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30 pages, 527 KB  
Article
Reliability and Validation of U.S. Army-Oriented Brief Work-to-Family and Family-to-Work Conflict Scales: An Email Sample of 262 Army Career Officers
by Walter R. Schumm, Glen Bloomstrom, Vance P. Theodore and Roudi Nazarinia Roy
Soc. Sci. 2025, 14(10), 599; https://doi.org/10.3390/socsci14100599 (registering DOI) - 10 Oct 2025
Abstract
Work–family conflicts (WFCs) and family–work conflicts (FWCs) have been found to be important to worker morale and retention as well as family (as defined by the respondents) well-being, with particular importance within the military, as indicated by a number of studies in the [...] Read more.
Work–family conflicts (WFCs) and family–work conflicts (FWCs) have been found to be important to worker morale and retention as well as family (as defined by the respondents) well-being, with particular importance within the military, as indicated by a number of studies in the United States, Canada, and European countries. However, few studies have focused on the impact of WFC and FWC for high ranking officers and their families. This study involved two samples of officers attending an advanced leadership course at Fort Leavenworth, Kansas, in 2007, featuring a total of 262 Army officers and another 45 officers from other services and countries. The sample of Army officers included 239 men (85.4% of whom were a parent) and 22 women (63.6% of whom were a parent; Fisher’s Exact Test, p < 0.02), with one missing case for sex. Of the men and women, respectively, most were married for the first time (190/11), with some never married (14/5), married but divorced (10/1), married/divorced/remarried (20/4), married/spouse died/remarried (1/0), married/divorced/remarried/divorced/remarried (4/0), and married/divorced/remarried/divorced/remarried (0/1). Measures for cohabitation or same-sex partnerships were not used. Two modified measures of WFC and FWC of four items each were tested and found to represent different factors and to have high internal consistency reliability. In general we found few sex differences, but female officers seemed to be more influenced by family–work conflict than male officers. One of our most substantial findings was that work–family conflict was more prevalent than family–work conflict within our sample. Also, we found that marital satisfaction tended to be higher than parental satisfaction and that officers usually found their own retention intentions to be higher than their perception of that of their spouses. Satisfaction with the military was consistently and strongly related to lower levels of work–family conflict while similar but weaker trends were found for family–work conflict. Most of our results were found to cross-validate with a subsample of non-Army officers in our sample. We found bias from marital social desirability to be lower for our marital process scale and for FWC than for marital satisfaction and WFC. In sum, our results confirm adverse effects of deployments and other stressors on military families and a continuing need for military support for families, even among higher ranking officer families. Full article
(This article belongs to the Section Family Studies)
13 pages, 250 KB  
Article
Job Satisfaction, Quality of Life, and Turnover Intention Among Nurses: A Comparative Study of Pattern-Based and Rotating Shift Schedules
by Yu Jin Jung and Haejin Kim
Healthcare 2025, 13(20), 2551; https://doi.org/10.3390/healthcare13202551 - 10 Oct 2025
Abstract
Background/Objectives: Shift work among nurses is associated with adverse outcomes, such as low job satisfaction, reduced quality of life, and high turnover intention. A pattern-based shift system has recently been introduced to provide more predictable and regular schedules. However, empirical research directly comparing [...] Read more.
