The characteristics of leadership and their effectiveness in quality management in healthcare - A systematic literature review and a content analysis.

Effective quality leadership is identified as a critical factor for organisational success. Leadership style has an important role in the implementation of quality management. This systematic review describes the characteristics of leadership in quality management in healthcare, and analyses their association with successful or unsuccessful quality management by using content analysis. Papers published in peer-reviewed journals between 2011 and June 2023 were selected by exploring the Abi/Inform, Business Source Complete, Cinahl, Pubmed and Web of Science electronic databases. Altogether 3014 records were found. PRISMA-protocol was used for selection of studies. 12 original and three review articles were included. Six leadership characteristics were identified that were linked to successful or unsuccessful implementation of quality management. The six categories were strategic, knowledge-oriented, value-based, supportive, participatory and communicative leadership. Supercategories and subcategories of successful and unsuccessful implementation are described. The results can be used to identify the leadership characteristics that promote successful quality management in healthcare organisations. In education for leaders and managers, attention should be in the characteristics and style of leadership and their impact on the effectiveness of quality management.

Influencing adolescents' attitudes towards nicotine products: A systematic review.

Background and aim: Use of nicotine can harm adolescents' brains and increase risk for future addiction to other drugs. Several international studies show that an acceptable attitude towards nicotine products increases the initiation or use of the products. Adolescents have limited or distorted knowledge about nicotine products. Many of them have a positive image of the properties and effects of nicotine products, which increases the chances of smoking or using snus. Yet, we know little about the relationship between youth nicotine use, youth attitudes towards nicotine products and the interventions to influence these attitudes. This systematic review synthesised adolescents' attitudes towards nicotine products and the ways to influence them. Methods: Systematic searches were carried out from PubMed, MEDLINE, CINAHL, and MEDIC databases and were targeted to randomised controlled trial (RCT) studies published in 2010-2021. Results: A total of seven RCT studies were reviewed with a total population (age range 9-17 years, adolescents 11-17 years) of 15,974. Findings were classified into four categories: school-based interventions, tobacco prevention campaigns, advertisements' influence on adolescents' opinions towards nicotine products, and their responses to cigarette pack warnings. Conclusion: Based on this systematic literature review, particularly school-based interventions have an effect on adolescents' attitudes towards smoking and preventing them from starting to smoke, when they are targeted before the age of puberty. School-based interventions should be further implemented and strengthened, as the school has been shown to have significant potential to support youth's health. There is a need for further information about the most effective interventions in the different age groups and the qualitative studies on the topic.

Determination of prevalence, characteristics, management and related factors for pain in the older adults: pain among nursing home residents

This study aimed to determine pain assessment approaches and pain management strategies in elderly people in a nursing home.The cross-sectional-descriptive study sample consisted of 147 older adults living in a nursing home in Turkey in 2019. They all agreed to participate in the study (n = 147); however, as our research was about older adultswith pain problems, the study was completed with a total of 108 older adultsexperiencing pain problems. The participants' average age was 73.60 ± 6.97 years. Geriatric pain scale scores were higher for women aged 75 years and over, those who had a chronic disease and those who received analgesics, and there was a statistically significant difference between the mean scores (p < 0.05). Nurses must pay attention to pain assessment and management in nursing homes because of the adverse effects of pain on older adults' health status, vital functions, and well-being.

Measuring patient empowerment - A systematic review.

OBJECTIVE: The purpose of this systematic review was to identify generic instruments measuring patient empowerment and related concepts and analyse the main content and psychometric properties of these instruments. METHODS: A systematic search was conducted using empowerment and related concepts (enablement, activation, engagement, perceived control) as search terms. The main content of the instruments was analysed by classifying the subscales and items of the elements of empowerment into patient's capacities, patient's knowledge, patient's behaviour and support by others. Psychometric properties were analysed with the criteria of Terwee and colleagues (2007). RESULTS: Thirteen instruments were identified; and out of them, five instruments covered all the four elements used to define of empowerment. Psychometric properties were variable; none of the instruments contained all the evaluated psychometric properties. CONCLUSION: There are generic instruments measuring empowerment and its related concepts. The instruments were heterogeneous in structure and psychometric properties. Empowerment is more wide-ranging and multidimensional than its related concepts. PRACTICE IMPLICATIONS: This review provides knowledge for healthcare professionals and researchers who want to support or evaluate patients' empowerment. With a generic instrument, it is possible to obtain comparable information from diverse patient groups. Further testing of psychometric properties of each instrument is recommended.

Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people.

BACKGROUND: There is a lack of agreement about applicable instrument to screen frailty in clinical settings. AIMS: To analyze the association between frailty and mortality in Finnish community-dwelling older people. METHODS: This was a prospective study with 10- and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. RESULTS: Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and FI (5.97 [4.13-8.64], and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10- (4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]). DISCUSSION: Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. CONCLUSIONS: FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.

Pelvic floor disorders and health-related quality of life in older women: Results from the Women's Gynaecological Health study in Lieto, Finland.

OBJECTIVE: The aim of this study was to analyse the prevalence of pelvic floor disorders and to describe health-related quality of life (HRQoL) among older women. We also compared participants' HRQoL with the age-matched general female population and analysed factors associated with HRQoL. STUDY DESIGN: This is a population-based study of a cohort of women born in 1948 and in 1950 (n = 143) which is also part of the Women's Gynaecological Health study in Lieto, Finland. METHODS: The data were collected by questionnaires which pertained to socio-demographics, health-related variables, pelvic floor disorders and HRQoL (15D). Linear model was conducted to estimate a model of factors that associated with HRQoL. RESULTS: The prevalence of urinary incontinence, faecal incontinence and pelvic organ prolapse was 50%, 13% and 12%, respectively. The overall HRQoL score of the study cohort is broadly similar to that of the agematched general Finnish female population (mean±SD15D scores 0.905±0.084 vs 0.912±0.077). Higher number of medications was the most important explanatory factor for lower HRQoL. CONCLUSION: Urinary incontinence was common; however, the impact on HRQoL was minor. The overall HRQoL score of the study cohort was broadly similar to that of age-matched general female population. Women who used a higher number of medications had lower HRQoL compared to women who used fewer medications.

Older patients' experiences of nurse-to-nurse collaboration between hospital and primary health care in the care chain for older people.

BACKGROUND: Nurse-to-nurse collaboration between nurses working in hospital and primary health care in the older people care chain is essential to ensure the continuity of care. The nature of good collaboration in this context is understood usually from the perspective of collaborating nurses. However, there seems to be a lack of research about this collaboration from the older patient's perspective who are at the centre of the collaboration. AIMS AND OBJECTIVES: To describe older patient's experiences of the collaboration between hospital and primary healthcare nurses delivering care to older people. DESIGN: A qualitative approach based on a descriptive phenomenological methodology was used. METHODS: Individual interviews were conducted using a purposeful sample of older patients (n = 18) who were cared for both in hospital and primary healthcare organisations. A qualitative data analysis method informed by Giorgi was used. RESULTS: The essence of the experience of nurse-to-nurse collaboration between hospital and primary health care was expressed as follows: the meaning of collaboration; the elements of collaboration valued; the visibility of collaboration; older patient involvement in collaboration; interaction within collaboration; and future expectations of collaboration. CONCLUSIONS: Although nurse-to-nurse collaboration between hospital and primary health care was not often visible to older patients, they highlighted the importance of this collaboration to ensure the continuity of care. The participants would have liked to be part of the collaborating group, at the centre of care, cared for by motivated nurses who had a clear understanding of their patients' health status. This study emphasises the need for improving collaboration between hospital and primary healthcare nurses by making it more visible and facilitating older patients' participation. The results demonstrate the need to understand patient perspectives in the development of care and the services provided for older people.

SUCCESSFUL IMPLEMENTATION OF LEAN AS A MANAGERIAL PRINCIPLE IN HEALTH CARE: A CONCEPTUAL ANALYSIS FROM SYSTEMATIC LITERATURE REVIEW.

