human
***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 Early palliative care improves the quality of life ( QoL ) and satisfaction with care of patients with advanced cancer , but little is known about its effect on caregivers . Here , we report outcomes of caregiver satisfaction with care and QoL from a trial of early palliative care . Patients and methods Twenty-four medical oncology clinics were cluster-r and omised , stratified by tumour site ( lung , gastrointestinal , genitourinary , breast and gynaecological ) , to early palliative care team referral , or to st and ard oncology care with palliative care only as needed . Caregivers of patients with advanced cancer ( clinical prognosis of 6 - 24 months , Eastern Cooperative Oncology Group 0 - 2 ) in both trial arms completed vali date d measures assessing  satisfaction with care  ( FAMCARE-19 ) and  QoL [ SF-36v2 Health Survey ; Caregiver QoL-Cancer ( CQoL-C ) ] , at baseline and monthly for 4 months . We used a multilevel linear r and om-intercept mixed-effect model to test whether there was improvement in the intervention group relative to the control group over 3 and 4 months . Results A total of 182 caregivers completed baseline measures ( 94 intervention , 88 control ) ; 151 caregivers ( 77 intervention , 74 control ) completed at least one follow-up assessment . Satisfaction with care improved in the palliative intervention group compared with controls over 3 months ( P = 0.007 ) and 4 months ( P = 0.02 ) . There was no significant improvement in the intervention group compared with controls for CQoL-C ( 3 months : P = 0.92 , 4 months : P = 0.51 ) , Physical Component Summary of the SF-36v2 Health Survey ( 3 months : P = 0.83 , 4 months : P = 0.20 ) , or Mental Component Summary of the SF-36v2 Health Survey ( 3 months : P = 0.87 , 4 months : P = 0.60 ) . Conclusion Early palliative care increased satisfaction with care in caregivers of patients with advanced cancer . Clinical Trials.gov identifier NCT01248624 The aim of this editorial is to highlight several research priorities and key implication s for policy and practice that inform an agenda to improve family carer support . The development of systematic approaches to identify carers who are at risk of poor psychosocial outcomes  is a priority . Family caregiving should not be pathologised as an inherently negative experience ; however , it would be a breach of care if more than 40 % of carers who appear to meet the criteria for psychological distress1 are not offered suitable supports . Related to this is the urgent need for greater investment in bereavement research ; while bereavement support is integral to palliative care , it is typically under-re source d , under-investigated and not systematic ally applied . We know that routine intervention for all bereaved carers is not warranted . The challenge is to discern those carers who are ‘ at risk ’ prior to the death of the patient and to identify suitable evidence -based strategies to assist them . Research indicates that carer re sources , rather than patient diagnosis or illness severity , are the primary predictors of carer burden and other carer outcomes . This implies that although the specific content may need to vary to suit the context , the core elements of family carer interventions may be relevant across disease groups . It is also apparent that the perceived quality of social support is more important than the size of the social network in improving carer outcomes .2 Current indications are that palliative care providers should assist carers by targeting social support and re sources and provide education that focuses on coping strategies and preparation for the carer role . In many countries , family carers are well prepared for the beginning of life when , for example , prospect i ve parents are routinely offered parenting classes . It is also not uncommon to assist carers prepare for and support relatives having major heart surgery . However , preparation for supporting a relative/ friend at the end of their life is not routinely offered . Carers typically want to know what the role entails , how to manage symptoms , signs of imminent death and re sources and strategies to sustain their own well-being . Given the majority of patients want to be cared for in their home environment , initiatives that assist carers to achieve this are needed . The period of time most people receive palliative care services is typically quite short ; hence , the challenge is to design interventions that are as brief as possible , readily accessible and easily delivered . The significant number of carers who support patients in the hospital/hospice setting should also not be neglected ; their needs are often hidden . Other valuable insights regarding how we deliver interventions are surfacing . For example , the conception that face-to-face carer support is the gold st and ard is being challenged . Emerging evidence suggests that telephone and video phone support may be equally effective in some circumstances.1,3 Emphasis on the development of a strategic , coordinated and priority-driven family carer research agenda is also important.4 The role of formal research collaborations may be a vehicle to foster this . Much of the carer research seems to be first-world centric . More attention needs to be directed towards family caregiving in under-re source d countries and in other under-represented population s such as ethnic minority groups . Several important policy and clinical matters warrant consideration if palliative care is to foster improved carer support . One of the core questions for policymakers and clinicians is whether or not it