Background Health care system distrust has emerged as a critical barrier to care, varying by social characteristics and affecting health outcomes through inadequate health care behaviour. However, research outside the US-American health care setting is sparse. Objective Based on a conceptual model of health care related distrust, the study aimed to (1) assess the extent of health care system distrust in Germany, (2) examine social inequalities in distrust, and (3) explore associations between distrust, unmet need, and medication non-adherence in the German population. Methods A cross-sectional online survey was conducted with a randomly selected sample drawn from a panel representing the adult population (N = 3246). Health care system distrust was measured using the 9-item Revised Health Care System Distrust scale, comprising competence and values subscales. Two items to assess unmet need and medication non-adherence as well as various social characteristics were additionally included. Results A substantial proportion of the respondents reported distrust in the German health care system. For instance, about one-fifth (strongly) disagreed that the health care system does its best to make patients’ health better. Multiple logistic regression analyses revealed various social inequalities regarding age, gender, migration history, education and income depending on the subscales. Additionally, both types of distrust were significantly associated with increased odds of unmet need and medication non-adherence after controlling for social characteristics. Conclusions Health care system distrust is prevalent in Germany and linked to social inequalities and adverse utilization. Addressing distrust requires targeted, patient-centered interventions emphasizing competence, empathy, communication, and equity.

Experiences of interpersonal discrimination in outpatient care (e.g. being treated disrespectfully) are a frequent phenomenon in Germany and in other countries. It can be expected that such experiences contribute to the production and perpetuation of health inequalities. We explored intersectional inequalities in interpersonal discrimination in outpatient care according to sex, history of migration, and income. Analyses were based on an online survey in a random sample of the adult population in Germany (n = 3246). A modified version of the Everyday Discrimination Scale was used to assess frequencies of interpersonal discrimination experiences in outpatient care. Sex, history of migration, and net income were considered as indicators of social inequalities. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted. Analyses showed significantly higher frequencies of interpersonal discrimination experiences for females and respondents with a low income while associations with migration history were not significant. Social inequalities in discrimination experiences were attributable to additive (and not multiplicative) effects of sex, migration history, and income, with sex contributing most and migration history least to these inequalities. Analyses across the 18 intersectional strata (combining subgroups of sex, income, and migration history) revealed significant differences in frequencies of discrimination experiences between the most (female second-generation migrants with low income) and least affected strata (men with high income and no migration history). As such discrimination experiences can result in reduced health care engagement and adverse health outcomes, these findings point to an important public health issue.

BackgroundBayesian regression models provide a robust framework for complex data analysis, which is particularly advantageous in scenarios with small sample sizes, common in psychology or medical research. However, specifying appropriate prior distributions that incorporate existing knowledge to regularize model parameters remains a challenge for many researchers. This can lead to unstable or implausible estimates. This study aims to demonstrate the impact of different prior distributions on regression models and to provide a practical guide for choosing and justifying informative priors to produce more stable and credible results.MethodsThe study involved two parts. First, a simulation study was conducted to systematically assess the sensitivity of Bayesian linear regression models to prior specification. We systematically varied the sample size, prior location, and prior scale to observe their impact on posterior estimates for a known true effect size. Second, a case–control study using real-world patient data (N = 526) demonstrated the practical application of choosing informative priors. Bayesian logistic regression models were used to analyze the relationship between severe dementia and fall incidence, comparing results from priors based on existing literature (“believer”), conservative priors (“agnostic”), and priors assuming an opposite effect (“skeptical”).ResultsThe simulation study showed that strongly informative priors had a substantial influence on posterior estimates, particularly for smaller sample sizes. As the sample size increased, the influence of the data increased, and the estimates converged toward the true effect. In the case–control study, a standard frequentist logistic regression produced an odds ratio of 8.87 with a very wide and unstable confidence interval (1.66–165.19), likely due to data sparsity. In contrast, a Bayesian model using a moderately informative “believer” prior derived from existing research yielded a more stable and plausible odds ratio of 4.01 with a substantially narrower credible interval (1.99–8.78).ConclusionCareful and transparent specification of informative priors is a critical tool in Bayesian analysis, especially when data are sparse. By incorporating justified evidence-based assumptions, researchers can regularize models to prevent implausible outcomes and produce more stable, interpretable, and credible results. This approach enhances the robustness of statistical inference in fields where small sample sizes are a frequent challenge.

