ICU infection surveillance can be based on electronic routine data: results of a case study.

BACKGROUND: The surveillance of hospital-acquired infections in Germany is usually conducted via manual chart review; this, however, proves resource intensive and is prone to a certain degree of subjectivity. Documentation based on electronic routine data may present an alternative to manual methods. We compared the data derived via manual chart review to that which was derived from electronic routine data. METHODS: Data used for the analyses was obtained from five of the University of Leipzig Medical Center's (ULMC) ICUs. Clinical data was collected according to the Protection against Infection Act (IfSG); documentation thereof was carried out in hospital information systems (HIS) as well as in the ICU-KISS module provided by the National Reference Center for the Surveillance of Nosocomial Infections (NRZ). Algorithmically derived data was generated via an algorithm developed in the EFFECT study; ward-movement data was linked with microbiological test results, generating a data set that allows for evaluation as to whether or not an infection was ICU-acquired. RESULTS: Approximately 75% of MDRO cases and 85% of cases of sepsis/primary bacteremia were classified as ICU-acquired by both manual chart review and EFFECT. Most discrepancies between the manual and algorithmic approaches were due to differentiating definitions regarding the patients' time at risk for acquiring MDRO/bacteremia. CONCLUSIONS: The concordance between manual chart review and algorithmically generated data was considerable. This study shows that hospital infection surveillance based on electronically generated routine data may be a worthwhile and sustainable alternative to manual chart review.

Group cognitive remediation therapy prior to behavioral weight loss treatment for adults with severe obesity: A randomized clinical trial (CRT study).

Objective: Individuals with obesity show executive dysfunctions that have been implicated in weight management failure. Initial evidence suggests that cognitive remediation therapy (CRT) conducted after behavioral weight loss (BWL) treatment improves weight loss and executive function, but efficacy for CRT conducted before BWL treatment is unknown. This study investigated whether group CRT in adults with Class II or III obesity (body mass index, BMI≥35 kg/m2) improves weight loss, executive function, weight management behavior, and mental and physical health in real-world group BWL treatment. Method: In this prospective single-center, assessor-blind trial (DRKS00009333), 270 adults with Class II and III obesity (age 44.5 ± 12.8 years, BMI 45.6 ± 6.9 kg/m2, and 68.9% women) were randomized to CRT with 8 group sessions over 2 months versus no treatment control, followed by routine BWL treatment of up to 12 months for both groups. The primary outcome was percent weight change at 6 months. Secondary outcomes included executive functions, weight management behaviors, and mental and physical health. Results: In intent-to-treat analyses, overall weight loss after 6 months was 1.2%, 95% CI [-2.0% to -0.4%], p = .002. The difference between arms was 0.4%, 95% CI [-1.1% to 1.8%], p = .629, Cohen's d = 0.09, after 6 months and 0.3%, 95% CI [-1.5% to 2.2%], p = .721, Cohen's d = 0.01, after 12 months. Improvements in most secondary outcomes including executive functions were seen at most time points, however, without differences between arms. Conclusions: Group CRT versus no treatment prior to real-world BWL treatment in adults with Class II and III obesity does not improve weight loss. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

[Development of an evaluation system for online self-help groups by using the example of German-speaking cancer forums]. / Erstellung eines Bewertungssystems für virtuelle Selbsthilfegruppen am Beispiel deutschsprachiger Krebsforen.

Development of an evaluation system for online self-help groups by using the example of German-speaking cancer forums Objectives: This paper pursues the question how the quality of forums can be evaluated. Therefor a grading system was designed and 23 German-speaking cancer forums were evaluated by content and formal criteria Methods: Using a keyword-based internet search, 23 forums were identified. Data was gathered about: number of themes, posts and members, structure, key subjects and type of financing. Furthermore, an evaluation system was developed, with which the forums where assessed. Results: The forums were divided in forums with (n = 10) and without (n = 9) focus on a type of cancer. Four are health portals with forum-function. The quality of online cancer forums is heterogeneous, the evaluation resulted an average quality index of 2.7 for the total cancer forums Conclusion: A good information editing, moderation, data protection and transparency are important quality criteria. The evaluation of forums may help the patients, to autonomously value the quality of the presented information.

Perceived social support and associations with health-related quality of life in young versus older adult patients with haematological malignancies.

