Transparent reporting of how patient-reported outcomes (PROs) are collected is essential to ensure reproducible and interpretable data. Different modes of assessment may affect data quality and feasibility, yet their use in cancer trials is poorly described. Electronic PRO (ePRO) assessment may improve data quality and enable active review, but it is unclear how often different modes of assessment like ePRO assessment are used and in which trials. We systematically searched PubMed for randomized controlled trials (published 2019–2023) that used cancer-specific PRO measures in patients with the six most common solid cancers. Trial characteristics, PRO reporting practices, and evidence of active review of PRO data were summarized descriptively. Univariate logistic regression was used to examine predictors of (1) reporting the mode of PRO assessment and (2) use of ePROs exclusively. Of 9331 references screened, 296 trials were included in the analysis. 135 (45.6

Background/Objective: Web-delivered psychoeducational tools offer scalable options for managing elevated stress. Passive psychoeducation that delivers self-guided content without active psychotherapy techniques or homework may be particularly accessible at low costs. The present study examined the acceptability and preliminary effectiveness of a seven-week app-based passive psychoeducational stress-management program in an unselected cohort of nursing students. Methods: In this parallel-group randomized controlled trial (preregistered at the German Clinical Trials Register), 154 nursing students were randomized to either a psychoeducation group (n = 77) or a waitlist control (n = 77). Outcomes were assessed at baseline and post-intervention using the Depression Anxiety Stress Scales–21 (DASS-21). A total of 56 completed the post-test assessment. The intervention group received a new psychoeducational module each week for seven weeks. After each module, participants rated satisfaction and reported adherence and application of content in daily life. The control group received no intervention. Results: Compared with the waitlist control, the intervention group showed a statistically significant reduction in perceived stress from pre- to post-test. Depressive symptoms demonstrated a trend toward improvement, whereas anxiety scores did not change significantly. Acceptability ratings were high and participants reported moderate uptake of strategies and perceived relief. Conclusions: A brief, app-based passive psychoeducational program appears feasible and acceptable for nursing students and can reduce perceived stress. However, the findings of the current study should be interpreted cautiously given the high attrition rate and the absence of long-term follow-up. Further studies with larger samples and replication under conditions of better retention are warranted.

BACKGROUND AND OBJECTIVE:To determine whether the existing European Organisation for Research and Treatment of Cancer (EORTC) QLQ-NMIBC24 and QLQ-BLM30 modules remain fit for purpose and to assess health-related quality of life (HRQoL) issues relevant for patients with metastatic bladder cancer (mBC). METHODS:Following the EORTC Quality of Life Group (QLG) guidelines, phase 1 included an expert meeting, five systematic reviews, and interviews with 14 healthcare professionals (HCPs) and 48 bladder cancer (BC) patients across six countries. HRQoL issues were identified through the literature and rated by HCPs and patients for relevance and importance. Decision rules guided selection for phase 2. In phase 2, selected issues were translated into items using the EORTC Item Library and expert consensus. KEY FINDINGS AND LIMITATIONS:A total of 443 articles and 62 interviews yielded 150 unique HRQoL issues; 40 issues and two branching questions were retained for the provisional module. Seventeen new items were added beyond the existing EORTC BC modules, while 11 existing items were excluded. Issues specific to mBC and newer treatments, such as immunotherapy, were identified. Limitations include potential selection bias due to purposive sampling and small sample sizes per treatment subgroup. CONCLUSIONS AND CLINICAL IMPLICATIONS:This phase 1-2 study supports the need to update the existing EORTC BC modules and incorporate additional items relevant to all disease stages, including mBC. A single, flexible module with branching logic may improve clinical applicability across patient subgroups. The provisional module will undergo international pretesting and psychometric evaluation in phase 3.

