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Background Registered nurses (RNs) in oncology must cope with the suffering of patients, the inevitability of death and their own transience. This poses a possible risk for the development of burnout, which can result in low job satisfaction and ultimately an increased intention to leave the job. Our aim was to assess psychological distress in registered nurses working in oncology. Objective and method A cross-sectional survey with the Oldenburger Burnout Inventory was presented to nurses within the German Cancer Society. It collected data on psychological distress via two subscales, exhaustion and disengagement. Socio-demographic data were assessed. Results Among 83 participating nurses, we found a prevalence of high disengagement in 17 oncology nurses (20.48%) and high exhaustion (M Exh >2.5 = burnout) in 44 (53.00%). Looking at the highest values of both scales, 18.08% of respondents were at high risk for psychological distress. There was a low correlation between disengagement and age ( r  = 0.331, p  < 0.01). The risk of high disengagement among nurses older than 50 ( n  = 9, 52.94%) was three times higher than for those who were 50 or younger ( n  = 8, 47.06%) (RR = 8.642, 95% CI: 1.475–5.749, p  < 0,01). Conclusion This survey highlights a high rate of burnout among German oncology nurses. Interventions should be developed, implemented, and delivered in an age-appropriate manner. To ensure high-quality care and patient safety, oncology nurses should be offered preventive mental healthcare services later in their careers. Clinical trial registration number The study was registered with the German Clinical Trials Register (DRKS500018851).

Purpose Health-related quality of life (HRQOL) in older persons is influenced by physical and mental health, as well as by their social contacts and social support. Older women and men have disparate types of social networks; they each value social ties differently and experience loneliness in unique and personal ways. The aim of this study is, therefore, to determine the longitudinal association between loneliness and social isolation with HRQOL in older people—separated by gender. Methods Data stem from the third and fourth follow-up of the ESTHER study—a population-based cohort study of the older population in Germany. A sample of 2171 older women and men (mean age: 69.3 years, range 57–84 years) were included in this study; HRQOL was assessed by using the Short Form-12 questionnaire (SF-12). Data on physical and mental health, loneliness, and social networks were examined in the course of comprehensive home visits by trained study doctors. Gender-specific linear regression analyses were performed to predict physical quality of life (measured by the PCS, physical component score of the SF-12) and mental quality of life (measured by the MCS, mental component score) after three years, adjusted by socioeconomic variables as well as physical, mental, and social well-being. Results At baseline, PCS was 41.3 (SD: 10.0) in women and 42.2 (SD: 9.6) in men ( p  = .04). MCS was 47.0 (SD: 10.2) in women and 49.6 (SD: 8.6) in men ( p  < .001). In both genders, PCS and MCS were lower three years later. Loneliness at t0 was negatively associated with both PCS and MCS after three years (t1) among women, and with MCS but not PCS after three years among men. In both genders, the strongest predictor of PCS after three years was PCS at t0 ( p  < .001), while the strongest predictors of MCS after three years were MCS and PCS at t0. Conclusion HRQOL in elderly women and men is predicted by different biopsychosocial factors. Loneliness predicts decreased MCS after three years in both genders, but decreased PCS after three years only in women. Thus, a greater impact of loneliness on the health of older women can be surmised and should therefore be considered in the context of their medical care.

A standard questionnaire for generalized anxiety disorders is the GAD-7. Attempts to improve its screening capacity in oncological settings resulted in a discussion about lowering its cut-off. This study examines the diagnostic accuracy of the GAD-7 items depending on applied cut-offs and whether, similar to depressive symptoms, a distinction between somatic-emotional and cognitive items might be relevant. Screening data from 4705 patients with cancer who were treated at the outpatient clinic of the National Centre for Tumour Diseases in Heidelberg were analysed. For the individual GAD-7 items sensitivity, specificity, positive and negative predictive values, and Clinical Utility Index were determined for cut-off ≥ 7, ≥ 8, ≥ 10 and ≥ 15 in the GAD-7 questionnaire. The best overall diagnostic accuracy was found for a cut-off ≥ 8. The cognitive items had the best diagnostic accuracy for identifying severe GAD (cut-off ≥ 15), and the somatic-emotional items had the best diagnostic accuracy for identifying mild to moderate GAD (cut-off ≥ 7, ≥ 8 and ≥ 10). Our data support the recommendation of lowering the GAD-7 cut-off in oncology settings and suggest that in anxiety disorders, a symptom overlap between the physical illness and a possible mental disorder should be considered.

