Palliative care aims to improve the quality of life of patients and their families and reduce suffering from life-threatening illness. In assessing palliative care efficacy, researchers must consider a broad range of potential outcomes, including those experienced by the patient's family/caregivers, clinicians, and the health care system. The purpose of this article is to summarize the discussions and recommendations of an Outcomes Working Group convened to advance the palliative care research agenda, particularly in the context of randomized controlled trials. These recommendations address the conceptualization of palliative care outcomes, sources of outcomes data, application of outcome measures in clinical trials, and the methodological challenges to outcome measurement in palliative care populations. As other fields have developed and refined methodological approaches that address their particular research needs, palliative care researchers must do the same to answer important clinical questions in rigorous and credible ways.

Data on initial treatment of 8232 cases of localized prostate cancer diagnosed in 2004 were obtained by medical record abstraction (including hospital and outpatient locations) from seven state cancer registries participating in the Centers for Disease Control and Prevention's Breast and Prostate Cancer Data Quality and Patterns of Care Study. Distinction was made between men receiving no therapy with no monitoring plan (no therapy/no plan [NT/NP]) and those receiving active surveillance (AS). Overall, 8.6% received NT/NP and 4.7% received AS. Older age at diagnosis, lower clinical risk group, and certain registry locations were significant predictors of use of both AS and NT/NP. AS was also related to having more severe comorbidities, whereas nonwhite race was predicted receiving NT/NP. Men receiving AS lived in areas with a higher number of urologists per 100 000 men than those receiving NT/NP. In summary, physician and clinical factors were stronger predictors of AS, whereas demographic and regional factors were related to receiving NT/NP. Physicians appear reluctant to recommend AS for younger patients with no comorbidities.

SUMMARY A program to teach financial management skills to parents of children with chronic illnesses and disabilities was developed. To test the effectiveness of this program, a randomized, controlled prospective study was conducted of 115 families of children with spina bifida, 58 of whom received financial counseling while 57 served as controls. Significantly more frequent changes in behavior were found in the intervention group than in the control group at the end of the one‐year study for 18 of the 68 variables, including such items as establishing records, using a budget, obtaining lowcost life insurance and taking appropriate tax deductions. Three‐quarters of the families in the intervention group believe that the counseling program had had or would have a beneficial effect on the quality of their lives. Financial counseling may benefit families with chronically ill or disabled children. RÉSUMÉ Conseil financier pour les families d'enfants avec incapacités chroniques Un programme a été développé pour enseigner le contröle financier à des parents d'enfants présentant des incapacités ou affections chroniques. Pour apprécier l'efficacité de ce programme, une étude prospective échantillonnée, contrölée a été conduite chez 115 families d'enfants avec spinabifida, 58 d'entre elles recevant des conseils financiers, tandis que les 57 autres constituaient des contôles. Des changements significativement plus fréquents que dans le groupe contrôle ont été notéà la fin d'une an pour 18 des 68 variables incluant de tels items que l'éstablissement d'un dossier, l'utilisation d'un budjet, l'obtention d'une assurance sur la vie à faible coût et les mesures appropriées à prendre pour obtenir des réductions d'impots. Trois‐quart des famillies de ce groupe d'intervention croient que le programme de conseil a eu un effet bénéfique sur la qualité de leur vie. Le conseil financier peut rendre service aux families avec enfants chroniquement malades ou infirmes. ZUSAMMENFASSUNG Finanzielle Beratung von Familien mit chronisch behinderten Kindern RESUMEN Consejo financiero para familias de niños con incapacidades crónicas

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