While the number of studies investigating the magnitude, reasons, and possible consequences of perceived discrimination in health care is growing, many of these studies do not differentiate between structural and interpersonal discrimination in health care. The latter rests upon stereotypes and takes place in direct interactions between the health care provider and the patient. In this study, we explore the frequency and main reasons of different interpersonal discrimination experiences in inpatient and outpatient care in Germany and associations of discrimination with delayed and forgone care. Analyses were based on an online survey among the adult population in Germany (N = 3,246). A modified version of the Everyday Discrimination Scale was used to assess interpersonal discrimination experiences in inpatient and outpatient care. For each of the experiences, the main reason(s) for discrimination was ascertained. Indicators of delayed and forgone care referred to necessary doctor visits in the last 12 months. Analyses revealed that two thirds (66

Perceived discrimination is known to be associated with adverse health. However, there is a lack of research on detailed experiences of interpersonal discrimination in health care settings and its relationship with health care outcomes in the general population. The objective was to examine the association between perceived interpersonal discrimination experiences in outpatient care and different issues of non-adherence in a population sample in Germany. Analyses were based on a cross-sectional online survey conducted in Germany. The sample (N = 3,246) was randomly drawn from a panel including the adult population. To assess discrimination, the Discrimination in Medical Settings Scale which originally based on the Everyday Discrimination Scale was used. Five items regrading courtesy, respect, unequal treatment, reserved and dismissive behaviour were introduced to measure the frequency of respective experiences. Patient non-adherence was asked with three questions. Bi- and multivariate analyses adjusted for social characteristics (sex, age, migration history, education, income, health insurance) were conducted. Results showed that reporting discrimination experiences was significantly associated with all indicators of non-adherence (not following doctor’s advice, not coming for a follow-up visit, not filling a prescription or obtaining recommended drugs). Moreover, there was a trend indicating the more discrimination experiences reported, the higher the likelihood to be non-adherent. Significant odds ratios in the fully adjusted models vary between 1.77 and 2.58. The present study highlights a critical issue regarding health care delivery in Germany and contradicts the goals of health equity. Discrimination reinforces illness behaviour that is known to be detrimental for treatment outcomes. Tackling interpersonal discrimination and stereotype threat in health care should be a major goal in medical education and training. Physician communication skill trainings have been found to positively influence patient adherence which is an important predictor for health outcomes.

Background Subjective unmet need is an established indicator of unequal access to medical care and is often measured by delaying and forgoing medically necessary treatment. Research on delayed and forgone care among the general population in Germany including different reasons, social deprivation measures, and the perceived health risk of unmet need is sparse. This study aims to examine reasons, inequalities, and health-related consequences of unmet need in terms of delayed and forgone care. Methods A cross-sectional online survey was carried out based on a randomly drawn sample of the German adult population in December 2022 ( N = 2,201). Respondents were asked whether medical treatments were delayed or forgone in the past 12 months due to different reasons (waiting time, travel distance, financial costs). If unmet need was indicated, the respondents were subsequently asked about their perception of related health risks. Associations with individual social (sex, age, migration history, education, income) and regional factors (social deprivation) as well as insurance status were examined using multilevel logistic regressions analyses. Results Among N = 1,955 respondents who indicated need for medical care, 30% reported at least one reason for forgone care (waiting time 23%, financial costs 11%, travel distance 9%). In terms of delayed care, highest rate was found for waiting time (34%). Multilevel analyses revealed significant associations of unmet need with female sex, younger age, lower education, lower income, and statutory health insurance. Associations varied depending on the reason for unmet need. Differences in regional social deprivation were particularly found for forgone care due to distance. Between half and nearly two-thirds of the participants reported worsening of symptoms in case of unmet need. Associations with social characteristics were inconsistent. Discussion Unmet need is a prevailing issue in Germany and associated with perceived worsening of health, various indicators of social inequality, and health insurance. Reducing waiting times (e.g. through the further development of appointment service centres) and private co-payments as well as ensuring health care provision in deprived areas can contribute to a decrease of barrier-related unmet need and health risks. However, more in-depth studies are required to account for the complex nature of health care access.