Background/Objectives: Shift work among nurses is associated with adverse outcomes, such as low job satisfaction, reduced quality of life, and high turnover intention. A pattern-based shift system has recently been introduced to provide more predictable and regular schedules. However, empirical research directly comparing the pattern-based shift system with traditional rotating shifts is lacking. Therefore, this study compared job satisfaction, quality of life, and turnover intention between nurses working under a pattern-based shift system and those working under a traditional rotating shift system. Methods: In total, 112 nurses (56 on a rotating shift and 56 on a pattern-based shift) were surveyed in this cross-sectional study. Job satisfaction was assessed using the Job Satisfaction Scale for Clinical Nurses, specifically developed for Korean nurses. Quality of life was measured using the Scale for Korean Adults’ Quality of Life. The Turnover Intention Measurement Tool, developed for Korean nurses, was used to evaluate turnover intention. Results: Nurses working under a pattern-based shift system reported significantly higher job satisfaction and quality of life than those in a traditional rotating shift system. No significant difference in turnover intention was observed between the two groups. Conclusions: Pattern-based shift systems were associated with higher job satisfaction and quality of life than traditional rotating shift systems; however, their impact on turnover intention was not significant. These findings highlight the need for comprehensive strategies in scheduling reform, as schedule predictability may improve nurses’ job satisfaction and quality of life but appears insufficient to reduce turnover intention, which is likely shaped by broader organizational and psychosocial factors. Full article
23 pages, 447 KB  
Article
Drivers of Local Food Consumption Among Young Consumers: Integrating Intrinsic and Extrinsic Motivations
by Elisabetta Savelli and Vincenzo Gissi
Sustainability 2025, 17(20), 8969; https://doi.org/10.3390/su17208969 (registering DOI) - 10 Oct 2025
Abstract
Local food (LF) consumption has achieved increasing attention over the last few decades, given its potential to enhance social, economic, and environmental sustainability. Despite its benefits, understanding consumer behaviour towards LF remains underexplored. This study investigates intrinsic and extrinsic motivations for LF consumption [...] Read more.
Local food (LF) consumption has achieved increasing attention over the last few decades, given its potential to enhance social, economic, and environmental sustainability. Despite its benefits, understanding consumer behaviour towards LF remains underexplored. This study investigates intrinsic and extrinsic motivations for LF consumption among young Italian consumers, applying Self-Determination Theory (SDT). Using structural equation modelling (SEM) on a sample of 931 respondents, this study reveals the significant roles of perceived benefits, knowledge, satisfaction, and food sustainability concern (FSC) in shaping people’s intention to consume LF. Moreover, the findings underscore the importance of food sustainability concerns, as an extrinsic motivation improving the effect of the intrinsic ones, thus fostering a persistent intention to consume local food. Full article
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16 pages, 313 KB  
Article
The Virgin Mary’s Image Usage in Albigensian Crusade Primary Sources
by Eray Özer and Meryem Gürbüz
Histories 2025, 5(4), 49; https://doi.org/10.3390/histories5040049 - 10 Oct 2025
Abstract
The image of the Virgin Mary appears with increasing frequency in written sources from the 12th and 13th centuries compared to earlier periods. Three major works produced by four eyewitness authors of the Albigensian Crusade (Historia Albigensis, Chronica, and Canso [...] Read more.
The image of the Virgin Mary appears with increasing frequency in written sources from the 12th and 13th centuries compared to earlier periods. Three major works produced by four eyewitness authors of the Albigensian Crusade (Historia Albigensis, Chronica, and Canso de la Crozada) reflect on and respond to this popular theme. These sources focus on the Albigensian Crusade against heretical groups, particularly the Cathars, and employ the Virgin Mary motif for various purposes. The Virgin Mary is presented as a Catholic model for women drawn to Catharism (a movement in which female spiritual leadership was also present) as a divine protector of the just side in war and as a means of legitimizing the authors’ claims. While Mary appears sporadically in Peter of Vaux-de-Cernay’s Historia Albigensis, she is extensively invoked in the Canso by both William and his anonymous successor. In contrast, the image of the Virgin Mary is scarcely mentioned in Chronica, likely due to the narrative’s intended audience and objectives. This article aims to provide a comparative analysis of how the image of the Virgin Mary is utilized in these primary sources from the Albigensian Crusade and to offer a new perspective on the relationship between historical events and authors’ intentions, laying the groundwork for further research. Full article
(This article belongs to the Section Cultural History)
26 pages, 999 KB  
Article
Drivers of Blockchain Adoption in Accounting and Auditing Services: Leveraging Theory of Planned Behavior with Identity and Moral Norms
by Nikolaos Gkekas, Nikolaos Ireiotis and Theodoros Kounadeas
J. Risk Financial Manag. 2025, 18(10), 573; https://doi.org/10.3390/jrfm18100573 (registering DOI) - 9 Oct 2025
Abstract
Blockchain technology has become a game changer in sectors like accounting and auditing. Its usage is still restricted due to a lack of insight into what drives people to adopt it for financial services like accounting and auditing. This research delves into the [...] Read more.
