Evaluation of Preoperative Acceptance of Proactive Palliative Care Intervention

Study Overview
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Brief Summary
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Advances in medicine have led to an increased life expectancy even with complex disease courses of malignant diseases. This leads to frequent critical situations for patients and high risk surgical interventions. The majority of patients and their practitioners are not prepared for the consequences of a complex and possibly fatal course. Palliative medicine makes it possible to anticipate the further course of the disease. As a result, palliative medicine has become increasingly important. The beginning of palliative medical interventions has extended from accompaniment limited to the dying phase to earlier phases of the disease. An early integration of palliative medicine showed a positive effect on the quality of life, the degree of depression and survival in patients suffering from cancer, for example. Furthermore, patients were more able to accept a change in therapy goal at the end of life. Similar results were shown for patients with a non-malignant severe disease such as COPD or heart failure. What needs further investigating is how to adequately screen and identify the patient populations who could benefit from early palliative care, so that they are prepared for potentially critical and life-threatening situations. The investigator's objective is therefore whether the Anesthesiology Outpatient Clinic is a suitable screening location for initiating early integrated palliative care for patients with a serious, life-shortening illness and a high perioperative risk.

Official Title
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Evaluation of Preoperative Acceptance of Proactive Palliative Care Intervention

Conditions
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Postoperative Complications, Cancer, Heart Failure, Chronic Obstructive Pulmonary Disease

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: over 18 years one elective operation with medium or high cardiac risk And in addition at least one of the following criteria: serious comorbidity pulmonary: Emphysema and / or COPD >= 2 after GOLD cardiac: NYHA > = 2 and / or a metastatic malignancy ASA physical status classification >= 3 and pre-frail or frail Exclusion Criteria: legal care Emergency operation any reasons which contradict inclusion in studies , e.g. cognitive deficit and lack of language skills Pregnant / breastfeeding women

Ages Eligible for Study
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Minimum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptance of the preoperative palliative counseling offer | Percentage of patients who accept the palliative counseling offer in relation to the total number of patients identified in the screening of the anesthesia outpatient clinic | through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Advance planning documents | Percentage of patients who, as a result of the palliative medical consultation offer, create or want to create a living will or power of attorney | through study completion, an average of 1 year | 
| Postoperative palliative counseling | Percentage of patients who would like further palliative medical advice postoperatively | through study completion, an average of 1 year | 
| Acceptance of the preoperative palliative counseling offer depending on the underlying disease | Percentage of patients with and without a malignant disease who accept the counseling offer | through study completion, an average of 1 year | 
| Therapy target decision-making situations | Percentage of patients in whom a decision to limit therapy occurs in the postoperative course | through study completion, an average of 1 year | 
| Gender difference | Percentage of female patients who accept the counseling offer in relation to male patients | through study completion, an average of 1 year | 
| Therapy goal decisions postoperatively | Percentage of patients who do not accept the offer of counseling and who have difficult therapy goal decisions postoperatively | through study completion, an average of 1 year |