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Background There is a significant number of long-term breast cancer survivors in Germany. However, research on the psychological challenges of cancer survivors is limited. This analysis describes prevalence, development and determinants of depression and anxiety 5 to 6 years after diagnosis and identifies predictors for an increase of anxiety and depression over time. Methods Data from 164 women was collected by survey and tumour documentation during post-operative hospital stay, 40 weeks and 5 to 6 years after diagnosis. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale. Sankey-diagrams were created for visual presentation of prevalence over time. Logistic and linear regression models were calculated to identify determinants of anxiety and depression. Results Respondents had higher levels of depression and anxiety 5 to 6 years than 40 weeks after the diagnosis. Lower vocational status and having children were associated with depression, surgery type was correlated with anxiety, and age, as well as comorbidities, were predictors for both anxiety and depression 5 to 6 years after diagnosis. An increase of depression over time was more likely when having children and comorbidities. An increase in anxiety was less likely after cancer recurrence. Conclusions Findings highlight that anxiety and depression are relevant burdens for breast cancer survivors in Germany. Several sociodemographic and clinical predictors are identified. There is need for psychosocial support after acute treatment and in the long-term. Research on psychological burdens of long-term breast cancer survivors in the identified vulnerable groups is needed.

Background Increased working from home has imposed new challenges on public service employees, while also granting opportunities for job crafting. Grounding on the Job Demands-Resources model and Hobfoll’s Conservation of Resources theory this exploratory research aims to investigate the work-nonwork balance of employees one and a half years after the outbreak of the COVID-19 pandemic. Therefore, the research focus lies on employees’ job crafting strategies to optimize their working from home experience concerning boundary management and energy resource management. Methods Twelve semi-structured telephone interviews were conducted with public service employees from different sectors in Germany. The experiences were content analyzed using the software MaxQDA and inductive and deductive categories were derived. Results Boundary management comprised different strategies such as communicative (e.g., negotiating work time), physical (e.g., going to the garden), temporal (e.g., logging off in between the work day) and behavioral (e.g., prioritizing tasks) strategies. The job crafting strategies regarding energy management included preventing exhaustion (e.g. taking breaks), healthy cooking and energy management in case of sickness (e.g. deciding on sick leave). Conclusions This qualitative case study enriches research on job crafting by offering insights on boundary tactics and energy resources management strategies for remote working during the COVID-19 pandemic. The results point out different starting points for employees and decision makers, how a work-nonwork balance, energy management and thus employees’ wellbeing may be increased when working from home in the future. Trial registration The study design and methodology were approved by the Ethics Committee of the University of Cologne and the study was prospectively registered (Ref No. 21-1417_1).

Background Despite facing significant mental health risks, healthcare professionals often demonstrate a low frequency of seeking psychological support. This study aimed to explore the factors influencing healthcare professionals’ psychological help-seeking behaviours in order to enhance the mental health of this critical population. Methods Semi-structured interviews were conducted with registered clinical doctors, nurses, and hospital managers aged 21–55 years, recruited from comprehensive public hospitals in China. Participants were selected through purposive and snowball sampling to ensure diversity in roles, specialities, and work experiences. The interview guide was developed using the Theoretical Domains Framework (TDF) to explore the reasons for seeking psychological support. Data were analyzed using framework analysis and relevant domains were identified according to the frequency of participants’ belief statements. The facilitators and barriers in each domain were summarized using the coded reference points. Results A total of 34 participants were interviewed (12 nurses, 8 physicians, 14 hospital managers). We identified seven relevant domains in influencing the behaviour of seeking psychological support: knowledge, beliefs about capabilities, environmental context and resources, social/professional role and identity, emotion, social influences, and behavioural regulation. The most common facilitators of psychological help-seeking include accessible resources, positive interpersonal relationships, increased awareness, effective behavioural strategies, and emotional acknowledgement, while barriers include privacy concerns, stigma, time constraints, doubts about the effectiveness of psychological services, limited knowledge, and perceived professional role conflicts. Conclusion The behaviour of healthcare professionals seeking psychological support is complex and influenced by the interaction of multiple factors. The findings highlight the need for targeted interventions that enhance mental health literacy, address stigma, provide accessible psychological support resources, and cultivate a supportive organisational culture to improve their well-being.

This study analyzes the longitudinal association between precarious employment and physical and mental health in a dualized labor market by disaggregating between-employee and within-employee effects and considering mobility in precariousness of employment. Analyses were based on the German Socio-Economic Panel from 2002 to 2018 considering all employees ages 18 to 67 years (n = 38,551). Precariousness of employment was measured as an additive index considering working poverty, nonstandard working time arrangements, perceived job insecurity, and low social rights. Health outcomes were mental and physical health. Random effects models were used and controlled for sociodemographic and socioeconomic variables. Results indicated that the association between precariousness of employment and mental and physical health is mainly based on between-employee differences and that prolonged precariousness of employment or upward or downward mobility are associated with poor health. We found evidence of polarization in health by precariousness of employment within a dualized labor market.