Blockchain technology has become a game changer in sectors like accounting and auditing. Its usage is still restricted due to a lack of insight into what drives people to adopt it for financial services like accounting and auditing. This research delves into the factors that influence the adoption of blockchain systems in accounting and auditing services by utilizing an enhanced edition of the Theory of Planned Behavior. In this study, alongside the previously established elements like Attitude, subjective norm, and Perceived Behavioral Control, self-perception and personal moral values are included to reflect how identity and ethics impact decision-making processes. Data were gathered via an online survey (N = 751) conducted on the Prolific platform, and the hypotheses were tested using Structural Equation Modeling. The hypotheses were examined through the Structural Equation Modeling method. The findings indicate that each of the five predictors plays a significant role in influencing Behavioral Intention, with personal moral values being the influential factor followed by subjective norm and Perceived Behavioral Control. Attitude plays an important role in shaping adoption choices and showcases the complexity involved in such decisions. As such, it is crucial to take into account ethical factors when encouraging the use of blockchain technology. This study adds to the existing knowledge of the Theory of Planned Behavior framework, offering insights for companies aiming to boost the implementation of blockchain systems in professional settings. Future research avenues and real-world implications are explored with an emphasis placed on developing targeted strategies that align technological adoption with personal values and organizational objectives. Full article
(This article belongs to the Section Financial Technology and Innovation)
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17 pages, 636 KB  
Article
Migration to Italy and Integration into the European Space from the Point of View of Romanians
by Vasile Chasciar, Denisa Ramona Chasciar, Claudiu Coman, Ovidiu Florin Toderici, Marcel Iordache and Daniel Rareș Obadă
Genealogy 2025, 9(4), 109; https://doi.org/10.3390/genealogy9040109 - 9 Oct 2025
Abstract
This study investigates the determinants of Romanian workers’ migration intentions towards Italy, integrating economic, social, and psychological perspectives. Based on a sample of 358 respondents, four hypotheses were tested concerning perceived living standards, working conditions, quality of public services, and anticipated integration difficulties. [...] Read more.
This study investigates the determinants of Romanian workers’ migration intentions towards Italy, integrating economic, social, and psychological perspectives. Based on a sample of 358 respondents, four hypotheses were tested concerning perceived living standards, working conditions, quality of public services, and anticipated integration difficulties. Data were analysed using descriptive statistics, Spearman’s rho correlation, Mann–Whitney U, Chi-square, ANOVA, and ordinal logistic regression. The results confirm that higher perceived living standards and better working conditions in Italy significantly increase the likelihood of expressing migration intentions, while favourable evaluations of healthcare and education act as additional pull factors. Conversely, anticipated integration difficulties, particularly language barriers and cultural adaptation, reduce migration intentions, indicating that socio-psychological obstacles can counterbalance economic incentives. By combining non-parametric and multivariate analyses, the study demonstrates that migration is a multidimensional process shaped not only by structural opportunities but also by behavioural and psychological appraisals. These findings are consistent with recent research on European labour mobility and contribute to the literature by highlighting the role of subjective perceptions in shaping migration decisions. Implications for policy include the need to address both economic disparities and integration barriers to support more balanced mobility within the European space. Full article
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23 pages, 1389 KB  
Article
The Transmission Effect of Threshold Experiences: A Study on the Influence of Psychological Cognition and Subjective Experience on the Consumption Intentions of Smart Sports Venues
by Zhenning Yao, Yujie Zhang, Sen Chen, Qian Huang and Tianqi Liu
Buildings 2025, 15(19), 3629; https://doi.org/10.3390/buildings15193629 - 9 Oct 2025
Abstract
As a key domain within smart buildings, Smart Sports Venues represent a strategic direction for the future development of the construction industry and hold immense potential to drive the transformation and upgrading of the sports industry. To explore the underlying mechanisms influencing consumer [...] Read more.
