10.5 , 95 % confidence interval : −16.4 to −4.7 ; p < 0.001 ) . Conclusion : Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes . Given the global significance of dementia , the implication s for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers Background : Increasing number of people are dying with advanced dementia . Comfort and quality of life are key goals of care . Aims : To describe ( 1 ) physical and psychological symptoms , ( 2 ) health and social care service utilisation and ( 3 ) care at end of life in people with advanced dementia . Design : 9-month prospect i ve cohort study . Setting and participants : Greater London , Engl and , people with advanced dementia ( Functional Assessment Staging Scale 6e and above ) from 14 nursing homes or their own homes . Main outcome measures : At study entry and monthly : prescriptions , Charlson Comorbidity Index , pressure sore risk/severity ( Waterlow Scale/Stirling Scale , respectively ) , acute medical events , pain ( Pain Assessment in Advanced Dementia ) , neuropsychiatric symptoms ( Neuropsychiatric Inventory ) , quality of life ( Quality of Life in Late-Stage Dementia Scale ) , re source use ( Re source Utilization in Dementia Question naire and Client Services Receipt Inventory ) , presence/type of advance care plans , interventions , mortality , place of death and comfort ( Symptom Management at End of Life in Dementia Scale ) . Results : Of 159 potential participants , 85 were recruited ( 62 % alive at end of follow-up ) .  Pain ( 11 % at rest , 61 % on movement ) and significant agitation ( 54 % ) were common and persistent . Aspiration , dyspnoea , septicaemia and pneumonia were more frequent in those who died . In total , 76 % had ‘ do not resuscitate ’ statements , less than 40 % advance care plans . Most received primary care visits , there was little input from geriatrics or mental health but contact with emergency paramedics was common . Conclusion : People with advanced dementia lived with distressing symptoms . Service provision was not tailored to their needs . Longitudinal multidisciplinary input could optimise symptom control and quality of life Background : Despite increased attention for palliative care in dementia , recent studies found burdensome symptoms and unmet family caregiver needs in the last phase of life . Feedback is being used to improve the quality of palliative care , but we do not know how effective it is . Aim : To assess the effect of two feedback strategies on perceived quality of end-of-life care and comfort in dying nursing home residents with dementia . Methods : In a cluster-r and omized controlled trial , the End-of-Life in Dementia – Satisfaction With Care and the End-of-Life in Dementia – Comfort Assessment in Dying scales were completed by bereaved family caregivers of residents with dementia of 18 Dutch nursing homes .  Two feedback strategies , generic feedback with mean End-of-Life in Dementia-scores and feedback with individual ( patient-specific ) End-of-Life in Dementia-scores , were compared to no feedback provided . The intervention groups discussed End-of-Life in Dementia-ratings in team meetings and formulated actions to improve care . Multi-level analyses assessed effects . Results : A total of 668 families rated the End-of-Life in Dementia – instruments . Compared to no feedback , the generic strategy result ed in lower quality of end-of-life care in unadjusted ( B = −1.65 , confidence interval = −3.27 ; −0.21 ) and adjusted analyses ( B = −2.41 , confidence interval = −4.07 ; −0.76 ) , while there was no effect on comfort . The patient-specific strategy did not affect the quality of end-of-life care , but it increased comfort in unadjusted analyses ( only , B = 2.20 , confidence interval = 0.15 ; 4.39 ; adjusted : B = 1.88 , confidence interval = −0.34 ; 4.10 ) . Conclusion : Neither feedback strategy improved end-of-life outcome . Perhaps , skills to translate the feedback into care improvement actions were insufficient . Feedback with favorable family ratings might even have triggered opposite effects . Trial number : NTR3942 BACKGROUND Increasing numbers of older people with advanced dementia are cared for in care homes . No cure is available , so research focused on improving quality of life and quality of care for people with dementia is needed to support them to live and die well . The Namaste Care programme is a multi-dimensional care program with sensory , psycho-social and spiritual components intended to enhance quality of life and quality of care for people with advanced dementia . The aim of the study was to establish whether the Namaste Care program can be implemented in UK care homes ; and what effect Namaste Care has on the quality of life of residents