PURPOSE: The aim of this study was to identify and analyze the characteristics of leadership and management associated with a successful Lean thinking adaptation in healthcare. DESIGN: A systematic literature review was undertaken using electronic databases: PubMed, PubMed Systematic Review, ABI/INFORM, Business Source Complete, Emerald, JBI, and Cinahl. Inclusion criteria were: (i) a description of Lean management or leadership in health care, (ii) a reference to Lean thinking, (iii) a peer-reviewed original research article or a literature review, and (iv) a full text article available in English. Among the 1,754 peer-reviewed articles identified, nine original articles and three systematic reviews met the inclusion criteria. Data on informants, methods, and settings were extracted and collated. Content analysis was used to conduct a review of the nine original studies describing and analyzing the success factors of Lean adaptation. The characteristics of leadership and management were analyzed by using the concept of a managerial windshield that divides leadership and management into four ontological dimensions: activities, style, focus, and purpose, each with typical developmental stages of skills and capabilities. The current study has some limitations: some papers from the journals not indexed in the searched databases may have been overlooked and the literature searches were carried out only for a 5-year period. FINDINGS: Considering the results using the windshield concept emphasizes the philosophy, principles, and tools of Lean thinking. Lean leadership and management factors in health care were mainly conceptualized as skills and capabilities such as problem solving, making changes occur, empowering, communicating, coaching, supporting, facilitating, being democratic, organizational learning, and organizational success, all of which represented middle-stage or advanced managerial skills and capabilities. PRACTICAL IMPLICATIONS: A conceptual analysis of systematically reviewed studies of Lean leadership and management point to certain traits as being typical when adapting Lean thinking to health care. The concept of a managerial windshield is useful when categorizing and analyzing essential managerial skills and capabilities for Lean implementation. Findings are beneficial when learning and educating the skills required for Lean transformation in healthcare organizations.

Prediction of the Future Need for Institutional Care in Finnish Older People: A Comparison of Two Birth Cohorts.

BACKGROUND: More recent birth cohorts of older people have better physical and cognitive status than earlier cohorts. As such, this could be expected to diminish the need for institutional care. The prediction of the future need for institutional care provides essential information for the planning and delivery of future care and social services as well as the resources needed. OBJECTIVE: To predict the future need for institutional care among older Finnish people born in 1940. METHODS: Representative samples of home-dwelling 70-year-olds from Turku, Finland were examined with similar methods in 1991 (those born in 1920) (n = 1,032) and in 2011 (those born in 1940) (n = 956). Predictors of institutionalization rates from the earlier 1920 cohort, together with data of sociodemographic factors, health, psychosocial and physical status, the need for help, and health behavior, were used to predict the future institutionalization rate among the 1940 cohort in this study using Cox regression models. RESULTS: Health as well as psychosocial and physical status were significantly better in the 1940 cohort compared to the earlier cohort. In the 1940 cohort, the predicted rates of institutionalization were 1.8, 10.4, and 26.0% at the ages of 80 (year 2020), 85 (year 2025), and 90 years (year 2030), respectively. At every age (80, 85, and 90 years), the predicted rates of institutionalization by Mini-Mental State Examination (MMSE) were about two-fold among those with MMSE scores 18-26 (3.0-38.8%) compared to those with scores 27-30 (1.6-23.7%) and those with a body mass index (BMI) <25 (2.5-34.3%) compared to those with a BMI of 25-29.9 (1.4-20.9%), and about three-fold among participants with several falls (5.3-57.0%) compared to participants with no falls (1.5-23.1%). CONCLUSIONS: The 1940 cohort performed better in health as well as psychosocial and physical status than the 1920 cohort. Nevertheless, the predicted rates of future need for institutional care were high, especially at the ages of 85 and 90 years, among those with a lowered cognitive or physical status.

An Enquiry into Nurse-to-Nurse Collaboration Within the Older People Care Chain as Part of the Integrated Care: A Qualitative Study.

