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: Introduction : Carers of patients with lung cancer often have a short time to access the support they require . The Macmillan Carers Project ( MCP ) was set up to provide non- clinical social support targeted in the community to the carers of patients with lung cancer and this study describes its evaluation . Methods : Prospect i ve case study using interviews with the carers , project workers and health and social care professionals to obtain qualitative data for thematic analysis . 81 patients ’ carers received support from the MCP ; 20 carers , 2 MCP workers and their manager and 10 other professionals ( chest consultant physician , lung cancer clinical nurse specialist , GP , four Macmillan nurses , hospice social worker and two community social workers ) were interviewed . Results : Patients were predominantly male ( 62 % ) , mean age 71 years and carers were predominantly female ( 70 % ) mean age 63 years . Carers identified the MCP as providing emotional support , more time , practical help , financial advice , information and back-up for a myriad of problems . Although there was some overlap with other services , the MCP was valued by carers and professionals as filling a gap in social care . Conclusions : The unique aspect of this study was support targeted to the carers of a single cancer site ( lung ) rather than generic cancer support . As lung cancer may progress rapidly , patients and their carers have a short time to gather new information , access services and adjust to their new circumstances and roles . By focusing on the needs of carers from the time of lung cancer diagnosis , we have shown that the MCP was a valued additional service , well received by carers , patients and professionals We examined the efficacy of an innovative family-based intervention design ed to decrease caregiving stress and increase family communication among individuals with chronic , life-limiting illnesses and their family caregivers in a r and omized , contact control group design . The intervention group received three home visits in which the interventionist actively worked with the family to construct a personal Legacy , usually a scrapbook with photographs or audiotaped stories .  Control group families received three supportive telephone calls . Of the 42 families that entered the project , 31 families completed follow-up assessment s within 9 to 10 weeks ( 14 control ; 17 intervention ; 72 % African American ) for a retention rate of 74 % . Intervention caregivers showed reduced caregiving stress in comparison with control group caregivers , who showed increases in stress . Intervention patients reported decreased breathing difficulty and increased religious meaning . Caregivers and patients reported greater social interaction on the part of the patient . All participants in the intervention group initiated a Legacy activity and reported that Legacy improved family communication .  Legacy interventions hold promise and are simple to implement BACKGROUND The purpose of this study was to determine if patients with advanced breast cancer and their family caregivers , who participated in a family based intervention , report better quality of life and other psychosocial outcomes than dyads who received st and ard care alone . METHODS Using a r and omized clinical trial , 134 patients and their family caregivers were assigned to usual care ( control ) or to usual care plus the family intervention ( experimental condition ) . Dyads were assessed at baseline , three- and six-months later . The intervention consisted of five sessions and addressed  family involvement , optimistic attitude , coping effectiveness , uncertainty reduction , and symptom management . RESULTS Patients in the family intervention reported significantly less hopelessness and less negative appraisal of illness than controls ; their family caregivers reported significantly less negative appraisal of caregiving . Intervention effects were evident at three-months , but were not sustained at six-months . No difference was found in the quality of life of dyads in experimental or control conditions . CONCLUSIONS Although the family intervention had positive effects initially , these effects were not sustained over time . Future studies need to consider program dose and duration of effect , outcome measures that are more sensitive to change , and realistic end-points for patients with advanced cancer This study used a r and omized controlled trial design to investigate the impact of hospice at home ( HAH ) on  caregiver bereavement outcome . Secondary analyses considered the association between bereavement , place of death , and carers ’ assessment of support .  