with advanced dementia , their families and staff . This article explores the qualitative findings of the study , reporting the effect of the programme on the families of people with advanced dementia and care home staff , and presenting their perceptions of change in care . METHODS An organisational action research methodology was used . Focus groups and interviews were undertaken pre/post implementation of the Namaste Care program . The research er kept a reflective diary recording data on the process of change . A comments book was available to staff and relatives in each care home . Data was analysed thematically within each care home and then across all care homes . RESULTS Six care homes were recruited in south London : one withdrew before the study was underway . Of the five remaining care homes , four achieved a full Namaste Care program . One care home did not achieve the full program during the study , and another discontinued Namaste Care when the study ended . Every home experienced management disruption during the study . Namaste Care challenged normal routinised care for older people with advanced dementia . The characteristics of care uncovered before Namaste was implemented were : chaos and confusion , rushing around , lack of trust , and rewarding care . After the programme was implemented these perceptions were transformed , and themes of calmness , reaching out to each other , seeing the person , and , enhanced well-being , emerged . CONCLUSIONS Namaste Care can enrich the quality of life of older people with advanced dementia in care homes . The program was welcomed by care home staff and families , and was achieved with only modest expenditure and no change in staffing levels . The positive impact on residents quality of life influenced the well-being of family carers . Care staff found the changes in care enjoyable and rewarding . Namaste Care was valued for the benefits seen in residents ; the improvement in relationships ; and the shift towards a person-centred , relationship-based culture of care brought about by introducing the program .  Namaste Care deserves further exploration and investigation including a r and omised controlled trial People with dementia have often been excluded from pain studies . However , there is evidence supporting that people with dementia experience frequent pain , often poorly assessed and undertreated , and that the etiology for pain descriptions is poorly documented . The Assessment of Discomfort in Dementia ( ADD ) Protocol is design ed to : a ) more accurately assess discomfort in people with dementia who can no longer verbally describe physical pain or affective discomfort ; b ) more accurately and thoroughly treat physical pain and affective discomfort ; and c ) decrease inappropriate use of psychotropic medication . The use of the ADD Protocol was studies with a convenience sample of 104 residents of long-term care with end-stage dementia . Use of the ADD Protocol was associated with a significant decrease in discomfort ( t = 6.56 , p = 0.000 ) . The most frequently seen behavioral symptoms associated with discomfort were tense body language , sad facial expression , fidgeting , perseverant verbalizations , and verbal outburts . The ADD Protocol was also associated with a significant increase in the use of scheduled analgesics and non-pharmacological comfort interventions . The protocol was not associated with an increase in the use of prn analgesics or with prn or scheduled psychotropics .  This study has provided some support for the notion that the needs of people with significant dementia can be discerned and treated OBJECTIVES To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia . DESIGN Cluster r and omized controlled trial . SETTING Twenty-four nursing homes in North Carolina . PARTICIPANTS Residents with advanced dementia and feeding problems and their surrogates . INTERVENTION Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia . Controls received usual care . MEASUREMENTS Primary outcome was the Decisional Conflict Scale ( range : 1 - 5 ) measured at 3 months ; other main outcomes were surrogate knowledge , frequency of communication with providers , and feeding treatment use . RESULTS Two hundred fifty-six residents and surrogate decision-makers were recruited . Residents ' average age was 85 ; 67 % were Caucasian , and 79 % were women . Surrogates ' average age was 59 ; 67 % were Caucasian , and 70 % were residents ' children . The intervention improved knowledge scores ( 16.8 vs 1 
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Conclusion : Almost all domains were addressed across all interventions currently offered for this population to various degrees , but not within a singular intervention .