INTRODUCTION: Health care systems for older people are becoming more complex and care for older people, in the transition between hospital and primary healthcare requires more systematic collaboration between nurses. This study describes nurses' perceptions of their collaboration when working between hospital and primary healthcare within the older people care chain. THEORY AND METHODS: Using a qualitative approach, informed by grounded theory, six focus groups were conducted with a purposive sample of registered nurses (n = 28) from hospitals (n = 14) and primary healthcare (n = 14) during 2013. The data were analyzed using dimensional analysis. FINDINGS: Four dimensions of collaboration were identified: 1) Context and Situation, 2) Conditions, 3) Processes and Interactions and 4) The Consequences of nurse-to-nurse collaboration within the older people care chain. These four dimensions were then conceptualized into a model of nurse-to-nurse collaboration. DISCUSSION AND CONCLUSION: Improved collaboration is useful for the safe, timely and controlled transfer of older people between hospital and primary healthcare organizations and also in healthcare education. The findings in this study of nurse-to-nurse collaboration provides direction and opportunities to improve collaboration and subsequently, the continuity and integration in older people care in the transition between organizations.

Predictors of institutionalization among home-dwelling older Finnish people: a 22-year follow-up study.

BACKGROUND: Identification of predictive factors on institutionalization provides the basis for the development and application of preadmission assessment. There is a lack of evidence for predictors of institutionalization for older people. AIMS: To examine the effect of predictive factors on institutionalization in home-dwelling 70-year-old people. METHODS: The data were collected in 1991 by the clinical examinations, a postal questionnaire, and an interview from the residents of Turku, Finland, born in 1920 (n = 1032). Institutionalization was defined as entry into a nursing home or sheltered housing at any time during a 22-year follow-up. RESULTS: A rate of institutionalization was 22.0%. In multivariable Cox regression analysis, impaired cognitive function (MMSE 18-26) (hazard ratio 1.71, confidence interval 1.24-2.36) and low BMI (<25 kg/m2) (compared to both BMI of 25-29.9 and that of ≥30, respectively, 1.88, 1.32-2.67, and 1.66, 1.05-2.60), having several falls during the previous year (2.50, 1.28-4.90). CONCLUSIONS: We conclude that impaired cognitive function, low BMI, and frequent falling predicted institutionalization during the 22-year follow-up. To reduce or postpone institutionalization, interventions should target risk factors, such as frailty, physical limitations, and falling. In addition, community-based services according to the needs and functional ability of the home-dwelling older people should be developed.

Empowering knowledge and its connection to health-related quality of life: A cross-cultural study: A concise and informative title: Empowering knowledge and its connection to health-related quality of life.

AIMS: Assess the association between patient education (i.e. empowering knowledge) and preoperative health-related quality of life, 6 months postoperative health-related quality of life, and the increase in health-related quality of life in osteoarthritis patients who underwent total hip or total knee arthroplasty. METHOD: This is a cross-cultural comparative follow-up study using structured instruments to measure the difference between expected and received patient education and self-reported health-related quality of life (EQ-5D) in Finland, Greece, Iceland, Spain and Sweden. RESULTS: The health-related quality of life was significantly increased 6 months postoperatively in all countries due to the arthroplasties. In the total sample, higher levels of empowering knowledge were associated with a higher health-related quality of life, both pre- and postoperatively, but not with a higher increase in health-related quality of life. On the national level, postoperative health-related quality of life was associated with higher levels of empowering knowledge in Finland, Iceland and Sweden. The increase in health-related quality of life was associated with levels of empowering knowledge for Greece. CONCLUSIONS: Overall, it can be concluded that the level of empowering knowledge was associated with high postoperative health-related quality of life in the total sample, even though there is some variation in the results per country.

Orthopaedic patient education practice.