BACKGROUND: Patient involvement is a key goal in modern healthcare, and quality of care improves with effective information flow between patients and healthcare professionals (HCPs). Patient-reported outcomes (PROs) are essential in patient-centered care. Electronic PRO monitoring (ePROM) involves collecting, analyzing, and documenting patient self-ratings, enabling treatment monitoring, screening, quality assurance, and research. The aim of this study was to investigate patients’ and HCPs’ understanding of the graphical presentation of longitudinal ePROM bar charts and the patients’ perspective on various modes of access to such data (e.g. paper reports, electronic formats, or HCP consultations). METHODS: Semi-structured interviews with 40 patients and 13 HCPs involved presenting longitudinal ePROM bar charts. Participants answered questions about changes and current states of four constructs (disease understanding, treatment effectiveness, depression, anxiety). They also interpreted the graphs and answered questions regarding report preferences, pros and cons of different report types, preferred assessment frequency, reactions to problems (e.g., red graph), and support requests for problematic results. RESULTS: Results showed that 80% of patients correctly interpreted the graphs (9/12 questions), with only one patient answering fewer than 50% correctly. 84.7% of HCPs answered at least 15/16 questions correctly. A significant association was found between patients’ understanding of ePROM results and their educational level. Most patients preferred receiving their ePROM reports through personal meetings with a written report for memory support. CONCLUSION: Both patients in psychosomatic medicine wards and HCPs demonstrated a high level of understanding of ePROM results, with patients' educational levels influencing accuracy. Patients strongly preferred receiving ePROM reports through personal contact, suggesting that future studies should explore the effects of this report method.

BACKGROUND:The Common Terminology Criteria for Adverse Events (CTCAE) is the standard for provider-based rating of adverse events in oncology, but its reliability for symptomatic adverse events is low. Patient-reported outcome (PRO) data might improve the inter-rater reliability of CTCAE assessments. We investigated whether providers' access to PRO data enhances the inter-rater reliability of CTCAE ratings and the detection of symptomatic adverse events. METHODS:This multinational, open-label, randomised controlled trial was done in 11 hospitals in ten countries. Adults (aged ≥18 years) with any cancer diagnosis receiving chemotherapy, immunotherapy, or radiotherapy of curative or palliative intent were eligible. Patients were randomly assigned (1:1) to the intervention group (in which providers saw patients' PRO data as they were doing CTCAE assessments) or the control group (in which providers did not have access to PRO data) within each centre through a minimisation algorithm and a weighted cutoff; no additional stratification factors were applied. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and 16 additional items from the EORTC Item Library, covering 17 symptomatic adverse events. Two independent providers (oncologists or trained nurses) did CTCAE ratings. The primary endpoint was the inter-rater reliability of CTCAE ratings, expressed as intraclass correlation coefficients (ICCs), for all patients with complete assessments. The trial was registered at ClinicalTrials.gov (NCT04066868) and is now closed. FINDINGS:Between Feb 10, 2020, and Dec 6, 2024, a total of 1067 patients were enrolled (538 in the control group and 529 in the intervention group), with full data from 512 patients in the control group and 501 in the intervention group included in the analysis. Median age was 59 years (IQR 46-68); 558 (55·1%) of 1013 were female and 455 (44·9%) were male. Most had good functional status (403 [79%] of 512 had ECOG 0-1 in the control group and 371 [74%] of 501 in the intervention group). The most common cancer types were haematological (control group: 137 [27%] of 512; intervention group: 131 [26%] of 501), breast (control group: 118 [23%]; intervention group: 107 [21%]), and gastrointestinal (control group: 98 [19%]; intervention group: 89 [18%]). Inter-rater reliability was significantly higher in the intervention group for 13 of 17 symptomatic adverse events, with the largest differences for memory impairment (ICC 0·176; p<0·0001), irritability (0·161; p<0·0001), concentration impairment (0·157; p<0·0001), depression (0·126; p=0·0012), and anxiety (0·109; p=0·0018). There was no significant difference for pain, rash, and peripheral sensory neuropathy and the reliability was significantly higher in the control group than the intervention group for diarrhoea (ICC -0·066; p=0·013). INTERPRETATION:Availability of PRO data to providers for CTCAE rating improves the consistency of provider-based symptomatic adverse event detection in patients with cancer. PRO data supports reliable assessment of treatment-related toxicity, highlighting the value of integrating PRO data into clinical evaluations within cancer trials. FUNDING:EORTC Quality of Life Group.

