Although it is not a unidimensional scale [10], a sum score was used as well to describe outcome and to compare groups next to single items [8,11] with higher scores indicating more severe problems.

GPs recorded patients’ medical problems as well, including the performance status (PS) of the Eastern Cooperative Oncology Group (ECOG) [12]. The ECOG PS takes values between 0 and 4 (0 – fully active, able to carry on all pre-disease performance without Inhibitors,research,lifescience,medical restriction, 1 – restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, 2 – ambulatory and capable of all selfcare but unable to carry out any work activities, up and about more than 50% of waking hours, 3 – capable of only limited selfcare, confined to bed or chair more than 50% of waking hours, 4 – completely Inhibitors,research,lifescience,medical disabled, cannot carry on any selfcare, totally confined to bed or chair). Data analysis Data from patients on QLQ-C15-PAL as well as the POS item and sum scores are described as means (M) with standard deviation (SD). The most recent data are considered, i.e. the last available assessment from the patients before either their death or the end of the 6-month observation period. Since both questionnaires should measure closely related constructs, ‘Overall quality of life’

from the QLQ-C15-PAL Inhibitors,research,lifescience,medical and the POS sum score are correlated using Pearson’s correlation coefficient. Patients cared for by PAMINO-trained GPs (PG) and patients cared for by other GPs (CG) are compared using chi-square test for frequencies and t-tests for differences in group means. To confirm the results and to control for cluster effects in the practices as well as for possible influences of patient and GP characteristics, Inhibitors,research,lifescience,medical we additionally conducted regression models. For all tests, p<.05 is considered to be statistically significant. All statistical analyses are conducted using SPSS 15.0 (SPSS Inc., Chicago,

Ill.) and SAS 9.2 (SAS Institute Inc., Cary, NC). For sample size calculation, Inhibitors,research,lifescience,medical we assumed that every GP cared for 4 eligible patients who were Ibrutinib in vitro willing to participate in the study. To show a minimum mean difference of 2.0 points in the sum score of the POS, with an assumed standard deviation of 0.6, power set to 80%, and controlling for cluster effects, we needed to include 360 patients from 90 practices. Results GP and patient sample There were 100 patients cared for by 45 GPs participating in the study. Four patients did not fill out any questionnaire however in the study period; those patients were excluded from further analysis (Figure ​(Figure1).1). Sixty-two patients were cared for by 27 PAMINO-trained GPs; 34 patients belonged to 18 other practices. There was one GP with 3 patients in the control group who had a palliative care training other than PAMINO. GPs in both groups did not differ in respect to their demographic background and their years of experience (Table 1). Patient characteristics are shown in Table 2.