Cancer, Chronic Obstructive Pulmonary Disease, Heart Failure, Postoperative Complications
Conditions
Brief summary
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.
Interventions
None listed
Sponsors
Charite University, Berlin, Germany
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acceptance of the preoperative palliative counseling offer | through study completion, an average of 1 year | 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 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative palliative counseling | through study completion, an average of 1 year | Percentage of patients who would like further palliative medical advice postoperatively |
| Acceptance of the preoperative palliative counseling offer depending on the underlying disease | through study completion, an average of 1 year | Percentage of patients with and without a malignant disease who accept the counseling offer |
| Advance planning documents | through study completion, an average of 1 year | 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 |
| Gender difference | through study completion, an average of 1 year | Percentage of female patients who accept the counseling offer in relation to male patients |
| Therapy goal decisions postoperatively | through study completion, an average of 1 year | Percentage of patients who do not accept the offer of counseling and who have difficult therapy goal decisions postoperatively |
| Therapy target decision-making situations | through study completion, an average of 1 year | Percentage of patients in whom a decision to limit therapy occurs in the postoperative course |
Countries
Germany
Outcome results
None listed