In Germany, type of health insurance is an important aspect of health care inequalities because there is a dual structure of statutory and private health insurance and there are incentives for a preferential treatment of privately insured patients. Two questions will be addressed in the study: What are the public attitudes towards the dual system of health insurance and inequalities in health care between those with statutory and private insurance? Are these attitudes associated with socio-demographic characteristics, health insurance and political party preferences? Based on a random sample, an online survey among the adult population (18 + years) in Germany was conducted (N = 2,201). Attitudes towards statutory and private health insurance were assessed using four items. Two items related to inequalities in access and quality of care; two were aimed at the system structure and remuneration. Age, gender, education, migration history, region of residence, health insurance and political party preference were included in the analyses as predictors. About 77

Abstract Background Patient-centredness has become a central quality indicator for oncology care. Elements include shared decision-making, patient navigation and integration of psychosocial care, which impact patient-reported and clinical outcomes. Despite efforts to promote patient-centred care in Germany in recent decades, implementation remains fragmented. Further, research on patient experiences with cancer care and its determinants is limited. Therefore, this study examines which patient- and facility-specific factors are associated with patient-centred quality care delivery. Methods A cross-sectional study was conducted among 1,121 cancer patients in acute treatment, rehabilitation, and aftercare for different cancer entities across Germany. A participatory developed questionnaire was used. Outcome measures were the quality of physician-patient interaction and provision of psychosocial care during acute care. Predictors comprised patient-specific characteristics and treatment facility-specific factors. Multiple linear regression and multivariate binary logistic regression analyses were performed. In addition, a content analysis of open-ended comments on the patients’ overall cancer care needs was applied. Results Multiple linear regression analysis showed recent diagnosis (β=−0.12, p = < 0.001), being male (β=−0.11, p = 0.003), and having a preference for passive decision-making (β=−0.10, p = 0.001) to be significantly associated with higher interaction quality, but not age, education and health insurance type. An overall low impact of patient characteristics on interaction quality was revealed (adj. R2 = 0.03). Binary logistic regression analysis demonstrated the availability of central contact persons (OR = 3.10, p < 0.001) followed by recent diagnosis (p < 0.001), having breast cancer (p < 0.001) and being female (OR = 1.68, p < 0.05) to significantly predict offering psycho-oncological counselling to patients in acute care facilities. The availability of peer support visiting services (OR = 7.17, p < 0.001) and central contact persons (OR = 1.87, p < 0.001) in the care facility, breast cancer diagnosis (p < 0.001) and a higher level of education (p < 0.05) significantly increased the odds of patients receiving information about peer support in the treatment facility. Despite relatively satisfactory quality of physician-patient interactions in cancer care (M = 3.5 (± 1.1)), many patients expressed that better patient-centred communication and coordinated, comprehensive cancer care are needed. Conclusion The findings reflect effective developments and improvements in cancer care and suggest that patients’ social characteristics are less decisive for delivering patient-centred quality care than systemic factors surrounding the care facilities. They can serve to inform oncology care in Germany.

OBJECTIVE:To investigate variations in intended utilization in cases of an acute psychotic episode, an alcohol related or depressive disorder depending on different case characteristics. METHODS:A telephone survey with case vignettes was conducted (N=1,200). Vignettes varied in terms of urgency of symptoms, daytime, sex of the afflicted person and age/mental disorder. The respondents were asked to indicate whom they would contact first in the described case. RESULTS:Outpatient physicians were named most frequently as the first point of contact (61.1%) while only 6.5% of the respondents named emergency medicine including the medical on call service (8.1% in high urgency cases, i. e. emergencies that did not tolerate any delay). Intended utilization varied by urgency and age/mental illness. CONCLUSION:More Information about the need to seek medical help immediately in cases of mental illnesses with high urgency should be provided.

Objective: To compare health service use (HSU) between migrants and non-migrants in Germany.Methods: Using data from the population-based German National Cohort (NAKO), we compared the HSU of general practitioners, medical specialists, and psychologists/psychiatrists between six migrant groups of different origins with the utilization of non-migrants. A latent profile analysis (LPA) with a subsequent multinomial regression analysis was conducted to characterize the HSU of different groups. Additionally, separate regression models were calculated. Both analyses aimed to estimate the direct effect of migration background on HSU.Results: In the LPA, the migrant groups showed no relevant differences compared to non-migrants regarding HSU. In separate analyses, general practitioners and medical specialists were used comparably to slightly more often by first-generation migrants from Eastern Europe, Turkey, and resettlers. In contrast, the use of psychologists/psychiatrists was substantially lower among those groups. Second-generation migrants and migrants from Western countries showed no differences in their HSU compared to non-migrants.Conclusion: We observed a low mental HSU among specific migrant groups in Germany. This indicates the existence of barriers among those groups that need to be addressed.