BackgroundAs social media are evolving rapidly online support groups (OSG) are becoming increasingly important for patients. Therefore, the aim of our study was to compare the users of traditional face-to-face support groups and OSG.Patients and methodsWe performed a cross-sectional comparison study of all regional face-to-face support groups and the largest OSG in Germany. By applying validated instruments, the survey covered sociodemographic and disease-related information, decision-making habits, psychological aspects, and quality of life.ResultsWe analyzed the complete data of 955 patients visiting face-to-face support groups and 686 patients using OSG. Patients using OSG were 6 years younger (65.3 vs. 71.5 years; p < 0.001), had higher education levels (47 vs. 21%; p < 0.001), and had higher income. Patients using OSG reported a higher share of metastatic disease (17 vs. 12%; p < 0.001). Patients using OSG reported greater distress. There were no significant differences in anxiety, depression, and global quality of life. In the face-to-face support groups, patient ratings were better for exchanging information, gaining recognition, and caring for others. Patients using OSG demanded a more active role in the treatment decision-making process (58 vs. 33%; p < 0.001) and changed their initial treatment decision more frequently (29 vs. 25%; p < 0.001).ConclusionsBoth modalities of peer support received very positive ratings by their users and have significant impact on treatment decision-making.Implications for cancer survivorsOlder patients might benefit more from the continuous social support in face-to-face support groups. OSG offer low-threshold advice for acute problems to younger and better educated patients with high distress.Trial registrationwww.germanctr.de, number DRKS00005086

Purpose Cancer-related fatigue is a subjective, distressing, and common sequela of cancer which is often disregarded and underdiagnosed. Fatigue is assessed by self-report requiring communication between patient and physician. In this study, we investigated the patients’ perspective on the patient–physician communication about fatigue. Methods On average five months after diagnosis 1179 cancer patients, recruited in Germany, completed a survey as part of the LIFT project. The survey included questions on sociodemographic data, fatigue, depression, fatigue management, patient–physician communication, and communication barriers. Data were analyzed descriptively and using logistic regression analyses. Results Half of the participants reported that their physician had never asked them whether they felt exhausted. Patients undergoing chemo-, radio-, or immunotherapy were more likely to be asked about fatigue, while older age and major depression decreased the likelihood. Sixty-four percent of the patients felt impeded by communication barriers. Common barriers were not knowing who to turn to for fatigue (39%), time constraints (31%), and the fear of being perceived as weak (22%). Almost half of the participants indicated that their physicians were not appreciative and did not deal adequately with fatigue-related questions. Conclusion This study revealed gaps in the patient–physician communication regarding cancer-related fatigue. Contrary to guideline recommendations a minority of physicians addressed fatigue. On the other hand, cancer patients felt reluctant to bring up this topic due to structural barriers and fears. Physicians should routinely address fatigue and adopt a communication style which encourages patients to likewise state their symptoms and raise their questions. Trial registration Clinicaltrials.gov, identifier: NCT04921644. Registered in June 2021.

PurposeThe main aim of the study was to explore the expectations and knowledge of advanced-stage cancer patients about immunotherapy.MethodsThis mixed methods study included 53 cancer patients on immune checkpoint inhibitors (ICIs), 55 cancer patients undergoing chemotherapy (CT), and 53 non-cancer patients. Participants’ expectations about ICIs and CT were compared. Additional qualitative data were derived from semi-structured interviews.ResultsAmong patients who did not receive ICIs, 63 (58%) had never heard of ICIs and 94 (87%) had large gaps in their knowledge of ICIs. Among ICI patients, 33 (62%) simply described ICIs without errors. ICI perception was positive, regardless of whether respondents received or had heard of ICIs, which became particularly evident when compared to CT. ICIs were rated as more promising, and all adverse effects were expected to be significantly lower than those of CT. Knowledge about ICIs was also limited in the interviewed ICI patients. Some patients reported adverse effects of ICIs that were mostly mild and well-tolerated or easily treated.ConclusionsThe lack of understanding of ICIs should be improved by activities to increase the knowledge of ICI patients and the general population. In contrast to CT, ICIs invoked fewer negative associations with efficacy and toxicity. Therefore, attention should be paid to risk awareness when educating patients. (Clinical trial registration number: DRKS00011868)Trial Registration: German clinical trials register, www.germanctr.de, number DRKS00011868.

The rapid digitalization of healthcare is transforming medical care strategies. Individuals carrying (likely) pathogenic TP53 germline variants (P/LP TP53 ) require complex surveillance protocols. To support these individuals, we provided the adapted PatientConcept app to adults with a P/LP TP53 variant and their relatives. We analyzed the value of this adapted app for this cohort, as well as general aspects of Internet use, web-based healthcare options, mental and physical health, and fear of progression. (FOP). From a larger study consisting of 70 carriers and 43 relatives, 25 affected individuals and no relatives installed the app. App users tended to be younger and physically fitter but reported higher levels of psychological distress and FOP compared to non-users. Users rated their distress as high and expressed interest in an on-demand intervention tool offering concise information sessions. Overall, users were satisfied with the app, finding it useful and easy to understand, though they identified areas for improvement. Many app features were underutilized, indicating a need for further adaptation to the target group. Most users obtained medical information online, considering it helpful but often unreliable and difficult to evaluate. Nevertheless, app users felt confident in their ability to use the Internet for health-related search. Our study demonstrates the feasibility and acceptance of an app for individuals with LFS, supporting their surveillance and health behaviors.