Ninety-six informal carers of patients referred to HAH  were surveyed six weeks post-bereavement about the quality of terminal care . Carers next completed measures of their own bereavement response and general health six months post-bereavement . There was no evidence that HAH had an impact on bereavement outcome . In contrast , perceptions of inadequate terminal support and high symptom severity were associated with worse carer bereavement response . However , it remains unclear whether carers ’ retrospective ratings constitute an accurate account of symptoms and care . Home deaths were associated with both better bereavement response and better physical health post-bereavement than were inpatient deaths . Further research is needed to investigate the implication s of death at home for the carer PURPOSE To determine whether provision of a question prompt list ( QPL ) influences advanced cancer patients ' /caregivers ' questions and discussion of topics relevant to end-of-life care during consultations with a palliative care ( PC ) physician . PATIENTS AND METHODS This r and omized controlled trial included patients r and omly assigned to st and ard consultation or provision of QPL before consultation , with endorsement of the QPL by the physician during the consultation . Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC services were invited to participate . Consultations were audiotaped , transcribed , and analyzed by blinded coders ; patients completed question naires before , within 24 hours , and 3 weeks after the consultation . RESULTS A total of 174 patients participated ( 92 QPL , 82 control ) . Compared with controls , QPL patients and caregivers asked twice as many questions ( for patients , ratio , 2.3 ; 95 % CI , 1.7 to 3.2 ; P < .0001 ) , and patients discussed 23 % more issues covered by the QPL ( 95 % CI , 11 % to 37 % ; P < .0001 ) . QPL patients asked more prognostic questions ( ratio , 2.3 ; 95 % CI , 1.3 to 4.0 ; P = .004 ) and discussed more prognostic ( ratio , 1.43 ; 95 % CI , 1.1 to 1.8 , P = .003 ) and end-of-life issues ( 30 % v 10 % ; P = .001 ) . Fewer QPL patients had unmet information needs about the future ( 21 = 4.14 ; P = .04 ) , which was the area of greatest unmet information need . QPL consultations ( average , 38 minutes ) were longer ( P = .002 ) than controls ( average , 31 minutes ) . No differences between groups were observed in anxiety or patient/physician satisfaction . CONCLUSION Providing a QPL and physician endorsement of its use assists terminally ill cancer patients and their caregivers to ask questions and promotes discussion about prognosis and end-of-life issues , without creating patient anxiety or impairing satisfaction Despite evidence of high psychological distress and unmet needs , evaluated interventions for informal caregivers in palliative care are few . This study involved an observational outcome evaluation of attendees , and a comparison group , in specialist home palliative care .  The measures included  carer psychological status and patient physical status at baseline , 8 weeks , and 20 weeks . Qualitative data were collected regarding content , satisfaction with , and impact of intervention . Process data described the uptake , re sources , and group activity . The intervention combined informal multiprofessional teaching with facilitated peer exchange and support , and was delivered over 6 sessions of 90 minutes per week . The uptake rate was 25 % ; carers were less likely to accept if they were in paid employment ( OR=0.26 , P=0.06 ) , and more likely to accept if they utilized avoidance coping ( OR=1.13 , P=0.04 ) or their patient had worse physical status ( OR=2.1 , P=0.03 ) . Attendees described significant support and knowledge gains from the multiprofessional input and peer group . Most relied on social comparison processes to appraise their situation . Potential detection of significant effects on global psychological scores ( i.e. anxiety , depression , and burden ) using multivariate analysis was disallowed due to attrition . This acceptable and accessible intervention provided information and support ; further outcome studies are needed for a range of interventions . Short-term interventions are unlikely to affect global psychological scores , and future evaluations should include additional time points of data collection to demonstrate support during attendance OBJECTIVE --To investigate the current problems and needs of terminally ill cancer patients and their family members , and to discover their views of hospital , community , and support team services . DESIGN -- Prospect i ve study of patients and families by question naire interviews in the patients ' homes . SETTING --Inner London and north Kent ( London suburbs ) . SUBJECTS--65 Patients , each with a member of their family or a career . MAIN OUTCOME MEASURES --Ratings of eight current problems and ratings and comments on three services-hospital doctors and nurses , general practitioners and district nurses , and the support team staff-obtained after a minimum of two weeks ' care from palliative care support teams . RESULTS --Effect of anxiety on the patient 's nearest career . and symptom control were rated as the most severe current problems by both patients and families ; a few patients and families identified other severe problems . Families ' ratings of pain control , symptom control , and effect