***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: The increasing number of palliative care patients necessitates a simple , reliable instrument to routinely measure outcomes among hospice patients . We tested the utility of the  Brief Hospice Inventory ( BHI ) to assess outcomes of hospice patients and estimations of patients ' outcomes by nurse caregivers . In a prospect i ve study , 145 home-based hospice patients were enrolled in the study from VistaCare Hospice . During the first week of admission , patients and nurse caregivers completed the BHI , which assessed patients ' symptoms , satisfaction with care , and quality of life . Factor analysis supported a two-factor structure for the BHI for patients and caregivers , including a symptom subscale and quality of life subscale . Patients with severe symptoms showed improvement on the symptom subscale , but not the quality of life subscale , during the first 2 weeks after admission . The BHI shows utility in measuring hospice patients ' symptom severity and quality of life over time CONTEXT A clear underst and ing of what patients , families , and health care practitioners view as important at the end of life is integral to the success of improving care of dying patients . Empirical evidence defining such factors , however , is lacking . OBJECTIVE To determine the factors considered important at the end of life by patients , their families , physicians , and other care providers . DESIGN AND SETTING Cross-sectional , stratified r and om national survey conducted in March-August 1999 . PARTICIPANTS Seriously ill patients ( n = 340 ) , recently bereaved family ( n = 332 ) , physicians ( n = 361 ) , and other care providers ( nurses , social workers , chaplains , and hospice volunteers ; n = 429 ) . MAIN OUTCOME MEASURES Importance of 44 attributes of quality at the end of life ( 5-point scale ) and rankings of 9 major attributes , compared in the 4 groups . RESULTS Twenty-six items consistently were rated as being important ( > 70 % responding that item is important ) across all 4 groups , including pain and symptom management , preparation for death , achieving a sense of completion , decisions about treatment preferences , and being treated as a " whole person . " Eight items received strong importance ratings from patients but less from physicians ( P<.001 ) , including being mentally aware , having funeral arrangements planned , not being a burden , helping others , and coming to peace with God . Ten items had broad variation within as well as among the 4 groups , including decisions about life-sustaining treatments , dying at home , and talking about the meaning of death . Participants ranked freedom from pain most important and dying at home least important among 9 major attributes . CONCLUSIONS Although pain and symptom management , communication with one 's physician , preparation for death , and the opportunity to achieve a sense of completion are important to most , other factors important to quality at the end of life differ by role and by individual . Efforts to evaluate and improve patients ' and families ' experiences at the end of life must account for diverse perceptions of quality . JAMA . 2000;284:2476 - 2482 Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields Patients with advanced cancer frequently express positive attitudes and can be unduly optimistic about the potential benefits of treatment . In order to evaluate an illusory domain in the context of advanced cancer , we developed a scale of will to live and characterized the beliefs that patients held about the curability of their cancer , and how committed they were to using alternative treatments . A measure of quality of life was used as the dependent variable in order to assess the association between these attributes . After a preliminary exploration confirmed the presence of an illusory domain , these concepts were prospect ively tested in 149 ambulant patients with advanced cancer who attended for palliative systemic treatment , radiation treatment or supportive care .  The scale of global quality of life was reliable ( Cronbach 's alpha coefficient 0.72 ) . The distribution of the scores of will to live was skewed , with no respondent scoring poorly , and the scale was reliable ( Cronbach 's alpha coefficient 0.82 ) . The scale of belief in curability showed diverse beliefs . In some cases , there was a discrepancy between respondents ' beliefs in curability and what they believed to be the report by their doctors . There was also an association between a committed use of alternative treatments and a belief in the curability of the cancer ( p<0.001 ) . In a multiple regression analysis , both will to live and performance status remained associated with better quality of life scores after adjustment for other relevant variables ( p<0.05 and < 0.001 , respectively ) . These results suggest that positive illusory beliefs can be measured and are an important component of adaption for some patients with advanced cancer . Furthermore , this illusory domain may influence the perception and measurement of quality of life The aim of this study was to evaluate the feasibility , reliability and compliance of a new instrument , a diary to monitor physical symptoms for patients with cancer in the palliative phase of their illness . The development of the diary took place in three phases : two pilot studies and one intervention study . In Pilot I , reliability was tested within 13 pairs of patients and their proxy in a patient-proxy comparison . Pilot II was performed to test the feasibility of the instrument among 47 frail elderly . In the intervention study among patients with cancer in the palliative phase , the feasibility as well as the compliance has been tested . The phases have been completed with good results : reliability ( ICC ) of prevalent symptoms was above 0.75 , good feasibility and good compliance . The Symptom Monitor can be used by patients and doctors as an instrument to monitor physical symptoms . The effectiveness of the use of this diary for improvement in treatment of symptoms in the palliative phase of cancer is being tested in a r and omized clinical trial The Functional Assessment of Chronic Illness Therapy ( FACIT ) system provides a general , multidimensional measure of health-related quality of life ( FACT-G ) that can be augmented with disease or symptom-specific subscales . The 19-item palliative care subscale of the FACIT system has undergone little psychometric evaluation to date . The aim of this paper is to report the internal consistency , factor structure , and construct validity of the instrument using the palliative care subscale ( FACIT-Pal ) .  