As a key domain within smart buildings, Smart Sports Venues represent a strategic direction for the future development of the construction industry and hold immense potential to drive the transformation and upgrading of the sports industry. To explore the underlying mechanisms influencing consumer willingness to use Smart Sports Venues, this study constructs a theoretical model based on cognitive evaluation theory and collects data from 632 spectators in core cities of Western China (a region undergoing rapid urbanization where the sports industry is accelerating its development). As an emerging consumption scenario, Smart Sports Venues demonstrate significant development potential and representativeness in these cities. Empirical testing using structural equation modeling (SEM) combined with mediation and moderation analysis revealed the following results: (1) Perceptions of technology and convenience positively influence consumption intention; (2) Risk perceptions negatively influence consumption intention; (3) Critical experiences mediate the effects of technology perceptions, convenience perceptions, and risk perceptions on consumption intention; (4) Subjective Experience exerts a moderating effect. This study offered a novel theoretical explanation for how smart sports venues enhanced sports consumption willingness by revealing the “cognition-experience-behavior” transmission pathway—the complete journey consumers traversed from forming perceptions and experiencing on-site activities to ultimately making purchase decisions. Compared to existing research, this model innovatively integrated psychological cognition with behavioral response mechanisms, breaking away from traditional studies’ isolated analysis of technical parameters or consumption motivations. From an interdisciplinary perspective of sports consumption psychology and behavioral science, this study not only highlighted the value of smart sports venues as a pivotal link in technological innovation and industrial upgrading but also filled a gap in existing literature regarding how smart technologies influenced consumer behavior through psychological mechanisms. The findings provided theoretical foundations for optimizing smart sports architecture through user behavior data analysis and offered practical insights for the widespread adoption and development of smart building technologies. Full article
(This article belongs to the Section Architectural Design, Urban Science, and Real Estate)
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16 pages, 724 KB  
Article
Does Quality of Life Influence Pro-Environmental Intention? An Extension of Theory of Planned Behaviour
by Suk Min Pang, Hasni Mohd Hanafi, Choy Yoke Chong and Booi Chen Tan
Sustainability 2025, 17(19), 8953; https://doi.org/10.3390/su17198953 (registering DOI) - 9 Oct 2025
Abstract
In light of escalating global environmental deterioration, studies on pro-environmental intention and behaviour with the ultimate goal of identifying contributing factors to minimise environmental issues are common. Theory of Planned Behaviour (TPB) is widely used to study environmental intentions and behaviours. However, how [...] Read more.
In light of escalating global environmental deterioration, studies on pro-environmental intention and behaviour with the ultimate goal of identifying contributing factors to minimise environmental issues are common. Theory of Planned Behaviour (TPB) is widely used to study environmental intentions and behaviours. However, how quality of life (QoL) influences these intentions and interactions among TPB’s own variables within a single research framework has not been thoroughly explored. Therefore, this study extends TPB by incorporating the four dimensions of QoL, as measured by the Control, Autonomy, Self-Realisation, and Pleasure (CASP-19) scale, to understand pro-environmental intentions from Malaysian viewpoints. In this study, quantitative approach was applied, and the data were collected from Malaysians aged 18 and above (N = 182) in Klang Valley, Malaysia. Using Partial Least Squares Structural Equation Modelling (PLS-SEM), a two-step approach was employed to assess the measurement and structural models. The findings confirmed Theory of Planned Behaviour (TPB) is a robust model for environmental studies showing that subjective norm and perceived behavioural control significantly influence attitudes toward pro-environmental behaviour, ultimately leading to pro-environmental intention. Interestingly, this study found no relationship between QoL dimensions and pro-environmental intention. Lastly, both theoretical and managerial implications were discussed, and research limitations and suggestions for future research directions were put forward. Full article
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22 pages, 2301 KB  
Article
Handwritten Messages Boost Consumer Engagement in Food Delivery
by Yue Liu, Xiaoxiao Fu and Tian Lan
J. Theor. Appl. Electron. Commer. Res. 2025, 20(4), 281; https://doi.org/10.3390/jtaer20040281 - 9 Oct 2025
Abstract
Customer assistance (e.g., reviews and referrals) plays a vital role for catering merchants. This study investigates how handwritten (vs. printed) messages can enhance consumers’ intention to engage in such assistance activities in the context of food delivery. Using a multi-method approach (field and [...] Read more.