BACKGROUND: This study compared the perceived social support of young and older adult cancer patients, examining possible influencing factors as well as associations with health-related quality of life. METHODS: A total of 179 young patients (18-39 years) and 200 older adult patients (> 70 years) with haematological malignancies completed questionnaires on their perceived social support (ISSS-8, scales: Positive Support and Detrimental Interactions, range 0-16) and health-related quality of life (EORTC QLQ-C30). Tests for mean differences, correlations and regression analyses to determine associated variables of social support were performed. RESULTS: No difference was reported between young (M = 13.40, SD = 2.81) and older adult patients (M = 13.04, SD = 3.82; p = .313) for Positive Support. However, young patients (M = 4.16, SD = 3.10) reported having had more Detrimental Interactions than older patients did (M = 1.63, SD = 2.42; p < .001, Cohen's d = .910). Comparison of the EORTC QLQ-C30 Function scales showed poorer outcomes for young patients on Emotional, Cognitive and Social Functions and a higher outcome on Physical Function compared with older adult patients. Regression analyses indicated that age (young vs. older adult patients) significantly explained proportions of variance in all models, with young age having a negative impact on Emotional, Cognitive and Social Functions and a positive impact on Physical and Role Functions compared with old age. Significant associations between Detrimental Interactions and all the scales examined except Cognitive Function were found. CONCLUSIONS: The difference in negative perceptions of social support in young vs. older adult patients and its impact on health-related quality of life emphasises the necessity of differentiating between positive and negative social support. Negative interactions should be addressed through psychosocial care, particularly with young cancer patients.

Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD.

Background: Despite the encouraging results of noninvasive ventilation (NIV) in chronic hypercapnic COPD patients, it is also evident that some patients do not tolerate NIV or do not benefit from it. We conducted a study in which COPD patients with stable, chronic hypercapnia were treated with NIV and nasal high-flow (NHF) to compare effectiveness. Methods: In a multi-centered, randomized, controlled, cross-over design, patients received 6 weeks of NHF ventilation followed by 6 weeks of NIV ventilation or vice-versa (TIBICO) between 2011 and 2016. COPD patients with stable daytime hypercapnia (pCO2≥50 mmHg) were recruited from 13 German centers. The primary endpoint was pCO2 changes from baseline blood gas, lung function, quality of life (QoL), the 6 min walking test, and duration of device use were secondary endpoints. Results: A total of 102 patients (mean±SD) age 65.3±9.3 years, 61% females, body mass index 23.1±4.8 kg/m2, 90% GOLD D, pCO2 56.5±5.4 mmHg were randomized. PCO2 levels decreased by 4.7% (n=94; full analysis set; 95% CI 1.8-7.5, P=0.002) using NHF and 7.1% (95% CI 4.1-10.1, P<0.001) from baseline using NIV (indistinguishable to intention-to-treat analysis). The difference of pCO2 changes between the two devices was -1.4 mmHg (95% CI -3.1-0.4, P=0.12). Both devices had positive impact on blood gases and respiratory scores (St. George's Respiratory Questionnaire, Severe Respiratory Insufficiency Questionnaire). Conclusions: NHF may constitute an alternative to NIV in COPD patients with stable chronic hypercapnia, eg, those not tolerating or rejecting NIV with respect to pCO2 reduction and improvement in QoL.

Polypharmacy, limited activity, fatigue and insomnia are the most frequent symptoms and impairments in older hematological cancer survivors (70+): Findings from a register-based study on physical and mental health.

OBJECTIVES: Although the median age at cancer diagnosis is about 70 years, few studies have evaluated physical and mental health in older patients. The main objectives of our study are to provide information about depression, functional disabilities and symptom burden in older hematological cancer patients (HCP), compared to a community sample (CS) of older individuals. MATERIALS AND METHODS: We conducted a prospective study with interview assessments at a meantime of 26 month (range 1-60) after diagnosis or relapse of hematologic cancer (ICD: C81 - C96). Participants were 70 years or older. We assessed depressive symptoms (GDS-15), comorbid conditions, and physical symptom burden (EORTC QLQ-C30, Geriatric Screening) in comparison to a community sample matched by age and sex. RESULTS: 200 patients (response rate 50.5%, Mean age = 76 years, 64% male) and 225 citizens (response rate 44.5%) were interviewed. HCP were more depressed than CS (GDS-15 Mean-score = 3.0 vs. 2.3; p = 0.006). Both HCP and CS had an average of 5 comorbid conditions. In comparison to CS, HCP were found to have higher levels of polypharmacy and limited activity, higher prevalence in polyneuropathy, and higher symptom burden of fatigue, insomnia, and appetite loss. The comorbidity-index was particularly high in older patients, in patients with low education level as well as in patients with a high depression-score. CONCLUSIONS: Older HCP are at increased risk for depression and a variety of physical impairments compared to control population. Specific knowledge about disabilities and symptom burden could help to develop adequate survivorship-programs in this group of patients.