of anxiety on the patient were significantly worse than the patients ' ratings ( p less than 0.05 ) . Support teams received the most praise , being rated by 58 ( 89 % ) patients and 59 ( 91 % ) of family members as good as excellent . General practitioners and district nurses were rated good or excellent by 46 ( 71 % ) patients and 46 ( 71 % ) family members , but six ( 9 % ) in each group rated the service as poor or very bad , and ratings in the inner London district were significantly worse than those in the outer London district . Hospital doctors and nurses were rated good or excellent by 22 ( 34 % ) patients and 35 ( 54 % ) of family members , and 14 ( 22 % ) patients and 15 ( 23 % ) family members rated this service as poor or very bad . Negative comments referred to communication ( especially at diagnosis ) , coordination of services , the attitude of the doctor , delays in diagnosis , and difficulties in getting doctors to visit at home . Family members were more satisfied with the services than were patients . CONCLUSIONS --Palliative care needs to include both the patient and family because the needs of the family may exceed those of the patient . Support teams and some hospital and community doctors and nurses met the perceived needs of dying patients and families , but better education and organisation of services are needed There has been much research documenting the impact of having a loved one diagnosed with advanced cancer , but little is known about how to reduce care-giver burden . In this r and omized controlled trial , the authors examined the potential relationship of an advanced cancer patient ’s participation in an 8-session , structured , multidisciplinary intervention on the care-giver ’s burden and quality of life ( QOL ) . Although the patients r and omly assigned to the intervention ( n = 54 ) demonstrated improved QOL compared to the  control condition ( n = 49 ) participants ( P < .05 ) , there was no evidence that improving the patient ’s QOL made an impact on the caregiver ’s level of burden or the care-giver ’s QOL . Further investigation is warranted in this area , including interventions specifically design ed and targeted to both reduce caregiver burden and to improve caregiver QOL The aim of this study was to clarify patients ' characteristics and the level of symptom management in the transition to specialized home palliative care , and to examine prospect ively real-time evaluation of both terminal cancer patients and their families . This study was conducted at one of the largest institutions offering specialized home palliative care in Japan . We asked both the patient 's and the family 's health status at the initial assessment and 2 weeks later . One hundred sets of patients and their families were included in this study . Regarding patient characteristics at the time of referral to the specialized home palliative care service , patients referred from outpatient setting s had more severe physical symptoms than patients referred from inpatient setting s. The specialized home palliative care service could contribute to patients ' symptom and families ' psychosocial status This study suggests that yoga can be of benefit to patients ( and carers ) in palliative care setting s.  Complementary therapies have been employed in our day care unit for several years -- aromatherapy , reflexology and massage-- and have grown in popularity , enabling relaxation and a feeling of well-being . For patients striving to remain physically fit and , in consultation with our physiotherapist , we felt there may be a role for a gentle form of yoga . A study of the literature yielded information on yoga and cancer but little evidence of its use in palliative care . Having identified a form of yoga that could be adapted for those with physical frailties--  Dru yoga -- a 12-week pilot project was introduced into the day care unit . This proved to be highly successful and has now been incorporated as part of our therapeutic service OBJECTIVE The objective of this study was to assess the effect of cognitive-behavior ( CB ) group intervention on the psychological distress and adjustment of relatives of cancer patients with a primary disease . METHODS A total of 52 relatives of cancer patients participated in a  CB group intervention  , whereas another 52 served as control subjects . All participants completed preintervention and postintervention measures and a 4-month follow-up question naire consisting of the Brief Symptom Inventory ( BSI ) , the Psychological Adjustment to Illness Scale ( PAIS ) , the Mini Sleep Question naire , and the Multidimensional Scale of Perceived Social Support ; participants in the group intervention also reported compliance with home practice . RESULTS Participants in the intervention group scored significantly lower than the control subjects on the BSI and the PAIS , recorded fewer sleep difficulties in the postintervention and follow-up measures , and reported higher perceived support in the follow-up measure . By contrast , no significant change 
