Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers
Study Registrationhttps://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022837,DRKS00022837.BackgroundIntensified oncological treatment for advanced cancer patients at the end-of-life has been specified as aggressiveness of care (AOC) and increased over the past dec...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.673147/full |
| _version_ | 1818893277181509632 |
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| author | Justus Tönnies Mechthild Hartmann Dirk Jäger Caroline Bleyel Nikolaus Becker Hans-Christoph Friederich Markus W. Haun |
| author_facet | Justus Tönnies Mechthild Hartmann Dirk Jäger Caroline Bleyel Nikolaus Becker Hans-Christoph Friederich Markus W. Haun |
| author_sort | Justus Tönnies |
| collection | DOAJ |
| description | Study Registrationhttps://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022837,DRKS00022837.BackgroundIntensified oncological treatment for advanced cancer patients at the end-of-life has been specified as aggressiveness of care (AOC) and increased over the past decades. The aims of this study were to 1) determine the frequency of AOC in Central Europe, and 2) investigate differences in mental health outcomes in bereaved caregivers depending on whether the decedent had experienced AOC or not.Materials and methodsWe conducted a cross-sectional study in a large tertiary comprehensive cancer care center in Germany. Bereaved caregivers provided information about (a) treatment within the last month of life of the deceased cancer patient and (b) their own mental health status, i.e., decision regret, complicated grief, depression, and anxiety. After multiple imputation of missing data, differences in mental health outcomes between AOC-caregivers and non-AOC-caregivers were analyzed in a multivariate analysis of variances.ResultsWe enrolled 298 bereaved caregivers of deceased cancer patients. AOC occurred in 30.9% of all patients. In their last month of life, 20.0% of all patients started a new chemotherapy regimen, and 13.8% received ICU-treatment. We found differences in mental health outcomes between bereaved AOC- and non-AOC-caregivers. Bereaved AOC caregivers experienced significantly more decision regret compared to non-AOC caregivers (Cohen’s d = 0.49, 95% CI [0.23, 0.76]).ConclusionAOC occurs frequently in European health care and is associated with poorer mental health outcomes in bereaved caregivers. Future cohort studies should substantiate these findings and explore specific trajectories related to AOC. Notwithstanding, shared-decision making at end-of-life should increasingly account for both patients’ and caregivers’ preferences. |
| first_indexed | 2024-12-19T18:10:02Z |
| format | Article |
| id | doaj.art-bed289e0c7624dc0a6e72a37ee40e550 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-19T18:10:02Z |
| publishDate | 2021-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-bed289e0c7624dc0a6e72a37ee40e5502022-12-21T20:11:21ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-06-011110.3389/fonc.2021.673147673147Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved CaregiversJustus Tönnies0Mechthild Hartmann1Dirk Jäger2Caroline Bleyel3Nikolaus Becker4Hans-Christoph Friederich5Markus W. Haun6Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, GermanyDepartment of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, GermanyDepartment of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Child and Adolescent Psychiatry, Heidelberg University, Heidelberg, GermanyDivision of Cancer Epidemiology, German Cancer Research Center, Heidelberg, GermanyDepartment of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, GermanyDepartment of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, GermanyStudy Registrationhttps://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022837,DRKS00022837.BackgroundIntensified oncological treatment for advanced cancer patients at the end-of-life has been specified as aggressiveness of care (AOC) and increased over the past decades. The aims of this study were to 1) determine the frequency of AOC in Central Europe, and 2) investigate differences in mental health outcomes in bereaved caregivers depending on whether the decedent had experienced AOC or not.Materials and methodsWe conducted a cross-sectional study in a large tertiary comprehensive cancer care center in Germany. Bereaved caregivers provided information about (a) treatment within the last month of life of the deceased cancer patient and (b) their own mental health status, i.e., decision regret, complicated grief, depression, and anxiety. After multiple imputation of missing data, differences in mental health outcomes between AOC-caregivers and non-AOC-caregivers were analyzed in a multivariate analysis of variances.ResultsWe enrolled 298 bereaved caregivers of deceased cancer patients. AOC occurred in 30.9% of all patients. In their last month of life, 20.0% of all patients started a new chemotherapy regimen, and 13.8% received ICU-treatment. We found differences in mental health outcomes between bereaved AOC- and non-AOC-caregivers. Bereaved AOC caregivers experienced significantly more decision regret compared to non-AOC caregivers (Cohen’s d = 0.49, 95% CI [0.23, 0.76]).ConclusionAOC occurs frequently in European health care and is associated with poorer mental health outcomes in bereaved caregivers. Future cohort studies should substantiate these findings and explore specific trajectories related to AOC. Notwithstanding, shared-decision making at end-of-life should increasingly account for both patients’ and caregivers’ preferences.https://www.frontiersin.org/articles/10.3389/fonc.2021.673147/fullaggressiveness of careregretmental healthcancercaregiversmultivariate analysis of variance |
| spellingShingle | Justus Tönnies Mechthild Hartmann Dirk Jäger Caroline Bleyel Nikolaus Becker Hans-Christoph Friederich Markus W. Haun Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers Frontiers in Oncology aggressiveness of care regret mental health cancer caregivers multivariate analysis of variance |
| title | Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers |
| title_full | Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers |
| title_fullStr | Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers |
| title_full_unstemmed | Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers |
| title_short | Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers |
| title_sort | aggressiveness of care at the end of life in cancer patients and its association with psychosocial functioning in bereaved caregivers |
| topic | aggressiveness of care regret mental health cancer caregivers multivariate analysis of variance |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.673147/full |
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