is feasible for palliative care to be expected to meet the needs of the patients ’ entire family . It has been recommended that given re source constraints , the focus should be on the primary family carer ( as identified by the patient ) and where possible extended to other family members.5 Consideration might also be given to revising expectations about the goal of family support . The current World Health Organization definition of palliative care advocates that families ’ quality of life be improved ; perhaps a more realistic objective may be to aim to reduce the psychosocial burden of primary family carers . A related question is how to effectively legitimise family carer support . Most family carers do not want to discuss their needs and concerns in front of their relative ; they therefore need one-to-one time with healthcare and socialcare professionals . It is also clear that many healthcare workers find supporting carers challenging . Hence , where pertinent , consideration should be given to the potential merits of officially recognising family carers as ‘ care recipients ’ ; therefore , they are formally acknowledged as ‘ worthy ’ within the healthcare system . This may help justify much needed re sources and allow healthcare workers to allocate time and where pertinent offer interventions . In 488855 PMJ27710.1177/0269216313488855Palliative MedicineEditorial Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Research has consistently shown that family caregivers have a variety of unmet needs , despite comprehensive professional support for caregivers being a central aim of palliative care . This sub- study of a larger r and omized controlled trial sought feedback from 47 primary family caregivers of advanced cancer patients who had recently commenced home palliative care .  During semi-structured interviews in their homes , family caregivers were asked to comment on the key challenges associated with their role and whether they could identify challenges . These were associated with their own ill health , family circumstances , insufficient skills to manage patient symptoms , limited time for themselves and inadequate support from health professionals . Despite these challenges , 60 % of family caregivers were readily able to identify positive aspects of the role . Previous research has tended to focus on the negative impact of caregiving . The extent to which the positive aspects buffer the negative aspects of the role warrants further exploration , as does the long-term impact of the caregiver role on those who are unable to recognize positive elements BACKGROUND It is commonly written that more patients wish to die at home than currently achieve this . However , the evidence for preferences for place of terminal care and death has not been systematic ally review ed . AIM To carry out a systematic literature review of the preferences for  place of care and death  among advanced cancer patients . METHOD Studies were identified using systematic data base search es of MEDLINE ( 1966 - 1999 ) , PsychLit ( 1974 - 1999 ) , and Bath Information Data Service ( BIDS ) ( 1981 - 1999 ) . Studies were assessed and data extracted and synthesis es following the NHS Centre for Review s and Dissemination guidelines , grading studies according to design and rigor of methods . Studies of preferences in the general population and of groups including cancer patients and /or their caregivers were included . RESULTS Eighteen studies determining preferences in either the general population or groups including cancer patients were identified . Views were obtained prospect ively and retrospectively from patients , the general population , families , and professionals . Respondents indicated preferences for home death ( range 49%-100 % ) , except one study of patients in the care of a continuing care team in London where only 25%-29 % of patients wanted a home death , and inpatient hospice was the most favored option . However , the response rate of this study was not known . Among the general public there was a higher preference for  inpatient hospice care among in people with recent experience of a close friend or relative 's death or dying . Where the views of patients , families , and professionals were compared , all respondents broadly agreed although patients expressed the strongest home preferences . Only 2 of the studies provided longitudinal data , and 9 of the 18 had major deficits in design or reporting , such as poor or unknown response rate , unclear or un systematic methods of eliciting preferences or other sample or measurement bias . However , sensitivity analysis of only the more robust and larger studies did not alter the finding of a preference for home care at the end of life in over 50 % of patients . CONCLUSIONS Home care is the most common preference , with inpatient hospice care as second preference in advanced illness . Meeting these preferences could be important outcomes for services . Study design s in this area need to be improved CONTEXT There are few r and omized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer . OBJECTIVE To determine the effect of a nursing-led intervention on quality of life , symptom intensity , mood , and re source use in patients with advanced cancer . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from November 2003 through May 2008 of 322 patients with advanced cancer in a rural , National Cancer Institute- design ated comprehensive cancer center in New Hampshire and affiliated outreach clinics and a VA medical center in Vermont . INTERVENTIONS A multicomponent , psychoeducational intervention ( Project ENABLE [ Educate , Nurture , Advise , Before Life Ends ] ) conducted by advanced practice nurses consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion ( n = 161 ) vs usual care ( n = 161 ) . MAIN OUTCOME MEASURES Quality of life was measured by the Functional Assessment of Chronic Illness Therapy for Palliative Care ( score range , 0 - 184 ) . Symptom intensity was measured by the Edmonton Symptom Assessment Scale ( score range , 0 - 900 ) . Mood was measured by the Center for Epidemiological Studies Depression Scale ( range , 0 - 60 ) . These measures were assessed at baseline , 1 month , and every 3 months until death or study completion . Intensity of service was measured as the number of days in the hospital and in the intensive care unit ( ICU ) and the number of emergency department visits recorded in the electronic medical record . RESULTS A total of 322 participants with cancer of the gastrointestinal tract ( 41 % ; 67 in the usual care group vs 66 in the intervention group ) , lung ( 36 % ; 58 vs 59 ) , genitourinary tract ( 12 % ; 20 vs 19 ) , and breast ( 10 % ; 16 vs 17 ) were r and omized . The estimated treatment effects ( intervention minus usual care ) for all participants were a mean ( SE ) of 4.6 ( 2 ) for quality of life ( P = .02 ) , -27.8 ( 15 ) for symptom intensity ( P = .06 ) , and -1.8 ( 0.81 ) for depressed mood ( P = .02 ) . The estimated treatment effects in participants who died during the study were a mean ( SE ) of 8.6 ( 3.6 ) for quality of life ( P = .02 ) , -24.2 ( 20.5 ) for symptom intensity ( P = .24 ) , and -2.7 ( 1.2 ) for depressed mood ( P = .03 ) . Intensity of service did not differ between the 2 groups . CONCLUSION Compared with participants receiving usual oncology care , those receiving a nurse-led , palliative care-focused intervention addressing physical , psychosocial , and care coordination provided concurrently with oncology care had higher scores for quality of life and mood , but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or emergency department visits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00253383 Background Palliative care incorporates comprehensive support of family caregivers because many of them experience burden and distress . However , evidence -based support initiatives are few . Purpose We evaluated a one-to-one psychoeducational intervention aim ed at mitigating the distress of caregivers of patients with advanced cancer receiving home-based palliative care . We hypothesised that caregivers would report decreased distress as assessed by the General Health Question naire ( GHQ ) . Method A r and omised controlled trial comparing two versions of the delivery of the intervention ( one face-to-face home visit plus telephone calls versus two visits ) plus st and ard care to a control group ( st and ard care only )  across four sites in Australia . 
    Output:
    
agent
***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 Early palliative care improves the quality of life ( QoL ) and satisfaction with care of patients with advanced cancer , but little is known about its effect on caregivers . Here , we report outcomes of caregiver satisfaction with care and QoL from a trial of early palliative care . Patients and methods Twenty-four medical oncology clinics were cluster-r and omised , stratified by tumour site ( lung , gastrointestinal , genitourinary , breast and gynaecological ) , to early palliative care team referral , or to st and ard oncology care with palliative care only as needed . Caregivers of patients with advanced cancer ( clinical prognosis of 6 - 24 months , Eastern Cooperative Oncology Group 0 - 2 ) in both trial arms completed vali date d measures assessing  satisfaction with care  ( FAMCARE-19 ) and  QoL [ SF-36v2 Health Survey ; Caregiver QoL-Cancer ( CQoL-C ) ] , at baseline and monthly for 4 months . We used a multilevel linear r and om-intercept mixed-effect model to test whether there was improvement in the intervention group relative to the control group over 3 and 4 months . Results A total of 182 caregivers completed baseline measures ( 94 intervention , 88 control ) ; 151 caregivers ( 77 intervention , 74 control ) completed at least one follow-up assessment . Satisfaction with care improved in the palliative intervention group compared with controls over 3 months ( P = 0.007 ) and 4 months ( P = 0.02 ) . There was no significant improvement in the intervention group compared with controls for CQoL-C ( 3 months : P = 0.92 , 4 months : P = 0.51 ) , Physical Component Summary of the SF-36v2 Health Survey ( 3 months : P = 0.83 , 4 months : P = 0.20 ) , or Mental Component Summary of the SF-36v2 Health Survey ( 3 months : P = 0.87 , 4 months : P = 0.60 ) . Conclusion Early palliative care increased satisfaction with care in caregivers of patients with advanced cancer . Clinical Trials.gov identifier NCT01248624 The aim of this editorial is to highlight several research priorities and key implication s for policy and practice that inform an agenda to improve family carer support . The development of systematic approaches to identify carers who are at risk of poor psychosocial outcomes  is a priority . Family caregiving should not be pathologised as an inherently negative experience ; however , it would be a breach of care if more than 40 % of carers who appear to meet the criteria for psychological distress1 are not offered suitable supports . Related to this is the urgent need for greater investment in bereavement research ; while bereavement support is integral to palliative care , it is typically under-re source d , under-investigated and not systematic ally applied . We know that routine intervention for all bereaved carers is not