    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: Introduction : Carers of patients with lung cancer often have a short time to access the support they require . The Macmillan Carers Project ( MCP ) was set up to provide non- clinical social support targeted in the community to the carers of patients with lung cancer and this study describes its evaluation . Methods : Prospect i ve case study using interviews with the carers , project workers and health and social care professionals to obtain qualitative data for thematic analysis . 81 patients ’ carers received support from the MCP ; 20 carers , 2 MCP workers and their manager and 10 other professionals ( chest consultant physician , lung cancer clinical nurse specialist , GP , four Macmillan nurses , hospice social worker and two community social workers ) were interviewed . Results : Patients were predominantly male ( 62 % ) , mean age 71 years and carers were predominantly female ( 70 % ) mean age 63 years . Carers identified the MCP as providing emotional support , more time , practical help , financial advice , information and back-up for a myriad of problems . Although there was some overlap with other services , the MCP was valued by carers and professionals as filling a gap in social care . Conclusions : The unique aspect of this study was support targeted to the carers of a single cancer site ( lung ) rather than generic cancer support . As lung cancer may progress rapidly , patients and their carers have a short time to gather new information , access services and adjust to their new circumstances and roles . By focusing on the needs of carers from the time of lung cancer diagnosis , we have shown that the MCP was a valued additional service , well received by carers , patients and professionals We examined the efficacy of an innovative family-based intervention design ed to decrease caregiving stress and increase family communication among individuals with chronic , life-limiting illnesses and their family caregivers in a r and omized , contact control group design . The intervention group received three home visits in which the interventionist actively worked with the family to construct a personal Legacy , usually a scrapbook with photographs or audiotaped stories .  Control group families received three supportive telephone calls . Of the 42 families that entered the project , 31 families completed follow-up assessment s within 9 to 10 weeks ( 14 control ; 17 intervention ; 72 % African American ) for a retention rate of 74 % . Intervention caregivers showed reduced caregiving stress in comparison with control group caregivers , who showed increases in stress . Intervention patients reported decreased breathing difficulty and increased religious meaning . Caregivers and patients reported greater social interaction on the part of the patient . All participants in the intervention group initiated a Legacy activity and reported that Legacy improved family communication .  Legacy interventions hold promise and are simple to implement BACKGROUND The purpose of this study was to determine if patients with advanced breast cancer and their family caregivers , who participated in a family based intervention , report better quality of life and other psychosocial outcomes than dyads who received st and ard care alone . METHODS Using a r and omized clinical trial , 134 patients and their family caregivers were assigned to usual care ( control ) or to usual care plus the family intervention ( experimental condition ) . Dyads were assessed at baseline , three- and six-months later . The intervention consisted of five sessions and addressed  family involvement , optimistic attitude , coping effectiveness , uncertainty reduction , and symptom management . RESULTS Patients in the family intervention reported significantly less hopelessness and less negative appraisal of illness than controls ; their family caregivers reported significantly less negative appraisal of caregiving . Intervention effects were evident at three-months , but were not sustained at six-months . No difference was found in the quality of life of dyads in experimental or control conditions . CONCLUSIONS Although the family intervention had positive effects initially , these effects were not sustained over time . Future studies need to consider program dose and duration of effect , outcome measures that are more sensitive to change , and realistic end-points for patients with advanced cancer This study used a r and omized controlled trial design to investigate the impact of hospice at home ( HAH ) on  caregiver bereavement outcome . Secondary analyses considered the association between bereavement , place of death , and carers ’ assessment of support .  