BackgroundOverall, research on social determinants of access and quality of outpatient care in Germany is scarce. Therefore, social disparities (according to sex, age, income, migration background, and health insurance) in perceived access and quality of consultation in outpatient care (primary care physicians and specialists) in Germany were explored in this study.MethodsAnalyses made use of a cross-sectional online survey. An adult population sample was randomly drawn from a panel which was recruited offline (N = 2,201). Perceived access was assessed by waiting time for an appointment (in days) and travel time to the practice (in minutes), while quality of consultation was measured by consultation time (in minutes) and quality of communication (scale of four items, Cronbach's Alpha 0.89).ResultsIn terms of primary care, perceived access and quality of consultation was worse among women compared to men. Estimated consultation time was shorter among people with statutory health insurance compared to privately insured respondents. Regarding specialist care, people aged 60 years and older reported shorter waiting times and better quality of communication. Lower income groups reported lower quality of communication, while perceived access and quality of consultation was worse among respondents with a statutory health insurance. Variances explained by the social characteristics ranged between 1% and 4% for perceived access and between 3% and 7% for quality of consultation.ConclusionWe found social disparities in perceived access and quality of consultation in outpatient care in Germany. Such disparities in access may indicate structural discrimination, while disparities in quality of consultation may point to interpersonal discrimination in health care.

Background It has consistently been shown that perceived discrimination is associated with adverse health outcomes. Despite this uncontested relevance, there is a lack of research on the experiences of discrimination in health care. Therefore, the following research questions were addressed: (1) How often do people in Germany report having been discriminated in health care due to different reasons? (2) Which socio-demographic groups are most afflicted by perceived discrimination in health care? Methods Analyses are based on a cross-sectional online survey conducted in Germany. An adult population sample was randomly drawn from a panel which was recruited offline ( N = 2,201). Respondents were asked whether they have ever been discriminated in health care due to the following reasons: age, sex/gender, racism (i.e. migration history, religion, language problems, colour of skin), health issues or disability (i.e. overweight, mental illness/addiction, disability), socio-economic status (SES, i.e. income, education, occupation). Results 26.6% of the respondents reported discrimination experiences. Perceived discrimination due to health issues or disability was most frequent (15%), followed by age (9%) and SES (8.9%). Discrimination due to racism and sex/gender was less frequently reported (4.1% and 2.5%). Younger age groups, women, and 2nd generation migrants as well as respondents with low income and low education were more likely to report any kind of discrimination in health care. Two groups were found to be at special risk for reporting discrimination in health care across different reasons: women and younger age groups. Discrimination due to racism was more prevalent among respondents who have immigrated themselves than those who were born in Germany but whose parents have immigrated. Discrimination due to SES was significantly associated with (low) income but not with education. Conclusions More than a quarter of the adult population in Germany reported experiences of discrimination in health care. Such experiences were more frequent among lower SES groups, migrants, women, and younger people. Results underline the necessity of interventions to reduce the magnitude and consequences of discrimination in health care. Future studies should apply an intersectional approach to consider interactions between social inequality indicators regarding discrimination and to identify risk groups that are potentially afflicted by multiple discrimination.

Background: It is well established that emergency department (ED) crowding leads to worse health out comes. Although various patient surveys provide information about reasons to visit EDs, less is known in terms of beliefs about EDs among the general population. This study examines public beliefs regarding accessibility and quality of EDs and their associations with social characteristics (gender, age, education, immigration background) as well as knowledge about emergency care services and health literacy. Methods: We conducted a cross-sectional study based on a random sample of 2,404 adults living in Hamburg, Germany, in winter 2021/2022. We developed eight statements regarding accessibility and quality of EDs leading to two scales (Cronbach's alpha accessibility=0.76 and quality of care=0.75).Descriptive statistics of the eight items are shown and linear regression were conducted to determineassociations of the two scales with social characteristics as well as knowledge about emergency care services and health literacy (HLS-EU-Q6). Results: Nearly 44% of the respondents agreed that "you can always go to an ED, if you do not get as hort-term appointment with a general practitioner or specialist. "And 38% agreed with the statement, "If you do not have the time during normal practice hours due to your work, you can always go to an ED."In terms of quality, 38% believed that doctors in EDs are more competent than doctors in general practice, and 25% believed that doctors in EDs are more competent than doctors in specialized practices. In the fully adjusted model, public beliefs about emergency care accessibility and quality of EDs were significantly associated with all social characteristics and knowledge of emergency care options with the strongest associations between knowledge and accessibility (beta=-0.17;P<0.001) and between education and quality (beta=-0.23;P<0.001). Conclusion: We found endorsement of public beliefs about accessibility and quality of EDs that can lead to inappropriate utilization. Our results also suggest that knowledge of different emergency services plays an important role. Therefore, after system-related reorganizations of emergency care, information campaigns about such services tailored to socially deprived populations may help alleviate the issue of crowding.