The QLU-C10D is a preference-based measure of health-related quality of life (HRQL) for health economic evaluation in cancer patients. QLU-C10D health state utility values (HSUV) are estimated from QLQ-C30 data weighted by country-specific value sets. To further integrate the QLU-C10D in the international health-economic landscape, we developed country value sets for Belgium, Hungary, Portugal, and the Republic of Korea. In each country, online quota sampling was deployed to enrol participants representative of the general population for sex- and age- groups. We assessed socioeconomic information of participants. The standard EORTC QLU-C10D valuation protocol, a discrete-choice experiment, was used to elicit the country-specific value sets. Conditional logistic regressions were used to estimate general population preferences for survival time and impaired health domains. Utility decrements were estimated as the ratio of the coefficient for impaired health domains and the time coefficient. We used weighting to adjust for oversampling of higher education participants. Between September 2023 and February 2024, 4074 participants from the four countries were enrolled and included in analyses. Participants in all countries showed the greatest preference for the health domain of ‘physical functioning’, resulting in utility decrements of -0.182 to -0.372 for the impairment level ‘very much’. This was followed by the health domains of ‘Pain’, ‘Role Functioning’, and ‘Social Functioning’, which ranged between − 0.096 to -0.190 for the impairment level ‘very much’ across the four countries. Non-monotonicities were observed in all four countries, thus adjustments for non-monotonicity were performed for each country value set. The value sets of the QLU-C10D for the countries of Belgium, Hungary, Portugal and the Republic of Korea allow health-decision makers in these countries to estimate cancer-specific HSUVs, thereby incorporating the HRQL data collected with the QLQ-C30 into health economic decision-making.

BACKGROUND:The aim of this study is to develop a European Organisation of Research and Treatment of Cancer (EORTC) patient-reported outcome measure (PROM) to assess quality of life (QOL) in individuals diagnosed with a hereditary cancer predisposition syndrome (HCPS) with or without a previous cancer diagnosis. We report on content generation, questionnaire construction, and questionnaire evaluation of acceptability, comprehensiveness, and linguistic validity. METHODS:Following phase 1-3a of the EORTC Quality of Life Group module development guidelines, QOL issues were identified through a literature review and interviews with health-care professionals and individuals undergoing HCPS genetic counseling or testing. Based upon the results, a preliminary questionnaire was developed and pre-tested internationally for relevance, clarity, and linguistic appropriateness. Revisions were guided by qualitative feedback and predefined criteria. RESULTS:63 issues were identified from the literature and expanded to a 73-item questionnaire through interviews. Pre-testing of the questionnaire in 119 individuals (79.8 % female) across twelve centers in nine countries, including carriers of BRCA, Lynch syndrome, and Li-Fraumeni, showed limited applicability for those with negative or pending results. The target population was therefore refined to mutation carriers. Following item reduction, the final instrument comprised thirty validated and linguistically appropriate items. CONCLUSION:The EORTC QLQ-HCR30 is relevant and applicable for assessing QOL in individuals diagnosed with a HCPS and is now ready for preliminary psychometric evaluation (phase 3b and 4).

The European Organisation for Research and Treatment of Cancer’s computerized adaptive test instrument, the EORTC CAT Core, provides dynamic, individualised assessment across 14 health-related quality of life domains, including emotional functioning (EF), which encompasses anxiety and depression. When one of these symptoms is of primary interest, separate scores may better support clinical decision-making and increase measurement sensitivity. The aim here was to evaluate separate item banks for anxiety and depression as potential supplements to the EORTC CAT Core. Responses to 33 candidate EF items from 1,023 cancer patients were available from the original EF item bank project. Expert-based content classification was followed by psychometric analyses, including confirmatory factor analysis (CFA), item response theory (IRT) model calibration and evaluation, differential item functioning (DIF) analyses, and CAT simulations to assess measurement properties of the two item banks. Experts allocated nine items to anxiety and 17 to depression while seven items were judged to assess something else. CFA supported unidimensionality for each item bank. All items demonstrated acceptable IRT model fit, and no DIF of practical relevance was identified. CAT simulations indicated greater measurement precision than fixed 1- and 2-item scales, with potential sample size savings of up to 30