Professionals in the healthcare sector are a particularly vulnerable group for occupational strain due to high work-related psychological stress. For the implementation of targeted stress-prevention interventions as an important part of a workplace health management programme for all occupational groups and hierarchy levels, information about the current state of their mental health is mandatory. Hence, this study investigated the association of general well-being and different leadership styles among employees in a German tertiary hospital. Via an online survey, 10,101 employees were contacted. The final sample consisted of 1137 employees. Of these, 27.7% described themselves as leaders and 72.3% as followers. Most participants were female (74.8%), more than half were under 41 years old. Besides control variables, general well-being (WHO-5) and leadership style (transactional and transformational, laissez-faire and destructive leadership) were assessed. Leaders reported higher well-being scores than followers. Physicians without leadership responsibilities had the lowest scores for well-being. Practitioners of both transformational and transactional leadership were associated with higher well-being scores, while those practicing laissez-faire and destructive leadership had lower scores for almost every professional group. Results highlight the necessity for future multimodal health-preventive leadership interventions feature behavioural and organizational intervention modules specifically tailored to hospital professionals at different hierarchical and functional levels to foster the mental health of employees.

Hospital employees face significant occupational stress that negatively impacts both their well-being and organizational outcomes. This challenge is amplified during times of staff shortages, economic difficulties and conflicting roles. To support hospital workers effectively and create a positive work environment, it is crucial to identify specific groups experiencing greater challenges. This study examines how working conditions, job stress, and related consequences vary across professional groups, working hours, and job levels within hospitals. The study analyzed data from 406 employees (66% female) across three German hospitals, collected between December 2019 and January 2020 as part of the SEEGEN (Mental Health at the Hospital Workplace) study on mental health in hospital workplaces. Group differences in target variables were investigated via between-group one-way independent analyses of variance. Results showed that nurses, part-time employees, and non-leadership staff reported the most significant needs for improvement. Nurses experienced the lowest effort-reward balance, reduced job satisfaction, and the highest intention to leave their jobs. Part-time workers felt less control over their work decisions, perceived poorer cooperation among occupational groups, and reported a weaker psychosocial safety climate compared to full-time employees. They were also more irritated, less satisfied, and more inclined to consider leaving their jobs. Additionally, part-time workers rated their employers as less attractive and were less likely to recommend them. Leadership positions appeared to offer a protective effect against some of these negative outcomes. In conclusion, this study provides a comprehensive view of the differing work stressors and consequences faced by hospital staff based on their roles, work hours, and job levels. These insights emphasize the importance of tailoring interventions to target specific groups within hospitals to enhance occupational health and create supportive work environments. German Clinical Trial Register (DRKS): DRKS-ID DRKS00017249 (Registration Date: 8th October 2019).

Hospital workers are at high risk for stress-related mental health issues and are considered a vulnerable workforce in most Western countries. Although multilevel interventions that address individual and organizational factors show promise, there is limited robust evidence of their effectiveness in hospital settings. This study evaluated the SEEGEN trial, a cluster-randomized controlled trial conducted in the German healthcare sector, to assess the effectiveness of a structured multilevel intervention designed to reduce psychosocial stress and to promote mental well-being among hospital employees. The intervention included five modules that targeted different hierarchical levels, sources of interpersonal and structural stress, and potentially vulnerable life stages. These modules were: (i) top management training, (ii) dilemma management - coping by taking responsibility, (iii) promoting stress-preventive relational leadership competence, (iv) reconciling work and family life, and (v) staying healthy at work. The study was conducted at three clinical centers in Germany and included 18 clusters with a total of N = 415 participants. The clusters were randomly assigned to either an intervention or a wait-list control group. The primary outcome was psychological strain (Irritation Scale; IRR), and the secondary outcomes were mental well-being (WHO-5) and perceived psychosocial safety climate, (PSC-12). Intervention effects were estimated using a two-level linear analysis of covariance. Changes from baseline to the 11-month follow-up were analyzed. The intervention had no statistically significant effect on the primary or secondary outcomes. The lack of significant effects may be attributed to low participation rates, an insufficient intervention dosage, and contextual factors, such as the SARS-CoV-2 pandemic and staffing shortages in the participating hospitals. Although the intervention cannot currently be recommended for widespread implementation, the study provides valuable insights into developing, delivering, and overcoming the challenges of multilevel workplace interventions in healthcare settings.