Zusammenfassung Ziel der Studie Die Untersuchung von Variationen intendierter Inanspruchnahme in Fällen einer psychotischen Episode, einer alkoholbezogenen oder depressiven Störung in Abhängigkeit unterschiedlicher Falleigenschaften. Methode Eine telefonische Befragung mit Fallvignetten wurde durchgeführt (N=1.200). Die Vignetten variierten hinsichtlich Dringlichkeit, Tageszeit, Geschlecht und Alter/ Erkrankung. Die Befragten sollten angeben, an wen sie sich in den beschriebenen Fällen als erstes wenden würden. Ergebnisse Niedergelassene Ärzt*innen wurden am häufigsten als erste Anlaufstelle genannt (61,1%), wohingegen nur 6,5% der Befragten notfallmedizinische Angebote nannten (8,1% bei hoher Dringlichkeit, d. h. Notfälle, die keinen Aufschub duldeten). Die intendierte Inanspruchnahme variierte in Abhängigkeit von der Dringlichkeit und dem Alter bzw. der Erkrankung. Schlussfolgerungen Es sollte verstärkt darüber aufgeklärt werden, dass es bei dringlichen psychischen Beschwerden notwendig ist, umgehend medizinische Hilfe aufzusuchen.

Perceived treatment urgency of mental disorders are important as they determine utilization of health care. The aim was to analyze variations in perceived treatment urgency in cases of psychosis (adolescents), alcoholism (adults), and depression (older adults) with two levels of severity each by characteristics of the case and the respondents. A telephone survey (N = 1200) with vignettes describing cases of psychosis, alcoholism, and depression was conducted in Hamburg, Germany. Vignettes varied by symptom severity and sex. Perceived treatment urgency was assessed by three items. A sum scale was calculated. Linear regression models were computed to analyze differences in perceived urgency by characteristics of the case (severity, sex) and the respondents (sex, age, education, migration background, illness recognition, personal affliction). Perceived treatment urgency was significantly higher in severe cases and varied by education. Additionally, regarding psychosis, estimated urgency varied significantly by correct illness recognition. With regard to depression, perceived urgency differed significantly by age and correct illness recognition. Interaction effects between case severity and sociodemographic characteristics of the respondents, personal affliction, and correct recognition of the disorder were found. The identified differences should be considered in the development of interventions on mental health literacy with regard to adequate urgency assessment.

This study aims to assess whether cancer-specific knowledge (CSK) is associated with membership in a cancer peer support group (PSG) and other factors. A cross-sectional study investigated the CSK of 1121 cancer patients of various entities across Germany. CSK was measured with the BCKS-14, a 14-item knowledge instrument which was previously participatory developed with patient representatives and oncologists. Associations between CSK and PSG membership, sociodemographic factors, internet use, and preferences in medical decision-making were analysed with t-tests and multiple linear regressions. The t-test showed a statistically significant difference in CSK between members and non-members of PSGs. Knowledge for PSG members was on average 0.97 points higher (p < 0.001) and varied between 2 and 14 points compared to 0–14 points for non-members. Regression analysis revealed age, gender, time since diagnosis, education, internet use, and PSG activity to be statistically significant predictors. Younger (β = − 0.15; p < 0.001), female (β = 0.10; p = 0.001), higher educated patients (β = 0.27; p < 0.001) with and a diagnosis longer ago (β = 0.10; p = 0.002) who use the internet frequently for information seeking (β = 0.20; p ≤ 0.001) and members of cancer PSGs (β = 0.18; p ≤ 0.001) showed a higher CSK. Overall, CSK of the participants shows a high degree of variance. CSK should be promoted for all patients and especially for older, newly diagnosed patients with low educational levels and PSGs introduced early on as they contribute to improving CSK among other benefits.