Background:Patients with breast cancer often experience health-related quality of life (HRQoL) impairments that remain difficult to predict on an individual level. Prediction models can aid in understanding individual survivorship trajectories. However, current prognostic models are based on fixed intervals, limiting their utility in clinical follow-up schedules. Objective:This study aimed to develop and externally validate time-dynamic machine learning (ML) models that predict clinically relevant HRQoL impairments in nonmetastatic patients with breast cancer. Methods:Using the pooled multicohort EORTC (European Organisation for Research and Treatment of Cancer) BALANCE (big data in patients with breast cancer) dataset (n=6316) containing repeated HRQoL measurements (EORTC QLQ [Quality of Life Core Questionnaire]-C30), we constructed over 70,000 patient assessment pairs. ML algorithms were trained using the earlier HRQoL assessment and clinical data to predict dichotomized impairments in QLQ-C30 domains at the later assessment between 2 weeks and 5 years ahead, reflecting the range of follow-up intervals available in the dataset. The best performing model was determined via the area under the receiver operating characteristic curve in the internal validation, and externally validated in an independent cohort of the BALANCE dataset, in which the calibration and predictive performance in risk groups (patients: postmenopause, with financial difficulties, with obesity, with 2 or more comorbidities, with lower educational status, and with frailty) were also evaluated. Results:ML models showed good discrimination (area under the receiver operating characteristic curve 0.64-0.84) across most domains, especially for persistent symptoms such as fatigue, financial difficulties, or functioning scales. Gradient boosting models performed best, but tended to be overconfident, with poor calibration for low-prevalence symptoms such as diarrhea or constipation. Model performance varied by risk group (eg, lower education and frailty), though no group consistently performed poorly. Performance remained stable across time windows, with prior HRQoL being the strongest predictor at the respective scale level, while clinical variables such as the type of treatment were less important for prediction. Conclusions:Time-dynamic ML models can support personalized HRQoL prediction in breast cancer care. Future improvements should focus on calibration and fairness to enable equitable, clinically meaningful implementation.

As the EORTC Quality of Life Group (QLG) approaches its 50th anniversary in 2030, this paper reflects on the group’s development and outlines strategic priorities emerging from its January 2026 strategy meeting. Its more than 1400 current members from 43 countries work to support that patient reported outcomes (PROs) are measured rigorously, interpreted meaningfully, and valued consistently throughout the cancer care pathway. Since the introduction of it’s core questionnaire (EORTC QLQ-C30) in 1993, EORTC QLG measures have become the most widely used in cancer research worldwide. As the cancer care landscape becomes increasingly complex, we highlight the QLG’s ongoing impact and long-term sustainability, with the aim of inspiring other international research and oncology networks. We summarise key developments to date, including the design of its modular measurement strategy, whereby core questionnaires are complemented by additional modules and items from the Item Library. Subsequent initiatives have focused on enhancing the relevance and usability of measures in cancer clinical trials, increasing measurement flexibility to support a broader range of purposes including survivorship, economic evaluation, and routine clinical care, and facilitating outcomes interpretation. Our future work will both sustain the legacy of the past 45 years and shape the next era. We outline ongoing developments within the group and the wider research landscape that underscore the need for a clear future strategy, structured around six pillars: Innovation, research, methodology, and implementation; Policy, stakeholder management, and global outreach; Leadership and funding; Internal collaboration; People development; Patient engagement.

Background Mental illness is highly prevalent and associated with significant public health costs. Despite this, less than half of those affected receive treatment, often due to barriers such as stigma and accessibility. Internet-based interventions (IBIs) have shown promise in improving well-being and reducing psychological distress, yet many lack personalization and sufficient guidance. Addressing these limitations, beWell Tirol integrates cognitive behavioral content, individualized task selection, and on-demand coaching within a self-determined, app-based format, allowing users to autonomously select and adapt exercises according to their individual needs and preferences. Objective This study evaluates the usability, acceptance, and effectiveness of a digital mental health intervention, "beWell Tirol," a 4-month app-based program accompanied by a coach, targeting individuals experiencing high psychological distress. Methods A total of 25 participants with above-average psychological distress completed the 4-month intervention. The program included a selection of cognitive behavioral therapy-based exercises, which were available via the app, as well as bi-weekly coaching sessions. Assessments were conducted at baseline, post-intervention, and three months post-intervention, measuring usability (System Usability Scale, SUS) and satisfaction (primary outcomes), as well as psychological distress, resilience, self-efficacy, stress coping strategies, emotion regulation, and quality of life (secondary outcomes). Statistical analyses included repeated measures ANOVA and t-tests. Results The intervention demonstrated excellent usability (SUS score: M = 91.8, SD = 7.5) and high satisfaction. Significant improvements were observed in resilience, self-efficacy, psychological distress (Perceived Stress Scale, Brief Symptom Inventory), emotion regulation, and multiple dimensions of quality of life (p < .05). These improvements were partially sustained at follow-up. Conclusion The program was well accepted, demonstrated high usability, and was effective in improving mental well-being. The results support the feasibility and effectiveness of a coach-guided, self-determined digital intervention for promoting mental health. Future research should explore larger samples, including control groups. Trial registration ClinicalTrials.gov, NCT07300410, 09/12/2025, Retrospectively registered