Customer assistance (e.g., reviews and referrals) plays a vital role for catering merchants. This study investigates how handwritten (vs. printed) messages can enhance consumers’ intention to engage in such assistance activities in the context of food delivery. Using a multi-method approach (field and scenario-based experiments), we demonstrate that handwritten messages significantly increase customers’ willingness to provide assistance, an effect mediated by perceived interpersonal intimacy. Moreover, the impact of handwritten messages interacts with message content structure. The positive effect of handwritten typefaces is stronger for individual catering businesses than for chain restaurants, and more effective among hedonic customers compared to utilitarian ones. These findings offer practical guidance for service merchants on leveraging handwritten messages to foster customer assistance behaviors. Full article
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18 pages, 577 KB  
Article
Can AI Generate Useful Messages for Smoking Cessation Campaigns? A Test with Different Emotional Appeals and Source Attribution
by Wan-Lun Chang, Xiaomei Cai and Xiaoquan Zhao
Int. J. Environ. Res. Public Health 2025, 22(10), 1540; https://doi.org/10.3390/ijerph22101540 - 9 Oct 2025
Abstract
This study investigates the viability of using ChatGPT 3.5 to produce smoking cessation messages featuring different emotional appeals. The effect of source attribution to Artificial Intelligence (AI) vs. human experts is also examined. A sample of current smokers (N = 480) was [...] Read more.
This study investigates the viability of using ChatGPT 3.5 to produce smoking cessation messages featuring different emotional appeals. The effect of source attribution to Artificial Intelligence (AI) vs. human experts is also examined. A sample of current smokers (N = 480) was recruited from Prolific and randomly assigned to read one of five ChatGPT-generated messages reflecting a 2 (appeal: threat vs. humor) × 2 (source: AI vs. human experts) factorial design plus an irrelevant message control condition. Exposure to the smoking cessation messages led to a pattern of cognitive and emotional responses largely consistent with expectations based on previous research. Compared to control, the smoking cessation messages generated greater risk perceptions on the featured health effects but did not produce significantly stronger intentions to quit. Human experts as the source produced greater perceived source credibility than AI, but there was no source effect on other outcomes. No interaction between message appeals and source attribution was observed. Implications of the findings for tobacco education campaigns are discussed. Full article
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18 pages, 828 KB  
Article
Descriptive Trajectories of How Service Innovation Shapes Customer Exit Intentions in Online Travel Agencies
by Yingxue Xia and Hong-Youl Ha
J. Theor. Appl. Electron. Commer. Res. 2025, 20(4), 280; https://doi.org/10.3390/jtaer20040280 - 9 Oct 2025
Abstract
This study examines the descriptive trajectories through which service innovation is associated with customer exit dynamics after service failures, drawing on a three-wave panel of 532 online travel agency users and employing partial least squares structural equation modeling with predictive assessment. We analyze [...] Read more.
This study examines the descriptive trajectories through which service innovation is associated with customer exit dynamics after service failures, drawing on a three-wave panel of 532 online travel agency users and employing partial least squares structural equation modeling with predictive assessment. We analyze how innovation is associated with switching intentions via brand hate and brand distrust over time. Results reveal distinct temporal patterns: service innovation is linked to consistent reductions in both hate and distrust, yet only hate emerges as a salient mediator whose marginal association with switching intensifies over time. In contrast, distrust, although mitigated by innovation, remains relatively stable and behaviorally inert. Rather than asserting a causal explanation, we document temporal associations—labelled here as a “dilution effect”—to indicate that innovation coincides with weakening negative emotions but only partial attenuation of their behavioral correlates. By distinguishing between the fading but influential role of hate and the persistent yet inert nature of distrust, this study clarifies differentiated pathways through which negative states coincide with customer exit. For managers, the results highlight the need for staged innovation strategies to dissipate hate, complemented by long-term trust-repair initiatives to address enduring distrust and reduce customer churn. Full article
(This article belongs to the Section Digital Marketing and the Connected Consumer)
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24 pages, 430 KB  
Article
Analysis of the Experiences of Visitors the Museum Offer of Tourist Destination
by Antonio Badurina, Zrinka Zadel and Elena Rudan
Heritage 2025, 8(10), 425; https://doi.org/10.3390/heritage8100425 - 8 Oct 2025
Abstract
Museums play a significant role in a destination’s cultural and tourist offer, influencing the overall tourist experience. Based on survey conducted among visitors to the Museum of Apoxyomenos of the town of Mali Lošinj and the Cres Museum of the City of Cres, [...] Read more.