Two hundred fifty-six persons with advanced cancer in a r and omized trial testing a palliative care psychoeducational intervention completed the 46-item FACIT-Pal  at baseline . Internal consistency was greater than 0.74 for all subscales and the total score . Seventeen of the 19 palliative care subscale items loaded onto the four-factor solution of the established core measure ( FACT-G ) . As hypothesized , total scores were correlated with measures of symptom intensity ( r=-0.73 , P<0.001 ) and depression ( r=-0.75 , P<0.001 ) . The FACIT-Pal was able to discriminate between participants who died within three months of completing the baseline and participants who lived for at least one year after completing the baseline assessment ( t=-4.05 , P<0.001 ) . The functional well-being subscale discriminated between participants who had a Karnofsky performance score of 70 and below and participants with a Karnofsky performance score of 80 and above ( t=3.40 , P<0.001 ) . The findings support the internal consistency reliability and validity of the FACIT-Pal as a measure of health-related quality of life for persons with advanced cancer OBJECTIVE To determine the impact on a responder type analysis of using three published methods to obtain the minimally important difference ( MID ) on the conclusion of a r and omized controlled trial ( RCT ) . STUDY DESIGN AND SETTING Using data from an RCT of supportive-expressive group therapy ( SEGT-intervention ) vs. st and ard care ( control ) in women with metastatic breast cancer , we measured individual responsiveness to change according to three levels of predefined MID ( 0.2 SD , 0.5 SD , and 1 st and ard error of measurement ) of the following six vali date d question naires : Profile of Mood States , Impact of Event Scale , Psychosocial Adjustment to Illness Scale , EORTC Quality -of-Life Question naire Core-30 , Mental Adjustment to Cancer , and a pain visual analog scale . The proportion of women improved by SEGT  and the number needed to treat according to three levels of MID were calculated . RESULTS There was no consistent difference in the net proportion of women improving with the SEGT vs. control arm according to the three different levels of MID . CONCLUSION The choice between different levels of distribution-based MID did not make an important difference in the net proportion of women improving with the SEGT . Future research should compare MID derived from clinical anchors , in particular patient opinions The purpose of the study was to investigate psychometric properties of CAMPAS-R , an instrument for prospect ively monitoring patients ' symptoms and needs during palliative care at home .  CAMPAS-R was piloted for face and content validity and then administered alongside criterion measures to a home care sample . Cronbach 's alpha was used to test internal consistency and criterion-related validity was tested by non-parametric correlation with Brief Pain Inventory ( BPI ) , Hospital Anxiety and Depression Scale ( HADS ) and EORTC QLQ-C30 . Predictive validity was assessed by relating CAMPAS-R scores to survival .  One hundred and nine patients were recruited to the study . Good reliability and high correlations between CAMPAS-R and criterion measures were found . Predictive validity was demonstrated by significant differences in symptom scores between groups differing in length of survival .  CAMPAS-R is acceptable to patients , families and primary care professionals and is a valid , reliable instrument , which has the benefit of being easy to score A cross-validation of the Karnofsky Performance Status ( KPS ) and quality of life ( QOL ) as measured by item 30 of the quality of life question naire developed by the European Organization for Research and Treatment of Cancer Study Group ( EORTC QLQ-C30 ) was conducted using ordered logit analysis and prospect i ve data from a continuous sample of 139 lung cancer patients . The QOL is found to be a much broader concept than the KPS , since it likely captures not only physical functioning but also functioning in the non-physical dimensions of social , emotional , and possibly cognitive well-being as well as the level of distress in the physical dimensions of pain , breathing and fatigue . These results suggest that the palliative treatment of advanced cancer and the terminally ill should be guided by a broad concept of well-being that goes beyond one based only on physical functioning The purpose of this study was to establish whether or not readiness for death , as an indicator of healthy dying , is a measurable concept . Review of relevant literature revealed consensus regarding the universality of a human need for healthy dying . A theory of healthy dying was derived from the Rogerian paradigm . The McCanse Readiness for Death Instrument ( MRDI ) was constructed , which included indicators of physiological , psychological , sociological , and spiritual aspects of " healthy " field pattern as death is developmentally approached . The MRDI was a 26-item structured interview question naire which generated interval-ratio data through a visual analog scale . A pretest was conducted with a sample of 9 volunteer patients drawn from a small suburban outpatient hospice . The MRDI was concurrently administered to dying individuals , their primary caregivers , and their primary hospice nurses . Correlations between dying individuals ' scores and their primary caregivers ' estimates of patient death readiness as well as between patients and their primary hospice nurses were very encouraging . Cronbach 's coefficient alpha for internal consistency reliability was .59 . Content validity was supported by consensus of an expert panel of practicing hospice nurses . Construct validity was demonstrated through legitimate placement of the concept , healthy death readiness , within the theoretical web which supported it . The MRDI was then administered to a sample of 31 terminally-ill individuals , their primary caregivers , and their primary hospice nurses drawn from larger , urban hospice population s in three geographic areas of the United States . The MRDI was also administered to a contrast group of 39 cardiac-impaired individuals who were not terminally-ill . Overall internal consistency of the MRDI was found to be quite favorable ( alpha = .76 ) . Debilitating illness and actual mortality in the study sample precluded and /or confounded estimates of test-retest reliability . Convergent validity of the MRDI was indicated by significant correlations between patients ' scores and primary caregivers ' estimates ( r = .35 , p < .05 ) and between patients ' scores and primary hospice nurses ' estimates ( r = .53 , p < .01 ) . Discriminant validity of the MRDI was demonstrated by a significant mean difference between the group of terminally-ill patients and the group of non-terminal , cardiac-impaired patients 
    Output:
    
None of the instruments demonstrated satisfactory results for all measurement properties .
Responsiveness was not tested adequately for any of the instruments .
Very few of the studies provided information on the interpretation of the scores .
Overall , the MQOL , followed by the QUAL-E and the QODD , received the best ratings for their measurement properties .