warranted . The challenge is to discern those carers who are ‘ at risk ’ prior to the death of the patient and to identify suitable evidence -based strategies to assist them . Research indicates that carer re sources , rather than patient diagnosis or illness severity , are the primary predictors of carer burden and other carer outcomes . This implies that although the specific content may need to vary to suit the context , the core elements of family carer interventions may be relevant across disease groups . It is also apparent that the perceived quality of social support is more important than the size of the social network in improving carer outcomes .2 Current indications are that palliative care providers should assist carers by targeting social support and re sources and provide education that focuses on coping strategies and preparation for the carer role . In many countries , family carers are well prepared for the beginning of life when , for example , prospect i ve parents are routinely offered parenting classes . It is also not uncommon to assist carers prepare for and support relatives having major heart surgery . However , preparation for supporting a relative/ friend at the end of their life is not routinely offered . Carers typically want to know what the role entails , how to manage symptoms , signs of imminent death and re sources and strategies to sustain their own well-being . Given the majority of patients want to be cared for in their home environment , initiatives that assist carers to achieve this are needed . The period of time most people receive palliative care services is typically quite short ; hence , the challenge is to design interventions that are as brief as possible , readily accessible and easily delivered . The significant number of carers who support patients in the hospital/hospice setting should also not be neglected ; their needs are often hidden . Other valuable insights regarding how we deliver interventions are surfacing . For example , the conception that face-to-face carer support is the gold st and ard is being challenged . Emerging evidence suggests that telephone and video phone support may be equally effective in some circumstances.1,3 Emphasis on the development of a strategic , coordinated and priority-driven family carer research agenda is also important.4 The role of formal research collaborations may be a vehicle to foster this . Much of the carer research seems to be first-world centric . More attention needs to be directed towards family caregiving in under-re source d countries and in other under-represented population s such as ethnic minority groups . Several important policy and clinical matters warrant consideration if palliative care is to foster improved carer support . One of the core questions for policymakers and clinicians is whether or not it is feasible for palliative care to be expected to meet the needs of the patients ’ entire family . It has been recommended that given re source constraints , the focus should be on the primary family carer ( as identified by the patient ) and where possible extended to other family members.5 Consideration might also be given to revising expectations about the goal of family support . The current World Health Organization definition of palliative care advocates that families ’ quality of life be improved ; perhaps a more realistic objective may be to aim to reduce the psychosocial burden of primary family carers . A related question is how to effectively legitimise family carer support . Most family carers do not want to discuss their needs and concerns in front of their relative ; they therefore need one-to-one time with healthcare and socialcare professionals . It is also clear that many healthcare workers find supporting carers challenging . Hence , where pertinent , consideration should be given to the potential merits of officially recognising family carers as ‘ care recipients ’ ; therefore , they are formally acknowledged as ‘ worthy ’ within the healthcare system . This may help justify much needed re sources and allow healthcare workers to allocate time and where pertinent offer interventions . In 488855 PMJ27710.1177/0269216313488855Palliative MedicineEditorial Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Research has consistently shown that family caregivers have a variety of unmet needs , despite comprehensive professional support for caregivers being a central aim of palliative care . This sub- study of a larger r and omized controlled trial sought feedback from 47 primary family caregivers of advanced cancer patients who had recently commenced home palliative care .  During semi-structured interviews in their homes , family caregivers were asked to comment on the key challenges associated with their role and whether they could identify challenges . These were associated with their own ill health , family circumstances , insufficient skills to manage patient symptoms , limited time for themselves and inadequate support from health professionals . Despite these challenges , 60 % of family caregivers were readily able to identify positive aspects of the role . Previous research has tended to focus on the negative impact of caregiving . The extent to which the positive aspects buffer the negative aspects of the role warrants further exploration , as does the long-term impact of the caregiver role on those who are unable to recognize positive elements BACKGROUND It is commonly written that more patients wish to die at home than currently achieve this . However , the evidence for preferences for place of terminal care and death has not been systematic ally review ed . AIM To carry out a