[Aftermath of death of a seriously ill family member: Online survey of psychological distress and care satisfaction of relatives]. / Wie geht es Menschen nach dem Tod eines schwerkranken Angehörigen? ­ Onlinebefragung zur psychischen Belastung und Versorgungszufriedenheit von Hinterbliebenen.

AIM OF THE STUDY: The aim of the study was to assess the level of psychosocial distress and satisfaction with care in family caregivers after the death of a close relative. METHOD: Anxiety and depression (HADS) of family caregivers were evaluated in both bereaved family caregivers and a comparable group from the general population. Furthermore, satisfaction with care (ZUF-8) and social support (HOPE-Module, ESSI) were assessed after the patients had died. Regression models were employed to analyze associations between psychological distress and sociodemographic and care-related variables. RESULTS: We conducted an online survey with 200 bereaved family caregivers (93% female, time since death of the relative: M=306 days). Of these, 31% were the primary caregiver. The bereaved caregivers were highly psychologically distressed (high anxiety: 41%/high depression: 35%). From the survivors' point of view, care at the end of life was partially insufficient: about one in three of the dying patients had suffered from pain and 20% had not been treated with dignity. After the relative had passed away, 44% of the bereaved caregivers did not get information about support offers; one in three missed emotional assistance. Dissatisfaction with care and support was associated with increased psychological distress, higher age and a shorter period of care. CONCLUSION: The high level of psychological distress in bereaved family caregivers suggests high supportive care needs, which are often not met in practice. Family caregivers need to be prepared for the time after their relative's death and should be offered psychosocial support.

Doctor's recommendations for psychosocial care: Frequency and predictors of recommendations and referrals.

BACKGROUND: A significant number of oncological patients are heavily burdened by psychosocial stress. Doctors recommending or referring their patients to psycho-oncologists in the course of routine consultations can positively influence psycho-oncological care. The aim of this study was to analyze the frequency and predictors of such recommendations and to examine the use of these services by patients. METHODS: 4,020 cancer patients (mean age 58 years; 51% women) were evaluated in a multicenter, cross-sectional study in Germany. Data was gathered about doctors' referral practices, patients' utilization of psycho-oncological care services, and disease-related symptoms. The PHQ-9 depression scale and the GAD-7 anxiety scale were used to measure psychological burden. Descriptive data analysis was conducted on the basis of subgroup comparisons and multivariable analysis was done using binary logistical regression. RESULTS: 21.9% of the respondents reported having been given a recommendation or referral for psycho-oncological care by a doctor within the course of their cancer diagnosis and treatment. This comprises 29.5% of the patients identified by screening as being psychologically burdened. Nearly half of the patients who received a recommendation or referral (49.8%) acted on it. Predictors for seeking out psycho-oncological care included: patient desire (OR = 2.0), previous experience with psycho-oncological care (OR = 1.59), and female gender (OR = 1.57). Multivariable analysis indicated that patients' level of psychological burden (depression, anxiety) had no effect on whether doctors gave them a recommendation or referral. CONCLUSIONS: Along with examining the degree to which patients are burdened (e.g. using screening instruments), determining whether or not patients would like to receive psycho-oncological care is an important aspect of improving referral practices and, by extension, will allow important progress in the field of psycho-oncological care to be made.

Psychological distress, chronic conditions and quality of life in elderly hematologic cancer patients: study protocol of a prospective study.