Objective The 11‐item Patients' Perception of Safety Culture Scale (PaPSC) measures patients' perceptions of the safety culture within healthcare organizations. While patients can respond to these items, factors such as limited knowledge, unclear roles and insufficient information may influence their assessments. Despite previous research on the PaPSC, no qualitative validation has been conducted. This study addresses this gap by exploring patients' perspectives on safety culture. Methods A qualitative, exploratory approach was adopted, employing problem‐centred interviews with patients from the cardiology and cardiothoracic surgery wards of a tertiary care university hospital. Thematic coding combining deductive and inductive methods was used to identify predefined and emergent themes. Results Data saturation was reached after 22 interviews, providing a comprehensive account of patients' experiences. Most patients were able to respond to the PaPSC items, confirming its robustness in assessing safety culture. However, they emphasized interpersonal aspects such as empathy, trust and clear communication, and contextual elements such as the care environment and patient–staff interactions, which are less well represented in standardized instruments. Several items were perceived as ambiguous, highlighting the need for explanatory text to enhance clarity and response accuracy. Conclusions This study underscores the value of integrating qualitative methods with standardized tools such as the PaPSC to reveal nuanced aspects of safety culture. Active patient involvement in tool development can improve the comprehensiveness and effectiveness of safety interventions. Ensuring that safety culture assessments accurately reflect patients' experiences and needs contributes to more patient‐centred healthcare practices. Patient Contribution Problem‐centred interviews and the Think‐Aloud method were used in this study to ensure active patient participation. Patients contributes by identifying areas where survey items needed further clarification or contextualization, thereby enhancing the validity and usability of the Patients' Perception of Safety Culture Scale (PaPSC). Their feedback also led to the refinements in the study design and tools, underscoring the importance of patient‐centred approaches in healthcare safety research. Although patients were not directly involved in the study design, since the PaPSC scale items were predefined and derived from a prior critical review of existing instruments, their role in this validation study was crucial. The study aimed not to develop new items but to assess the applicability and clarity of an established instrument. The study empowered the patients to share their views openly in a supportive and respectful environment, offering valuable insights for improving safety culture assessment.

Background In Germany, about 17% of households speak a non-German language, yet the absence of national guidelines in language-discordant encounters leaves hospitals to address these challenges individually. The impact of language barriers on cancer care in Germany also remains understudied. This study investigates the role of language barriers in the patient experiences of breast cancer patients and the influence of hospital and regional linguistic diversity on these measures. Methods Data were collected in 2022 from 4,822 breast cancer patients treated in 86 hospitals. The Cologne Patient Questionnaire measured unmet information needs and communication experiences. Linguistic diversity of hospitals was categorized by the proportion of non-native speaking patients. Multilevel logistic regression models were estimated, adjusting for sociodemographic (education, age, health insurance) and clinical variables (staging, surgery type, chemotherapy). Results Despite generally high average German proficiency, non-native speaking patients reported significantly greater unmet information needs regarding their disease and treatment compared with German native speakers, aligning with research in English-speaking countries. In hospitals with higher linguistic diversity, the negative association of non-native language status appeared reduced, with non-native patients reporting more favorable interactions with staff. Conclusion Language barriers remain a critical but under-recognized determinant of cancer care quality in Germany. In the absence of standardized protocols for care of patients with language barriers, hospitals treating more linguistically diverse populations appear better equipped to navigate these challenges. These results point to an urgent need for national standards and targeted hospital-based strategies that systematically address language discordance, support guideline implementation, and promote equitable oncology care.

Although online health communities are acknowledged for their role in bridging the supply-demand gap in mental health services, the client decision-making process in these environments remains underexplored. This study aimed to explore the impact of different signals presented on psychological counselors' home pages on clients' choices. Adopting signaling theory as the framework, this study classified information into online and offline signals and developed a theoretical model to examine client choice behaviors. We collected data from 487 psychological counselors in a leading Chinese online mental health community during March, June, September, and December 2023. Based on these data, we constructed a 4-period balanced panel dataset. A fixed effects model was used to analyze which signals influence clients' choices of psychological counselors. Regarding online signals, the service price (β=0.186, P<.001) and online reputation (β=0.489, P=.002) of psychological counselors positively influence clients' choices. Concerning offline signals, psychological counselors' practical experience (β=0.007, P<.001) is positively related to clients' choices. Moreover, the results indicate that the relationship between a counselor's prosocial behavior and clients' choices is not linear but rather exhibits an inverted U-shape. This study reveals that the varied information provided by psychological counselors has distinct impacts on clients' choices in online health communities. It broadens the application of signaling theory to online behaviors and emphasizes the importance of both online and offline signals. These insights offer strategic guidance for counselors and online platforms to better meet potential clients' needs by optimizing the information presented on psychological counselors' home pages.