Ninety-six informal carers of patients referred to HAH  were surveyed six weeks post-bereavement about the quality of terminal care . Carers next completed measures of their own bereavement response and general health six months post-bereavement . There was no evidence that HAH had an impact on bereavement outcome . In contrast , perceptions of inadequate terminal support and high symptom severity were associated with worse carer bereavement response . However , it remains unclear whether carers ’ retrospective ratings constitute an accurate account of symptoms and care . Home deaths were associated with both better bereavement response and better physical health post-bereavement than were inpatient deaths . Further research is needed to investigate the implication s of death at home for the carer PURPOSE To determine whether provision of a question prompt list ( QPL ) influences advanced cancer patients ' /caregivers ' questions and discussion of topics relevant to end-of-life care during consultations with a palliative care ( PC ) physician . PATIENTS AND METHODS This r and omized controlled trial included patients r and omly assigned to st and ard consultation or provision of QPL before consultation , with endorsement of the QPL by the physician during the consultation . Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC services were invited to participate . Consultations were audiotaped , transcribed , and analyzed by blinded coders ; patients completed question naires before , within 24 hours , and 3 weeks after the consultation . RESULTS A total of 174 patients participated ( 92 QPL , 82 control ) . Compared with controls , QPL patients and caregivers asked twice as many questions ( for patients , ratio , 2.3 ; 95 % CI , 1.7 to 3.2 ; P < .0001 ) , and patients discussed 23 % more issues covered by the QPL ( 95 % CI , 11 % to 37 % ; P < .0001 ) . QPL patients asked more prognostic questions ( ratio , 2.3 ; 95 % CI , 1.3 to 4.0 ; P = .004 ) and discussed more prognostic ( ratio , 1.43 ; 95 % CI , 1.1 to 1.8 , P = .003 ) and end-of-life issues ( 30 % v 10 % ; P = .001 ) . Fewer QPL patients had unmet information needs about the future ( 21 = 4.14 ; P = .04 ) , which was the area of greatest unmet information need . QPL consultations ( average , 38 minutes ) were longer ( P = .002 ) than controls ( average , 31 minutes ) . No differences between groups were observed in anxiety or patient/physician satisfaction . CONCLUSION Providing a QPL and physician endorsement of its use assists terminally ill cancer patients and their caregivers to ask questions and promotes discussion about prognosis and end-of-life issues , without creating patient anxiety or impairing satisfaction Despite evidence of high psychological distress and unmet needs , evaluated interventions for informal caregivers in palliative care are few . This study involved an observational outcome evaluation of attendees , and a comparison group , in specialist home palliative care .  The measures included  carer psychological status and patient physical status at baseline , 8 weeks , and 20 weeks . Qualitative data were collected regarding content , satisfaction with , and impact of intervention . Process data described the uptake , re sources , and group activity . The intervention combined informal multiprofessional teaching with facilitated peer exchange and support , and was delivered over 6 sessions of 90 minutes per week . The uptake rate was 25 % ; carers were less likely to accept if they were in paid employment ( OR=0.26 , P=0.06 ) , and more likely to accept if they utilized avoidance coping ( OR=1.13 , P=0.04 ) or their patient had worse physical status ( OR=2.1 , P=0.03 ) . Attendees described significant support and knowledge gains from the multiprofessional input and peer group . Most relied on social comparison processes to appraise their situation . Potential detection of significant effects on global psychological scores ( i.e. anxiety , depression , and burden ) using multivariate analysis was disallowed due to attrition . This acceptable and accessible intervention provided information and support ; further outcome studies are needed for a range of interventions . Short-term interventions are unlikely to affect global psychological scores , and future evaluations should include additional time points of data collection to demonstrate support during attendance OBJECTIVE --To investigate the current problems and needs of terminally ill cancer patients and their family members , and to discover their views of hospital , community , and support team services . DESIGN -- Prospect i ve study of patients and families by question naire interviews in the patients ' homes . SETTING --Inner London and north Kent ( London suburbs ) . SUBJECTS--65 Patients , each with a member of their family or a career . MAIN OUTCOME MEASURES --Ratings of eight current problems and ratings and comments on three services-hospital doctors and nurses , general practitioners and district nurses , and the support team staff-obtained after a minimum of two weeks ' care from palliative care support teams . RESULTS --Effect of anxiety on the patient 's nearest career . and symptom control were rated as the most severe current problems by both patients and families ; a few patients and families identified other severe problems . Families ' ratings of pain control , symptom control , and effect of