BACKGROUND: Similar to most solid tumors, the incidence of hematologic malignancies has been rising. Although the median age at diagnosis is about 70 years, little is known about psychosocial aspects and comorbid conditions in elderly patients with hematologic cancers. The main objectives of our study are to assess the prevalence of psychological distress, chronic conditions, functional disabilities, and quality of life in both elderly hematologic cancer patients aged ≥70 years and an age-matched comparison sample of the general population. METHODS: We conduct a prospective study with three measuring points (t_1: ≥5 years after first time hematologic cancer diagnosis / relapse; t_2 and t_3 six months and 1 year after t_1). In addition, we use a cross sectional study design to recruit a comparison sample of the general population matched by age and sex. Both samples, patients and the comparison group complete validated questionnaires measuring psychological distress, chronic conditions, functional disabilities, and quality of life as well as health care needs and health care utilization. DISCUSSION: Our study will provide both a data set offering detailed information about elderly hematologic cancer patients' physical, psychological and demographic characteristics, and reference data of the elderly general population. Furthermore, the study will provide important information for the development and implementation of psychooncological support offers and survivorship care plans.

[Exhaustion and overload of family caregivers of palliative cancer patients]. / Erschöpfung und Überlastung pflegender Angehöriger von Krebspatienten in der palliativen Situation.

Family caregivers of terminal ill cancer patients receiving home based palliative care were interviewed at 2 measurement points. Symptoms of exhaustion and overload (Copenhagen Burnout Inventory, CBI) and caregiver burden (German version of the "Burden Scale for Family Caregivers", BSFC-10) were assessed. The physical and emotional exhaustion of the family caregivers increased over the time of care, regardless of age, gender, education and religion. Caring partners as well as caregivers with financial burden due to the care situation were more exhausted and overloaded than other caregivers. The construct "exhaustion and overload" was closely associated with psychological distress, quality of life and sense of coherence. Offering psychological support for family caregivers should be an integral part of outpatient palliative care. Furthermore it is important to discuss the financial situation of family caregivers at the beginning of home care and refer them to appropriate support services if needed.

[Attitudes towards euthanasia: The impact of experiencing end-of-life care]. / Einstellungen zur Sterbehilfe.Welchen Einfluss hat die Pflege eines sterbenskranken Angehörigen?

BACKGROUND: It is a matter of debate whether euthanasia should be part of medical practice. OBJECTIVES: The current study investigates the attitudes of bereaved family members of cancer patients towards euthanasia. MATERIALS AND METHODS: We conducted a survey with 211 people who had recently lost a close relative to cancer. Participants were asked whether euthanasia should be part of medical practice.Two logistic regression models were calculated in order to determine the factors influencing the attitude towards active euthanasia and assisted suicide. RESULTS: About 70% and 75% of the respondents approved active euthanasia and assisted suicide, respectively. Religious denomination and psychological distress had a significant impact on the attitude towards active euthanasia. About 10%of the deceased patients had asked for active euthanasia. CONCLUSIONS: There was no difference between bereaved family members and the general population regarding the acceptance of euthanasia. Attitudes towards active euthanasia are associated with psychological distress and shaped by cultural values rather than by the experience of end-of-life care.

Cancer-related fatigue in patients before and after radical prostatectomy. Results of a prospective multi-centre study.

PURPOSE: A multi-centre, longitudinal study was conducted to assess the prevalence of fatigue amongst men with localized prostate cancer, to describe several dimensions of fatigue and to explore the predictability of fatigue by psychological distress and physical function. METHODS: The prevalence of fatigue was evaluated using the Multidimensional Fatigue Inventory in 329 prostate cancer patients before, 3, 6 and 12 months after surgery. Psychological distress was assessed using the Hospital Anxiety and Depression Scale. Physical function was measured using the EORTC QLQ-C30. RESULTS: After surgery, about 14 % of the patients were screened with chronic fatigue. For all dimensions of fatigue, only small longitudinal changes could be observed. Psychological distress could be identified as a good predictor of fatigue after but not before surgery. CONCLUSIONS: Radical prostatectomy has no or little impact on the prevalence of fatigue. However, about 14 % of patients with chronic fatigue could possibly benefit from psychosomatic interventions. Interventions should consider the simultaneous appearance of fatigue and psychological distress and a reduced physical function.

Psychological distress and quality of life of palliative cancer patients and their caring relatives during home care.