Background Against the backdrop of demographic change and the shortage of skilled workers, employees’ psychological wellbeing is of special interest for employers. In previous studies, individual health literacy has already been positively associated with psychological wellbeing. However, in order to improve health literacy, it is essential to take into account both the individual prerequisites and the demands and complexity of the system in which individuals operate. As current studies primarily focus on employees’ individual health literacy and as the concept of organizational health literacy, so far, is mainly used in the context of health care institutions, this study investigates on the impact of organizational health literacy and health supporting leadership on the relationship between individual health literacy and employees’ psychological wellbeing in a big German company based in the financial sector. Methods Data of an employee survey that was conducted in a big German company of the financial sector in October 2021 were analyzed by two mediation analyses using the PROCESS macro by Hayes for SPSS. A total of 2555 employees was included in analyses (51.4% male and 48.6% female). Results The relationship between individual health literacy and employees’ psychological wellbeing is partially mediated by organizational health literacy, indirect effect ab 0.268 – CI [0.170, 0.378] and by health supporting leadership, indirect effect ab 0.228 – CI [0.137, 0.329]. Conclusion Study results provide new indications for planning and evaluating the health strategy of companies. Regarding the psychological wellbeing of employees, practitioners and researchers should focus not only on individual health literacy but also on organizational health literacy and health supporting leadership.

Background Return to work (RTW) is a key parameter of outcome quality that ensures social participation. Therefore, this study analyses the sociodemographic and disease-related determinants of RTW among newly diagnosed breast cancer patients. Methods In a prospective, multicentre cohort study, breast cancer patients were surveyed three times: directly after surgery, after 10 weeks, and after 40 weeks. Logistic regression analysis was applied to estimate the association of RTW at 40 weeks following discharge with sociodemographic and disease-related characteristics ( n  = 577). Results The sociodemographic variables “entrance certificate at a university of applied science” compared to “university entrance certificate” (OR = 3.1, 95%-CI = 1.2–8.1), age group “55–59 years” compared to “18–44 years” (OR = 3.2, 95%-CI = 1.2–8.4) and “having children” (OR = 2.8, 95%-CI = 1.2–6.2) as well as the disease-related variables “rehabilitation” (OR = 0.5, 95%-CI = 0.3–0.9), self-rated health “good” and “excellent” compared to “bad” (OR = 2.7, 95%-CI = 1.4–5.5; OR = 11.6, 95%-CI = 4.2–31.8) and the UICC-classification “stage II” and “stage III/IV” in comparison to “stage 0/I” (OR = 0.5, 95%-CI = 0.3–0.8; OR = 0.2, 95%-CI = 0.1–0.5) significantly affect RTW among breast cancer patients (Nagelkerke’s Pseudo-R 2  = 0.275). Conclusions The findings show that significant differences in RTW exist between patient groups and suggest that RTW issues must be addressed more effectively before, during and after treatment. For future research on RTW in Germany, longitudinal studies with a follow-up of several years are necessary. Information and support deficits should be tackled by social services or breast care nurses. Trial registration Database Health Services Research, VfD_PIAT_12_001630 , registered 01.03.2012

Background Guideline-compliant provision of psycho-oncological (PO) care is still challenging in Germany. Hence, a new care programme, called integrated cross-sectoral psycho-oncology (isPO), was implemented to improve the integration of needs-oriented PO care. Quality of care (QoC) was externally evaluated from the patient’s perspective. We aim to gain insight into patients’ experiences with isPO and how their assessment affects relevant patient-reported outcomes (anxiety and depression, health status, and work ability). Methods An explanatory, sequential mixed-methods design was applied. Patients were surveyed twice during their 1-year care trajectory: after 3 (T1) and 12 (T2) months. Data sets were matched using pseudonyms. Care documentation data, including sociodemographic characteristics and the primary outcome variable (anxiety and depression), were matched. In the survey, patients rated their satisfaction with respective isPO service providers and the programme in general (QoC). Health status (EORTC-QLQ-C30) and work ability (WAS) were measured. Descriptive analyses and t-tests for dependent samples were conducted to assess changes in outcome variables over time. Linear regression analyses were conducted to assess whether care satisfaction predicted outcome variables. Patients who completed their isPO care trajectory were asked to participate in semi-structured telephone interviews to share their experiences. Purposeful sampling was applied. All 23 interviews were audiotaped, transcribed, and analysed via content-structuring method. Results Patients reported medium-to-high satisfaction with their isPO care. All patient-related outcomes significantly improved over time and QoC measures predicted those outcomes. Needs orientation (e.g., care intensity or mode of delivery) was perceived as essential for high QoC, and outpatient care with fixed contact persons as highly important for care continuity. Furthermore, patients identified programme optimisation needs, such as period of care or extension of care to relatives. Conclusions Patients assessed the isPO programme’s QoC positively. They identified facilitators for QoC and optimisation needs. Therefore, data on QoC can function as an indicator for a programme’s feasibility and maturity within care reality. As patients’ care satisfaction positively influences important patient-related outcomes, it may be routinely considered for quality management. Based on patients’ perspectives, isPO seems to be recommendable for routine psycho-oncological care in Germany, if ongoing programme optimisation within structured quality management is guaranteed. Trial registration The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30.10.2018.