Elisabeth Lucia Zeilinger

Aims: Post-traumatic stress symptoms (PTSS) are a substantial yet underrecognised mental health concern in oncology. Large-scale epidemiological data across diverse cancer types are scarce. This study aimed to estimate the prevalence of post-traumatic stress disorder (PTSD) and to identify socio-demographic and psychosocial correlates in a large, unselected outpatient cohort. Methods: In this cross-sectional study, 4,103 adult outpatients with solid tumours or haematologic malignancies were screened during routine care using the PTSS-8-Cancer scale. Socio-demographic, clinical and psychosocial variables were collected concurrently. Associations between screening results and patient characteristics were examined using correlational and chi-square analyses. Results: Overall, 32.5% screened positive for probable PTSD. Prevalence was highest in breast cancer (39.7%), female genital cancers (37.2%) and head and neck cancers (36.1%). A positive screening for PTSD was more common among women, younger patients, those with lower income, without a partner and with a history of psychiatric illness. While these associations were statistically significant, effect sizes were generally small. Conclusions: One in three cancer outpatients experience substantial PTSS, with elevated prevalence in certain diagnostic groups. Small effect sizes for socio-demographic predictors underscore that psychological distress is broadly distributed. Findings support universal psychosocial screening and integration of trauma-informed care into oncology services to address a significant, population-level mental health burden.

Background: On 1 January 2022, assisted suicide became legal in Austria with the enactment of the Dying Decree Law (Sterbeverfügungsgesetz, StVfG). This law has posed complex practical and ethical challenges for nursing facilities and hospitals. Medical and nursing directors are tasked with guiding their staff amidst legal uncertainties, emotional burdens, and limited institutional dialogue. Objectives: This study aimed to assess directors’ self-reported knowledge of the law, their experiences managing assisted suicide requests, their perceived adequacy of support in navigating the legal framework, and the presence of institutional guidelines. Design: A cross-sectional mixed-methods study. Methods: An online questionnaire was used to collect data from 239 medical and nursing directors across all nine federal states of Austria (mean age = 49.5 years, SD = 8.5; 65.7% female, 32.2% male; 23.7% working in faith-based institutions, 61.9% in non-faith-based institutions, and 14.4% prefer not to disclose). Quantitative data were analysed using chi-square tests, t tests, and ANOVAs, while thematic analysis was applied to open-ended responses. Results: 44.0% of directors knew the regulations of the Dying Decree Law but were insecure in regards to the application in practice, while 13.4% of directors reported no familiarity with Law at all. Legal familiarity correlated with gender ( p = 0.020, V = 0.183) and institutional religious affiliation ( p = 0.019, V = 0.197). Satisfaction with institutional guidelines was linked to gender ( p = 0.004, r = 0.15), religious affiliation ( p = 0.003, r = −0.15), and institution type ( p = 0.011, η² = 0.126). While 36.2% reported no institutional guidelines on assisted suicide, 13.8% were unaware of their existence. Conclusion: The findings reveal knowledge gaps, institutional disparities, and limited guidance on the Dying Decree Law. Directors report insufficient preparedness, highlighting the need for clearer institutional guidelines and enhanced legal, ethical, and psychological support. Trial registration: This study was registered in the Open Science Framework (OSF) at https://osf.io/bgpsa .

Introduction: This study examines the lived experiences of family caregivers navigating the legal and emotional complexities of Austria's newly enacted Dying Decree Law. Methods: A qualitative interview study was conducted with nine family caregivers (eight women) of people seeking assisted suicide (PSAS) in Austria. Participants were recruited through purposive sampling through multiple recruitment channels. Interviews were analysed using thematic analysis (supported by MAXQDA). Results: Seven overarching themes emerged: (1) Dynamics of Dying and Saying Goodbye; (2) Inclusion versus Exclusion in the Decision‐Making Process; (3) Role Negotiation and Responsibilities; (4) Bureaucratic and Legal Barriers; (5) Social Exclusion and Stigmatisation; (6) Support Needs and Structures; and (7) Ramifications in the Post‐Mortem Phase. Family caregivers reported a lack of formal guidance, often leading to isolation and exhaustion. Open communication was repeatedly highlighted as essential in order to honour the PSAS's wishes and alleviate family caregivers' grief. Conclusion: Family caregivers function as advocates and bureaucratic managers while simultaneously serving as carers who provide the PSAS with physical and emotional support. Rather than relying on the legal framework alone, public policy should also formally acknowledge this dual role and deliver government‑led structural support for family caregivers to lessen their emotional and bureaucratic burden. Patient or Public Contribution: Family caregivers of PSAS were central to this research. We interviewed family caregivers about their experiences with assisted dying under Austria's Dying Decree Law, and incorporated their suggestions for addressing the identified challenges and improving support structures. Their contributions were integral to the study's findings and its focus on enhancing support structures for family caregivers within assisted dying systems.