PURPOSE: Palliative patients and their family caregivers were interviewed at the beginning of home care in personal interviews at home in regard to their psychological distress as well as their quality of life. METHODS: Quality of life was collected with the palliative module EORTC QLQ-C15-PAL (patients) and the Short Form-8 Health Survey (caregivers). The psychological distress was assessed using the Hospital Anxiety and Depression Scale, the extent of social support with the Oslo 3-items social support scale. Two multiple regression models were employed to examine factors associated with psychological distress. Data from 106 palliative patients (39.6 % female) and their family caregivers (67.9 % female) were included in the analysis. RESULTS: Every fourth patient had clinically relevant anxiety levels and half of the palliative patients had clinically symptomatic depression scores. The main symptoms of the patients were: fatigue, loss of appetite, pain, and shortness of breath. Patients' and caregivers' anxiety and depression scores were significantly correlated (anxiety r = 0.386, depression r = 0.416). Thirty-three percent of caregivers suffered from high anxiety and 28 % from depression. Spousal caregivers had higher psychological distress than other caregivers. Other relevant factors for higher distress were high financial burden and low social support. There was hardly any family member receiving professional psychological support. CONCLUSIONS: In palliative patients, depressive symptoms should not be judged as a normal attendant of the terminal illness situation. Instead, patients should be referred to appropriate support services for pharmacological or psychological treatment. Spousal caregivers and caregivers who are socially not well integrated are in particular need of support. Attention to the financial burden of family caregivers is also very important. Due to the existing correlation between the psychological situation of palliative patients and their caring relatives, couples must be considered an emotional system rather than just two individuals.

[Quality of life and satisfaction of family caregivers in palliative care - results of postmortem interviews with bereaved family members]. / Lebensqualität und zufriedenheit pflegender angehöriger von krebskranken palliativpatienten ­ befragung nach versterben der patienten.

INTRODUCTION: Family caregivers play an important role in palliative care. However, the number of studies focussing on the quality of life of these family caregivers is limited. The current study evaluates quality of life and satisfaction with medical care in bereaved family members. MATERIAL AND METHODS: Comparisons were made between (1) male vs. female family caregivers (N = 44) and (2) bereaved family caregivers vs. general population (EORTC QLQ-C30). Furthermore, the satisfaction of the family caregivers with medical care was assessed after the death of their relatives (ZUF HOPE). The interviews were conducted between six and eight weeks following the death of the palliative patients. RESULTS: Regarding quality of life, bereaved family caregivers suffered from both reduced emotional functioning and general quality of life. Female caregivers had lower functional values and stronger symptoms of insomnia, fatigue and pain than male caregivers. Bereaved family caregivers had a lower quality of life than the general population. Retrospectively, family caregivers were very satisfied with most aspects of outpatient palliative care. The only aspect criticised by the bereaved family members was a lack of psycho-social support. CONCLUSION: Family caregivers need stronger support in order to prevent burnout and to improve outpatient care. In this context, gender differences must also be considered.

[Family caregivers of palliative cancer patients: health-related quality of life and care-related burden]. / Gesundheitsbezogene Lebensqualität und Pflegebelastung von Angehörigen palliativer Tumorpatienten in häuslicher Versorgung.

Family caregivers of palliative cancer patients are usually much burdened. In order to avoid the failure of home care, family caregivers need support. The current study evaluates support needs in family caregivers of palliative cancer patients. 53 family caregivers of palliative cancer patients answered the questionnaire. Health-related quality of life was assessed using the EORTC QLQ-C30 questionnaire. Home care burden was assessed using the "Burden Scale for Family Caregivers" (BSFC). Family caregivers suffered of reduced social and emotional function. Female and older caregivers reported a stronger home care burden than male and younger caregivers. For female and older family caregivers of palliative cancer patients, home care is very burdensome. Thus, female caregivers need, above all, psychosocial support, whereas older caregivers need the most support in a physical and social level.

[The assessment of therapy success after radical prostatectomy]. / Die Beurteilung des Behandlungserfolges nach Radikaler Prostatektomie.

OBJECTIVES: Patient satisfaction plays an important role in the outcome quality of treatment for localized prostate carcinoma. This paper identifies factors that impact patients' assessment of therapy success one year after surgery. METHODS: Patient assessment of therapy success was measured with the Hamburger Fragebogen zum Krankenhausaufenthalt (Lecher et al. 2002). Also, several sociodemographic, clinical and quality-of-life factors were tested for their impact on the patient assessment of therapy success. RESULTS: 25 % of patients gave a negative assessment of therapy success. Factors with the strongest impact were urinary incontinence, sexual impotence, younger age and higher risk of recidive. CONCLUSIONS: Especially the prevention of urinary continence and sexual dysfunction may lead to a better assessment of therapy. Moreover, the patients' expectations have a great impact on the assessment of therapy success.