BACKGROUND:Multimodal treatment uses evidence-based therapeutic approaches by integrating pharmacotherapy, psychotherapy, physiotherapy, occupational therapy, relaxation techniques and mind body exercises, social/family therapy, and lifestyle interventions in the treatment of mental disorders. This study investigates changes in mental health indicators among patients undergoing multimodal inpatient care, using patient-reported outcomes (PROs) to monitor symptom development and well-being. METHODS:We conducted an exploratory retrospective analysis of patients receiving multimodal inpatient treatment at a ward for psychosomatic medicine between January 2015 and February 2024. We included patients with stress-related mental disorders (F32-34, F40-48, F50, F54). We compared their overall well-being and symptom load at the time of hospital admission and discharge using validated questionnaires, using parametric statistical tests. RESULTS:A total of 395 patients were included in the analysis. A transdiagnostic analysis across all patients showed significant improvements in PRO scores in global, physical, and psychological quality of life, depression severity, illness perception, overall symptom burden, and state anxiety from admission to discharge. In particular, patients with eating disorders and trauma-related conditions experienced the most notable gains in quality of life and reductions in depressive symptoms. Anxiety levels showed the greatest improvement in patients with somatoform disorders, whereas patients with eating disorders experienced smaller reductions. DISCUSSION:This study highlights that patients undergoing multimodal inpatient treatment for stress-related mental disorders showed improvements in symptoms and well-being across diagnostic groups and these improvements can be captured by routine PRO monitoring. In the future, routine PRO monitoring could inform more individualised treatment adjustments within the multimodal program.

Elektronisch erfasste Patientenberichte („electronic patient-reported outcomes“, ePRO) sind digitale, von Krebspatienten ausgefüllte Fragebögen. Trotz Hinweisen auf eine Verbesserung der klinischen Versorgung, ist die Integration von ePRO in der klinischen Kopf-Hals-Onkologie Neuland. Diese Arbeit skizziert den Implementierungsprozess für ePRO der Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde der Medizinischen Universität Innsbruck (HNO Innsbruck). Die Implementierung erfolgt durch eine Projektteam in einer Präimplementierungsphase (Bedarfsevaluation, Implementierungsplanung, Identifikation innerklinischer Barrieren, Prototypenentwicklung, Testung und Adaptierung sowie Anwenderschulung), Implementierungsphase (Implementierung und Anwendertraining) und Postimplementierungsphase (Qualitätskontrolle, Projektausweitung). Das Projektteam an der HNO Innsbruck besteht aus 10 Mitgliedern, die Digitalisierungsbedarf in der Krebsnachsorge identifizierten. Eine Hybridimplementierunglösung („Computer-based Health Evaluation System“, CHES; Fa. Evaluation Software Development, ESD, Innsbruck, Österreich) wurde gewählt. ePRO („European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – 30 items“, EORTC-QLQ-C30; Head and Neck Functional Integrity Scale, HNC-FIT Scale; und EORTC Head and Neck Cancer Module, EORTC H N43) werden 12-mal über 5,5 Jahre erhoben. Insgesamt 25 Anwender bewerten den Prototypen als benutzerfreundlich (Patientensicht: 8,1 ± 1,6; 3–10; Anwendersicht: 8,6 ± 1,1; 6–10). Als Hauptvorteil wurde die schnellere Anamnese (72

Regularly collected patient-reported outcome measures (PROMs) can facilitate early symptom detection and improve health outcomes. This explorative analysis aimed to investigate PROM adherence and factors associated with daily PROM completion among pediatric cancer patients. We analyzed data from a prospective study at the Medical University of Innsbruck in which pediatric patients with cancer treated with chemotherapy completed daily PROMs via a web-based portal (ePROtect). We analyzed the PROM adherence during their first year of treatment descriptively and using a linear mixed model to evaluate factors associated with PROM adherence. Fifty patients (42