anxiety on the patient were significantly worse than the patients ' ratings ( p less than 0.05 ) . Support teams received the most praise , being rated by 58 ( 89 % ) patients and 59 ( 91 % ) of family members as good as excellent . General practitioners and district nurses were rated good or excellent by 46 ( 71 % ) patients and 46 ( 71 % ) family members , but six ( 9 % ) in each group rated the service as poor or very bad , and ratings in the inner London district were significantly worse than those in the outer London district . Hospital doctors and nurses were rated good or excellent by 22 ( 34 % ) patients and 35 ( 54 % ) of family members , and 14 ( 22 % ) patients and 15 ( 23 % ) family members rated this service as poor or very bad . Negative comments referred to communication ( especially at diagnosis ) , coordination of services , the attitude of the doctor , delays in diagnosis , and difficulties in getting doctors to visit at home . Family members were more satisfied with the services than were patients . CONCLUSIONS --Palliative care needs to include both the patient and family because the needs of the family may exceed those of the patient . Support teams and some hospital and community doctors and nurses met the perceived needs of dying patients and families , but better education and organisation of services are needed There has been much research documenting the impact of having a loved one diagnosed with advanced cancer , but little is known about how to reduce care-giver burden . In this r and omized controlled trial , the authors examined the potential relationship of an advanced cancer patient ’s participation in an 8-session , structured , multidisciplinary intervention on the care-giver ’s burden and quality of life ( QOL ) . Although the patients r and omly assigned to the intervention ( n = 54 ) demonstrated improved QOL compared to the  control condition ( n = 49 ) participants ( P < .05 ) , there was no evidence that improving the patient ’s QOL made an impact on the caregiver ’s level of burden or the care-giver ’s QOL . Further investigation is warranted in this area , including interventions specifically design ed and targeted to both reduce caregiver burden and to improve caregiver QOL The aim of this study was to clarify patients ' characteristics and the level of symptom management in the transition to specialized home palliative care , and to examine prospect ively real-time evaluation of both terminal cancer patients and their families . This study was conducted at one of the largest institutions offering specialized home palliative care in Japan . We asked both the patient 's and the family 's health status at the initial assessment and 2 weeks later . One hundred sets of patients and their families were included in this study . Regarding patient characteristics at the time of referral to the specialized home palliative care service , patients referred from outpatient setting s had more severe physical symptoms than patients referred from inpatient setting s. The specialized home palliative care service could contribute to patients ' symptom and families ' psychosocial status This study suggests that yoga can be of benefit to patients ( and carers ) in palliative care setting s.  Complementary therapies have been employed in our day care unit for several years -- aromatherapy , reflexology and massage-- and have grown in popularity , enabling relaxation and a feeling of well-being . For patients striving to remain physically fit and , in consultation with our physiotherapist , we felt there may be a role for a gentle form of yoga . A study of the literature yielded information on yoga and cancer but little evidence of its use in palliative care . Having identified a form of yoga that could be adapted for those with physical frailties--  Dru yoga -- a 12-week pilot project was introduced into the day care unit . This proved to be highly successful and has now been incorporated as part of our therapeutic service OBJECTIVE The objective of this study was to assess the effect of cognitive-behavior ( CB ) group intervention on the psychological distress and adjustment of relatives of cancer patients with a primary disease . METHODS A total of 52 relatives of cancer patients participated in a  CB group intervention  , whereas another 52 served as control subjects . All participants completed preintervention and postintervention measures and a 4-month follow-up question naire consisting of the Brief Symptom Inventory ( BSI ) , the Psychological Adjustment to Illness Scale ( PAIS ) , the Mini Sleep Question naire , and the Multidimensional Scale of Perceived Social Support ; participants in the group intervention also reported compliance with home practice . RESULTS Participants in the intervention group scored significantly lower than the control subjects on the BSI and the PAIS , recorded fewer sleep difficulties in the postintervention and follow-up measures , and reported higher perceived support in the follow-up measure . By contrast , no significant change 
    Output:
    