Museums play a significant role in a destination’s cultural and tourist offer, influencing the overall tourist experience. Based on survey conducted among visitors to the Museum of Apoxyomenos of the town of Mali Lošinj and the Cres Museum of the City of Cres, located on the islands of Cres and Lošinj in Croatia, the views of visitors on the museum experience, its role in shaping the overall tourist experience and its connection with the level of consumption, satisfaction with the destination and intention of re-visiting were analysed. The findings of this research suggest that satisfaction with the museum experience can significantly contribute to a positive perception of the destination, encouraging recommendations and increasing the intention to revisit. The results confirm that satisfaction with museum experience strongly contributes to the positive assessment of the destination, encourages recommendations, and increases the intention to return. Although only a weak positive correlation has been established between total visitor consumption and consumption within museums, museums are recognised as important revenue generators and economic factors in the destination. Socio-demographic factors had no significant impact on satisfaction, indicating the universality of the museum’s offer. The findings of this research point to the importance of museum content, promotion, and integration of museums into tourism strategies as potential key elements in the development of tourist destinations. Based on the results obtained, the importance of museum contents, promotion, and integration of museums in tourist strategies is confirmed as key elements of the development of destinations. This research contributes to understanding museums as active participants in the cultural and economic development of tourist destinations. Full article
(This article belongs to the Section Museum and Heritage)
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29 pages, 1637 KB  
Article
Rethinking Performance Evaluation: Strategic Alignment in the Service Sector Through a Case-Based Framework
by Maria C. Tavares and Mariana Vaz
Adm. Sci. 2025, 15(10), 390; https://doi.org/10.3390/admsci15100390 - 8 Oct 2025
Abstract
Performance management is critical for aligning human capital with organizational strategy, particularly in the increasingly competitive service sector. However, universally effective performance appraisal systems (PASs) exist, as effectiveness depends on contextual and organizational specificities. In Portugal, where services account for nearly three-quarters of [...] Read more.
Performance management is critical for aligning human capital with organizational strategy, particularly in the increasingly competitive service sector. However, universally effective performance appraisal systems (PASs) exist, as effectiveness depends on contextual and organizational specificities. In Portugal, where services account for nearly three-quarters of gross value added, PAS implementation remains underdeveloped, highlighting a gap between strategic intent and practice. This study aims to address that gap by investigating how a performance appraisal model can be tailored to the service sector. A case study was conducted at PCI—Creative Science Park, S.A., a consulting firm, using a qualitative approach. The research design combined a literature review to identify theoretical dimensions of performance evaluation with an employee questionnaire to capture organizational perceptions and priorities. Integration of both strands of evidence informed the construction of the framework. The findings indicate that employees value objective-based evaluation as the most relevant dimension, complemented by customer feedback, adaptive performance, and organizational citizenship. Furthermore, the integration of 360° feedback mechanisms and regular review cycles emerged as key enablers of fairness and engagement. By combining theoretical insights with employee perspectives, this study contributes to a customized and flexible PAS that enhances strategic alignment in the service sector. The proposed model provides both scholarly value, by advancing the discussion on context-specific PAS design, and practical value, by offering a reference for organizations seeking to align human performance with mission-critical outcomes. Full article
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13 pages, 582 KB  
Article
Do Lactating Mothers’ Descriptions of Breastfeeding Pain Align with a Biopsychosocial Pain Reasoning Tool? A Qualitative Study
by Lester E. Jones, Lisa H. Amir, Nicole Shi En Chew, Shi Yun Low, Victoria Yu Ting Woo, Doris Fok, Yvonne Peng Mei Ng and Zubair Amin
Brain Sci. 2025, 15(10), 1087; https://doi.org/10.3390/brainsci15101087 - 8 Oct 2025
Abstract
Background/Objectives: Despite the intent of most mothers to breastfeed their children, breast or nipple pain can be the reason for early cessation of breastfeeding. Current understanding about lactation-related pain revolves around mechanical or pathological causes, discounting the role of psychosocial factors which can [...] Read more.
