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.

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

The participants will be selected out of the population consulted at the anesthesiology outpatient clinic of the University hospital Berlin - Charite.