AIM: The aim of this study was to explore orthopaedic nurses' perceptions of patient education practice; the educational skills of a nurse, the content, structure and educational approaches to patient education and its changes during nine years at a university hospital in Finland. METHODS: The subjects of this survey were orthopaedic nurses at one university hospital - 56 nurses in 2001 and 51 nurses in 2010. RESULTS: On the whole, no statistically significant change had taken place in the nurses' patient education skills in the two periods compared. In 2001, the nurses discussed more often the learning objectives with patients compared to 2010. In both years, individual education sessions and written material were often used. In both years, the bio-physiological area of patient education was found to be dealt with most adequately, while the social area received less attention in 2010 than in 2001. CONCLUSIONS: According to our results, no change in a positive direction in nurses' patient education skills and the implementation of patient education can be seen over the past decade. The results of the study indicate clear development needs in patient education practice.

Loneliness of older people aged 70: a comparison of two Finnish cohorts born 20 years apart.

OBJECTIVE: This study aimed to examine loneliness among two birth cohorts, born 20 years apart, when they were 70 years of age, and to identify factors explaining loneliness. METHODS: The cohorts consisted of older home-dwelling residents of Turku, Finland, from the birth cohort 1920 in 1991 (N=1530) and the birth cohort 1940 in 2011 (N=1307). Suffering from loneliness was assessed with the question: 'Do you suffer from loneliness?' Cross-tabulations with chi-square test, general linear model (GLM) and multiple regression analysis were used in statistical testing and modeling. RESULTS: In the 1940 cohort, around one-fifth (18%) of the respondents suffered from loneliness at least sometimes, while the corresponding figure in the 1920 cohort was around one-fourth (26%). Our analyses indicated that the effect of cohort was not a statistically significant explanatory factor of loneliness. Living status, self-rated health and memory compared to age peers were statistically significant explanatory factors for suffering from loneliness. When we controlled the effect of depressiveness on the experience of loneliness, it was shown that the effects of living status and self-rated health remained statistically significant, whereas memory compared to age peers did not. Depressiveness itself was highly important. The combined effect of living status and self-rated health emerged as the most significant explanatory factor for loneliness. Older people with poor self-rated health who lived alone were most likely to suffer from loneliness. CONCLUSION: The findings give healthcare professionals an opportunity to plan for interventions aimed at combating loneliness among home-dwelling older people.

Factors connected with positive life orientation at age 70, 80, 85 and 90 - The Turku Elderly Study.

BACKGROUND: A positive life orientation (PLO) is important for staying healthy physically, mentally and functionally. However, little is known about the factors connected with PLO in home-dwelling older people, even though it is an important topic. AIM: The aim of this study was to identify factors connected with positive life orientation among home-dwelling older people. STUDY DESIGN: An explorative, population-based cross-sectional study of the age cohort of 70-year-olds living at home at the age of 70, 80, 85 and 90. METHODS: The data were collected in 1991 among all residents of Turku, Finland, born in 1920 (N = 1530). Follow-ups were conducted in 2001 (n = 656), 2006 (n = 304) and 2011 (n = 156). A multiple regression analysis was conducted to estimate a model of factors that connected with PLO. RESULTS: Several factors were significantly connected with PLO at ages 70, 80, 85 and 90. For example, if 70-year-old respondents perceived themselves as being in better health than others of the same age, it improved their PLO. We also observed that PLO was improved by good self-rated health during the past 12 months at 80, good self-rated health at 85 and good self-rated health compared to others of the same age at 90. The various explanatory models explained between 24 and 36% of the variance in outcomes. CONCLUSION: Overall, our results showed that the respondents' own subjective views were significant independent factors of PLO in all four analyses (70, 80, 85 and 90 years). These subjective experiences remained significant even when objective indicators such as medication use, the presence of diseases and functional capacity were taken into account.

Finnish nurses' perceptions of care of older patients.

The aim of the study was to explore how far the perceptions of care of nurses in Finland take into account the preferences of the older patient and the patient's family members and to evaluate related background factors. The data were collected by questionnaire with nurses (n=167) working in a geriatric hospital. The questionnaire contained items about shared decision-making, attitudes to nursing patients, assessment of patients' functional ability and need for care, goal-setting, evaluation of outcomes and discharge planning. This study showed that taking into account the preferences of the patient and the patient's family members regarding the patient's care was challenging for the nurses in practice. About one-third of the nurses reported making the decisions on a patient's care themselves and not respecting patient autonomy in situations where patients are not able to assess their own situation. In addition, the nurses reported asking for the views of patients less frequently than those of family members when assessing and setting patient care goals. In practice, nurses need to be aware of this, during the transition from routine-centred care to patient-centred care.