Frequent utilization of emergency care and overcrowded emergency departments (EDs) are highly relevant topics due to their harmful consequences for patients and staff. The present study examines variations of intended health care use in urgent and non-urgent cases among the general population. In a cross-sectional telephone survey, a sample of N = 1,204 adults residing in Hamburg, Germany, was randomly drawn. At the beginning of the survey, one of 24 different vignettes (case stories) describing symptoms of inflammatory gastrointestinal diseases were presented to the participants. The vignettes varied in sex (male/female), age (15, 49, 72 years), daytime (Tuesday morning, Tuesday evening), and urgency (low, high). Participants were asked in an open-ended question about their primal intended utilization if they or their children would be affected by such symptoms. Overall, about 14 % chose emergency facilities (ED, ambulance, emergency practice) despite presentation of non-urgent conditions (n = 602). Intended emergency care use varied considerably even if the degree of urgency was comparable. Adolescence, male sex, and symptoms occurring in the evening were associated with increased ED and ambulance use. Inappropriate utilization of ED and ambulance (analyses regarding utilization due to non-urgent problems) was more often observed among male respondents and those with a migration background (1st generation). Information campaigns focused on emergency care use and reorganisation of emergency care wards are possible interventions.

Background There is evidence that perceived urgency of medical complaints is associated with emergency care utilization. Patients’ perception of urgency can differ from physicians’ assessment. This study explored public perceptions of urgency of severe cases of COVID-19 and inflammatory gastrointestinal disease and analyzed variations in perceptions of urgency by characteristics of the afflicted person in the vignettes and sociodemographic characteristics of respondents. Methods Vignettes with severe symptoms of either inflammatory gastrointestinal disease or COVID-19 with comparable urgency of treatment were used in a telephone survey in Germany (N = 1,207). Besides disease, the vignettes varied in terms of sex, age (child, middle-aged person, old person) and daytime (Tuesday morning, Tuesday evening). Respondents were asked to rate the urgency of the reported symptoms with four items. A sum scale was computed. Variations in perceptions of urgency according to vignette characteristics and sociodemographic characteristics of the respondents (sex, age, educational level, migration background, children (yes/no) and personal affliction) were analyzed using a linear regression model. Results In terms of vignette characteristics, multivariate analysis showed a lower estimated urgency for males, as well as for the middle-aged and aged persons, compared to the child vignettes, and for COVID-19, compared to inflammatory gastrointestinal disease. Regarding the characteristics of the respondents, estimated urgency increased with age and was lower among respondents, who were previously affected by the symptoms themselves. Conclusion Although urgency in the vignettes was comparable, variations in estimated urgency by age and sex of the afflicted person and the described disease as well as age and personal affliction of the respondents were identified. This could result in an inadequate health care service utilization. Therefore, variations in public perceptions of urgency should be considered in the planning of public campaigns on adequate health care services utilization.

OBJECTIVE:Empowerment is critical for cancer patients to make informed choices, to manage medication, and to navigate through the oncological care system. Cancer peer support provides patients with information, emotional relief and may promote empowerment. This paper provides a systematic review of the literature examining the impact of cancer peer support interventions on psychological empowerment. METHODS:PubMed, Web of Science, CINAHL, Cochrane Library, PsycINFO and PSYNDEX databases were systematically searched from inception until December 2020. We included quantitative studies, published in English or German, which examined peer-led cancer support interventions and their impact on the three components of psychological empowerment (intrapersonal, interactional and behavioural) among participating cancer patients. RESULTS:Database searches and screening of relevant reference lists identified 2336 potentially relevant articles. A total of 29 studies were included in the review. Active coping, self-efficacy and knowledge were the most prominent dimensions of empowerment in these studies. The majority of studies revealed that peer support led to a small to medium, significant increase in psychological empowerment, and was associated with further patient-reported benefits. CONCLUSIONS:The existing evidence suggests a weak to moderate, positive association between cancer peer support and the three components of psychological empowerment among cancer patients. Peer support groups should be seen as an important element in cancer care and clinical practice and, thus, be more systematically involved in cancer care.