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@ARTICLE{Tnnies:169360,
      author       = {J. Tönnies and M. Hartmann and D. Jäger and C. Bleyel and
                      N. Becker$^*$ and H.-C. Friederich and M. W. Haun},
      title        = {{A}ggressiveness of {C}are at the {E}nd-of-{L}ife in
                      {C}ancer {P}atients and {I}ts {A}ssociation {W}ith
                      {P}sychosocial {F}unctioning in {B}ereaved {C}aregivers.},
      journal      = {Frontiers in oncology},
      volume       = {11},
      issn         = {2234-943X},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {DKFZ-2021-01440},
      pages        = {673147},
      year         = {2021},
      abstract     = {$https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML\&TRIAL_ID=DRKS00022837,DRKS00022837.Intensified$
                      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.We 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.We 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]).AOC
                      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.},
      keywords     = {aggressiveness of care (Other) / cancer (Other) /
                      caregivers (Other) / mental health (Other) / multivariate
                      analysis of variance (Other) / regret (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34150639},
      pmc          = {pmc:PMC8212704},
      doi          = {10.3389/fonc.2021.673147},
      url          = {https://inrepo02.dkfz.de/record/169360},
}