Positive life orientation in old age: a 15-year follow-up.

BACKGROUND: Positive life orientation (PLO) is considered an important dimension of successful aging. AIM: To investigate how self-reported PLO changed among home-dwelling people from age 70 to 80 and 85 years. STUDY DESIGN: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. SUBJECTS AND METHODS: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (N=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. PLO was assessed with the following items: life satisfaction, feeling needed, having plans for the future, having zest for life, feeling depressed, and suffering from loneliness. We created a PLO score from the answers to these questions, where 1 represented the best PLO and 0 the poorest. RESULTS: At baseline, the participants showed rather high levels of positive life orientation (PLO total score 0.83). PLO declined markedly after the 70-year-old participants reached the age of 80 and 85 years (p<.001). However, depressive feelings remained quite stable. The decrease was similar among men and women except for the items suffering from loneliness and feeling needed. At age 70 and 80 years women suffered more from loneliness than men, while men experienced feeling needed more than women. CONCLUSIONS: Positive life orientation declines during old age, especially from age 70 to 80 years. Thereafter the decline is less steep except for changes in future plans and feeling needed.

Depressive symptoms among older people: a 15-year follow-up.

BACKGROUND AND AIMS: Depressive symptoms are common symptoms impairing the quality of life of older people. This population-based birth year cohort study investigated the prevalence of depressive symptoms and factors associated with them among home-dwelling older people. STUDY DESIGN: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. METHODS: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (n=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. All examinations included an identical study protocol; the participants' self-reported health status/habits and depressive symptoms were investigated via a questionnaire. Afterwards, thorough clinical examinations including the Zung depression scale were conducted by a nurse and physician/geriatrician. RESULTS: The mean of the Zung depression scale total score was 34 (SD 7.7) at the age of 70 and a significant increase was found in both re-examinations. At the age of 80 the mean of the Zung score was 35.8 (SD 7.5) while it was 37.6 (SD 8.9) at the age of 85 years. A similar increasing trend was found in the proportion of persons classified into the high Zung score group (≥45 points) indicating more depressive symptoms over the 15 year follow-up. Univariate and multivariate analyses showed that mostly functional and social factors were associated with subjectively reported depressive symptoms, while few associations were evidenced between depressive symptoms and medical conditions or poor health. CONCLUSIONS: Our findings revealed an increase in prevalence of depressive symptoms throughout the course of the investigation. Our findings suggest that even in the absence of a diagnosis of major depression, depressive symptoms assume importance in the evaluation of the health status and need for health care services among older people.

Breast cancer patients receiving postoperative radiotherapy: distress, depressive symptoms and unmet needs of psychosocial support.

BACKGROUND AND PURPOSE: The diagnosis and treatment of breast cancer can cause considerable psychological consequences, which may remain unrecognized and untreated. In this study, the prevalence of depressive symptoms and distress, and unmet needs for psychosocial support were assessed among breast cancer patients receiving postoperative radiotherapy. MATERIAL AND METHODS: Out of 389 consecutive patients, 276 responded and comprised the final study group. Depressive symptoms were assessed with the Beck Depression Inventory. Distress was measured with the Distress Thermometer. Hospital records of the patients were examined for additional information. RESULTS: Nearly one third of patients (32.1%) displayed depressive symptoms, and more than a quarter of patients (28.4%) experienced distress. Younger age (p=0.001) and negative hormone receptor status (p=0.008) were independent factors associated with distress. One quarter of the patients expressed an unmet need for psychosocial support, which was independently associated with depressive symptoms and/or distress (p=0.001) and younger age (p=0.006). CONCLUSIONS: During radiotherapy for breast cancer, the staff should have awareness of the higher risk of depression and distress in their patients and should consider screening tools to recognise distress and depressive symptoms. Special attention should be paid to younger patients.