Over the past two decades, the growing number of theories, models and frameworks developed in implementation research has generated a significant problem o

This paper presents a participatory research project in which co-researchers with intellectual disabilities were actively involved in studying factors that contribute to good mental health. Through a five-step, multi-method design incorporating a systematic review, expert interviews, focus groups, a Delphi survey and dissemination workshops, we integrated academic and experiential knowledge at multiple stages of the research process. Co-researchers contributed to the development of accessible study materials, supported qualitative data analysis, and co-authored publications and presentations. We employed creative and inclusive methods such as visual rating tools, easy-to-read materials, and gamified approaches to support accessibility and engagement. Regular meetings, collaborative decision-making, and mutual learning formed the foundation of our participatory process. The aim of this paper is to provide a transparent, practical account of our participatory approach, highlighting its benefits and challenges. We reflect on team dynamics, methodological adaptations and structural barriers that limited full inclusion, such as the formal employment restrictions of co-researchers imposed by social systems. Our findings suggest that participatory research with people with ID is not only feasible, but also methodologically and ethically enriching. We argue that such an approach enhances the relevance, applicability and impact of qualitative research, particularly in the field of mental health. By sharing concrete strategies and critical reflections, this paper contributes to the growing discourse on inclusive and participatory research practices. It also offers practical guidance for future projects involving co-researchers with ID. The paper intentionally combines academic and accessible writing elements to reflect the participatory principles underlying the project and to encourage discussion about accessibility within academic publishing.

Women with intellectual disabilities (IDs) face persistent health inequities, particularly in preventive services such as breast cancer screening, where participation rates remain disproportionately low. These disparities contribute to higher mortality and poorer survivorship outcomes, often linked to later-stage diagnoses. To better understand these challenges and inform the development of inclusive screening programs, this qualitative study conducted in Austria explored barriers, facilitators, and needs related to breast cancer screening from the dual perspectives of 17 women with mild-to-moderate IDs aged 45 and older and 10 caregivers. Semi-structured focus groups and interviews were analyzed thematically within a constructivist framework, integrating perspectives from both groups. Barriers included social taboos around sexuality, psychological distress, exclusion through standardized procedures, and unclear responsibility among stakeholders. Facilitators involved person-centered communication, accessible information, emotional and practical support, and familiar healthcare environments. Women with IDs expressed a strong desire for education, autonomy, and inclusion, while caregivers played a pivotal role in enabling access. These findings demonstrate that low screening participation among women with IDs is driven by systemic and organizational barriers rather than lack of health awareness or willingness to participate. Without structurally inclusive design, organized screening programs risk perpetuating preventable inequities in early detection. Embedding accessibility, clear accountability, and person-centered communication as standard features of breast cancer screening is therefore a public health priority to reduce avoidable late-stage diagnoses and narrow survival disparities for women with IDs.

Background: Advance care planning (ACP) is a critical process for ensuring person-centred end-of-life care, yet it remains underutilized among people with intellectual disabilities (ID). Understanding caregivers’ perspectives is essential to identify barriers and facilitators to ACP implementation and improve practice. This study aimed to examine how professional caregivers in Austria perceive and experience ACP for people with ID, including its current use, barriers, facilitators, and strategies to improve uptake. Methods: A cross-sectional survey was conducted using a structured online form comprising multiple-choice and open-ended questions. Data were collected from 125 professional caregivers across Austria who were primary caregivers of at least one adult with ID and proficient in German. Quantitative data were analysed descriptively, while qualitative responses to open-ended questions were subjected to content analysis. Results: A total of 33.6% of caregivers reported engaging in ACP discussions, with considerable barriers including cognitive and communicative challenges, emotional discomfort, and structural constraints. Facilitators included person-centred communication, interdisciplinary collaboration, and targeted training. Notably, 83.2% of caregivers expressed interest in ACP training. Conclusions: ACP is rarely practiced in the care of people with ID in Austria. However, caregivers identified clear pathways to improve implementation, particularly through training, use of tailored communication methods, and systemic support within care institutions. Promoting inclusive ACP practices is essential to uphold the autonomy and health equity of people with ID, ensuring their voices are heard in decisions about their future and end-of-life care.