systematic literature review of the preferences for  place of care and death  among advanced cancer patients . METHOD Studies were identified using systematic data base search es of MEDLINE ( 1966 - 1999 ) , PsychLit ( 1974 - 1999 ) , and Bath Information Data Service ( BIDS ) ( 1981 - 1999 ) . Studies were assessed and data extracted and synthesis es following the NHS Centre for Review s and Dissemination guidelines , grading studies according to design and rigor of methods . Studies of preferences in the general population and of groups including cancer patients and /or their caregivers were included . RESULTS Eighteen studies determining preferences in either the general population or groups including cancer patients were identified . Views were obtained prospect ively and retrospectively from patients , the general population , families , and professionals . Respondents indicated preferences for home death ( range 49%-100 % ) , except one study of patients in the care of a continuing care team in London where only 25%-29 % of patients wanted a home death , and inpatient hospice was the most favored option . However , the response rate of this study was not known . Among the general public there was a higher preference for  inpatient hospice care among in people with recent experience of a close friend or relative 's death or dying . Where the views of patients , families , and professionals were compared , all respondents broadly agreed although patients expressed the strongest home preferences . Only 2 of the studies provided longitudinal data , and 9 of the 18 had major deficits in design or reporting , such as poor or unknown response rate , unclear or un systematic methods of eliciting preferences or other sample or measurement bias . However , sensitivity analysis of only the more robust and larger studies did not alter the finding of a preference for home care at the end of life in over 50 % of patients . CONCLUSIONS Home care is the most common preference , with inpatient hospice care as second preference in advanced illness . Meeting these preferences could be important outcomes for services . Study design s in this area need to be improved CONTEXT There are few r and omized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer . OBJECTIVE To determine the effect of a nursing-led intervention on quality of life , symptom intensity , mood , and re source use in patients with advanced cancer . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from November 2003 through May 2008 of 322 patients with advanced cancer in a rural , National Cancer Institute- design ated comprehensive cancer center in New Hampshire and affiliated outreach clinics and a VA medical center in Vermont . INTERVENTIONS A multicomponent , psychoeducational intervention ( Project ENABLE [ Educate , Nurture , Advise , Before Life Ends ] ) conducted by advanced practice nurses consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion ( n = 161 ) vs usual care ( n = 161 ) . MAIN OUTCOME MEASURES Quality of life was measured by the Functional Assessment of Chronic Illness Therapy for Palliative Care ( score range , 0 - 184 ) . Symptom intensity was measured by the Edmonton Symptom Assessment Scale ( score range , 0 - 900 ) . Mood was measured by the Center for Epidemiological Studies Depression Scale ( range , 0 - 60 ) . These measures were assessed at baseline , 1 month , and every 3 months until death or study completion . Intensity of service was measured as the number of days in the hospital and in the intensive care unit ( ICU ) and the number of emergency department visits recorded in the electronic medical record . RESULTS A total of 322 participants with cancer of the gastrointestinal tract ( 41 % ; 67 in the usual care group vs 66 in the intervention group ) , lung ( 36 % ; 58 vs 59 ) , genitourinary tract ( 12 % ; 20 vs 19 ) , and breast ( 10 % ; 16 vs 17 ) were r and omized . The estimated treatment effects ( intervention minus usual care ) for all participants were a mean ( SE ) of 4.6 ( 2 ) for quality of life ( P = .02 ) , -27.8 ( 15 ) for symptom intensity ( P = .06 ) , and -1.8 ( 0.81 ) for depressed mood ( P = .02 ) . The estimated treatment effects in participants who died during the study were a mean ( SE ) of 8.6 ( 3.6 ) for quality of life ( P = .02 ) , -24.2 ( 20.5 ) for symptom intensity ( P = .24 ) , and -2.7 ( 1.2 ) for depressed mood ( P = .03 ) . Intensity of service did not differ between the 2 groups . CONCLUSION Compared with participants receiving usual oncology care , those receiving a nurse-led , palliative care-focused intervention addressing physical , psychosocial , and care coordination provided concurrently with oncology care had higher scores for quality of life and mood , but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or emergency department visits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00253383 Background Palliative care incorporates comprehensive support of family caregivers because many of them experience burden and distress . However , evidence -based support initiatives are few . Purpose We evaluated a one-to-one psychoeducational intervention aim ed at mitigating the distress of caregivers of patients with advanced cancer receiving home-based palliative care . We hypothesised that caregivers would report decreased distress as assessed by the General Health Question naire ( GHQ ) . Method A r and omised controlled trial comparing two versions of the delivery of the intervention ( one face-to-face home visit plus telephone calls versus two visits ) plus st and ard care to a control group ( st and ard care only )  across four sites in Australia . 
    Output:
    