Objective:Cancer-related fatigue (CRF) is the most common side effect associated with both cancer and its treatment. There are several screening tools for CRF, but their concordance remains largely unclear. Therefore, the study aimed to compare different existing screening tools and how they relate to validated CRF assessments.Methods:338 patients with different types of cancer were analyzed. Three different screening tools for CRF ('Energy Scale', 'Cella Screening', and the 'Impact Scale') were applied and compared with validated fatigue measures (Cella Criteria, EORTC QLQ-FA12). The assessments were compared cross-sectionally at three timepoints during the first 12 weeks after study inclusion.Results:When comparing the three different screening tools, we found that they resulted in different numbers of patients being screened positive for CRF and therefore potentially requiring further diagnostics. Regarding the Energy Scale, 87.5% of negatively screened patients were classified as not fatigued by the Cella Criteria, but approximately half of positively screened patients were classified as 'false positive'. The Impact Scale discriminated best between fatigued/non-fatigued patients when compared to the Cella Criteria. Comparing all screening tools with the FA12, the vast majority of patients who screened positive had higher FA12 scores. The level of concordance remained similar at all timepoints.Conclusions:There appear to be differences in the ability of existing screening tools to discriminate between fatigued/non-fatigued patients. The Impact Scale seems to provide the most valid indication of a patient's CRF status.Trial registration:ClinicalTrials.gov identifier: NCT05448573..

IntroductionSeveral smoking cessation methods are available, but the approaches were originally developed for the general population and are often applied to people with mental health problems. To address the needs of smokers with and without mental health problems for an exercise-assisted smoking cessation program, it seems necessary to know more about potentially different perspectives on what prevents them from quitting, how to increase motivation to quit, and how such a program is perceived.MethodsIn this study, an online survey was conducted to assess preferences for an exercise-assisted smoking cessation program, reasons for smoking, barriers, motives, and need of support for quitting smoking. A total of 257 smokers took part in the study, 82 reported mental health problems.ResultsIn addition to significant differences in sociodemographic and smoking-related characteristics between smokers with and without mental health problems, regression analyses revealed that factors such as age, BMI, and confidence in quitting were associated with smoking cessation behavior in the total sample. Significant differences were found between the two groups in their reasons for smoking, barriers, motives, and support for quitting. While both groups preferred an exercise-assisted smoking cessation program to last 10–11 weeks with a frequency of 2 to 3 days a week, smokers with mental health problems favored shorter exercise sessions and would choose walking or dancing as helpful exercise.ConclusionDue to different addiction-related variables and preferences, a special smoking cessation program combined with exercise for smokers with mental health problems should be developed and tested for effectiveness in clinical trials.

Background/Objective: Nursing and non-nursing students experience high stress levels, making them susceptible to mental health issues. This study compared stress, anxiety, and depression between these two groups after 2 years of the COVID-19 pandemic. Additionally, it explored the relationship between perceived helplessness, self-efficacy, and symptoms of mental stress and strain resulting from challenging internship conditions for nursing students. Methods: This cross-sectional study included 154 nursing students (mean age = 22.43 years) and 291 non-nursing students (mean age = 27.7 years). Data were collected using the Depression Anxiety Stress Scales (DASS-21), Perceived Stress Scale-10 (PSS-10), and a questionnaire on mental stress and strain. Results: Nursing students reported significantly higher scores in the DASS-21 subscales depression (ηp2 = 0.016) and anxiety (ηp2 = 0.037), and global stress (PSS-10; ηp2 = 0.029) compared to non-nursing students, but no significant difference on the DASS-21 Stress subscale. The observed group differences in the present study may be partially attributed to group differences in demographic factors. Helplessness correlated strongly with nearly all scales of mental stress and strain during internships (all p’s < 0.001), while self-efficacy showed a strong negative correlation with non-occupational difficulties, health impairment, and emotional problems (all p’s < 0.001). Conclusions: Nursing students experience elevated depression, anxiety, and perceived stress levels compared to non-nursing students. Stronger feelings of helplessness and lower confidence in their ability to overcome challenges were strongly correlated with mental stress and strain during clinical training. Targeted interventions such as cognitive behavioral training and stress management should be integrated into nursing curricula to enhance resilience and coping strategies.