Background/Objectives: Despite the intent of most mothers to breastfeed their children, breast or nipple pain can be the reason for early cessation of breastfeeding. Current understanding about lactation-related pain revolves around mechanical or pathological causes, discounting the role of psychosocial factors which can influence management of pain. The Breastfeeding Pain Reasoning Model is a clinical reasoning tool developed to support those evaluating women’s lactation-related pain. We aimed to explore perspectives of breastfeeding women on lactation-associated pain and determine how they align with the Breastfeeding Pain Reasoning Model (BPRM). Methods: We conducted a qualitative descriptive study using phenomenological approach in Singapore. Eighteen women with recent breast and/or nipple pain during lactation underwent individual semi-structured interviews in 2022. Thematic analysis was performed. Results: Deductive analysis showed that lactation-associated pain was aligned with BPRM’s domains (i.e., local stimulation, external influences, and central modulation). Psychosocial factors likely influencing central processing of pain were not recognised by most of the participants. Participants described severe breastfeeding pain often accompanied by feelings of vulnerability, injustice, and uncertainty. Inductive analysis identified two additional themes of motivation and expectations. Conclusions: Greater awareness of the interplay between the broad influences on pain is needed. Using an interoceptive lens could help to illustrate how signals from the breast inform the brain, and how social, emotional, and cognitive factors influence the individuals’ perception of painful experiences. Educating breastfeeding women and healthcare personnel about the biopsychosocial nature of pain may empower women to better navigate the challenges of breastfeeding and improve breastfeeding outcomes. Full article
(This article belongs to the Special Issue Interoception and Women’s Health)
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19 pages, 1056 KB  
Article
“Are You Just Looking to ‘Survive’?”: A Qualitative Study of Importance of Oncology Endpoints Beyond Overall Survival in Early-Stage Cancer
by Shelagh M. Szabo, Sarah Walker, Evelyn Griffin, Aya McMillan, Robert Bick, Frances Simbulan, Eon Ting and Stephanie Snow
Cancers 2025, 17(19), 3260; https://doi.org/10.3390/cancers17193260 - 8 Oct 2025
Abstract
Background/Objectives: In early-stage oncology clinical trials, the use of endpoints beyond overall survival (OS), including recurrence-free survival (RFS) or event-free survival (EFS), is becoming more common. To understand whether these outcomes are important to patients, this study explored the perceived value of non-OS [...] Read more.
Background/Objectives: In early-stage oncology clinical trials, the use of endpoints beyond overall survival (OS), including recurrence-free survival (RFS) or event-free survival (EFS), is becoming more common. To understand whether these outcomes are important to patients, this study explored the perceived value of non-OS endpoints among Canadians treated for early-stage cancer or with curative intent. Methods: Canadians treated for early-stage breast, lung, or gastrointestinal cancer participated in semi-structured interviews. Participants provided perspectives on OS, RFS, disease-free survival (DFS), EFS, and pathological complete response (pCR) endpoints. Reflexive thematic analysis was used to explore patterns in responses and alignment of trial endpoints with patient treatment goals, priorities and preferences. Results: The mean age of the 33 participants was 54.8 years, and 21 were female; 28 reported prior surgery, and 21 were also treated with chemotherapy (11 specified as neo-adjuvant; 9 specified adjuvant). All participants valued OS, and most viewed non-OS endpoints as reflective of their treatment priorities, including maintaining health-related quality of life and getting back to ‘normal’. They also valued timely and equitable treatment access and equated having access to new treatments with better options. While participants considered efficacy data from clinical trials provided by non-OS endpoints sufficient to want access to new treatments, the relative importance of being disease- or recurrence-free versus maximizing length of life differed according to recurrence status, prognosis, cancer type and life stage. Conclusions: These findings support the relevance and importance of non-OS endpoints to Canadians with early-stage cancer and highlight participants’ desire for rapid approval of treatments with demonstrated improvements in non-OS endpoints. Full article
(This article belongs to the Section Cancer Survivorship and Quality of Life)
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