[Death, euthanasia and end-of-life decisions according to the relatives' perspective -- a survey after the death of a close relative]. / Sterben, Sterbehilfe und Therapieverzicht aus Angehörigensicht - Ergebnisse einer Hinterbliebenenbefragung.

UNLABELLED: Empirical research on euthanasia and medical decisions at the end of life usually focus on the doctors' perspective. The perspectives of patients, relatives respectively the bereaved families have been neglected so far. The project "Patients as partners. Tumour patients and their participation" aims to improve the participation of tumour patients in medical decision making at the end of life by means of several offerings for patients. In order to develop a theoretical model, interviews were conducted with patients, relatives, doctors and members of the bereaved families. Between March 2002 and July 2004 questionnaires were sent to the bereaved families about eight to ten weeks after their relatives had perished. Before dying, the patients had been looked after and offered consultation by a palliative care team either in hospital or at home. RESULTS: Of 151 sent out questionnaires, 59.6 % (n = 90) were filled in and sent back by members of the bereaved families. 52.3 % of the patients had died in hospital, 33.7 % in their private home. All of the patients who died at home, but only one in three patients who died in hospital also wanted to die there. The relatives were predominantly very satisfied or satisfied with the medical care (67.8 %). 11 % of the bereaved families said, their dying relatives had seriously asked for euthanasia. In 74.4 % of all cases, decisions for the renunciation of therapy were made, mostly due to a worsening of the general condition (54.4 %) or a progress of the disease (46.6 %). CONCLUSION: The questioning was successfully conducted. Members of bereaved families are able and also prepared to answer questions about the last days of their relatives lives. The question about the desired dying place has proved to be workable. In empirical research, the perspective of the relatives and bereaved families should be taken in to account seriously.

[Between self-determination and role abdication: opinions about euthanasia -- results of a study of Thuringians palliative tumour patients]. / Zwischen Selbstbestimmung und Rollenverzicht: Einstellungen zum Sterben und zur Sterbehilfe -- Ergebnisse einer Befragung von palliativbehandelten Tumorpatienten in Thüringen.

This study reports the degree to which terminally ill tumour patients wish to be involved in medical decisions about their care and death. In addition, the study aimed to examine euthanasia from the patient's perspective. 272 tumour patients with a life expectancy of less that 1 year took part in a face to face survey. The survey examined attitudes, beliefs and desires with respect to euthanasia, where one would like to die and who should be present as well as attitudes to advance directives. The majority of tumour patients (75 %) wanted to die at home and in the presence of family members (90 %). A multidimensional scaling analysis generated two clusters which were interpreted as self-other determination and integration-non-integration as a patient within the health system. The central theme for the tumour patients is to protect their autonomy in the decision making process at the end of their lives. Desires expressed by these tumour patients did not reflect public discussions about active, passive or indirect assisted suicide. The results demonstrate that doctors should communicate especially sensitively with tumour patients and their relatives.

[The patient and his family]. / Der Patient und seine Familie -- Einstellungen und Mitsprachemöglichkeiten von Angehörigen palliativ behandelter Tumorpatienten.

UNLABELLED: Medical decision-making models focus on doctor-patient relationship. The impact of the family, specifically the involvement of the relatives in the information- and decision-making process have rarely been evaluated yet. Within the project "Patient as partners - cancer patients and their involvement in medical decision making" progressive disease cancer patients, their relatives and doctors as well as Thuringian general practitioners have been interviewed with regard to their attitudes (among others) towards the medical system and information and decision making processes. RESULTS: From the patient's point of view, the family is highly important in decision-making (very important/important 80.3 %). 73 % of the patients, but only 58 % of the relatives feel very good/good informed about the treatment. With regard to prognosis, 30 % of the patients and 27 % of the relatives feel less/poorly informed. 83.7 % of the relatives believe they cannot influence treatment decisions. According to this, Thuringian general practitioners judge the influence of family members on treatment decisions quite low (very high/high 12.9 %, partly 37.4 %, low/not possible 49.7 %), though the relatives' wish for involvement is seen quite realistic (89 % of the GP's believe that the family wants to be involved). CONCLUSION: From the patients point of view, the family has got a high status with regard to medical decision-making. In palliative cancer patients doctors should offer an early and continuous involvement of relatives in information and decision-making processes in order to reduce misjudgements and frustration within the families.