The research, conducted by Jean C. Yi, Sheri Ballard, Emily Jo Artim, Casey Walsh, and K. Scott Baker at Fred Hutchinson Cancer Center, took a mixed methods approach, combining hard utilization data from the electronic health record with in-depth qualitative interviews. All participants were one to five years past the end of cancer treatment, a window when survivorship care is considered especially critical. The team queried the electronic health record to determine which survivors had been seen in the Survivorship Clinic, then conducted qualitative interviews with a randomly selected subset of participants drawn from a larger parent study testing a digital health intervention. That parent trial, known as INSPIRE—the INteractive survivorship program to improve health care REsources—is designed to test a digital intervention with stepped care telehealth to improve outcomes for adolescent and young adult survivors.

The demographic profile of the small group that did use the clinic was telling. Among the 38 clinic users, 86.8 percent were female, 71.1 percent were White, 86.8 percent were not Hispanic, and 65.7 percent had been treated for breast cancer. This skew toward female, White, and breast cancer populations raises questions about equitable reach, though the study’s primary focus was on understanding why utilization was so low across the board. The picture that emerged from the electronic health record was unambiguous: survivorship services, even when available at the very institution where these patients had been treated, were being used by fewer than one survivor in twenty.

To understand the reasons behind those numbers, the researchers screened a subset of 147 participants enrolled in the parent trial for approach to qualitative interviews, ultimately completing forty interviews. The interviewees had a mean age of 38.4 years, with half having had breast cancer; 78 percent were female, 83 percent were White, and 92 percent had attained a college degree or higher education. Despite being well educated and demographically similar to the clinic-using group, only one of the forty interview participants had ever visited the Survivorship Clinic. That single data point may be the most arresting in the study: even among survivors engaged enough to enroll in a survivorship research trial, virtually none had accessed the clinic down the hall.

Through content analysis of the interview transcripts, the researchers identified a set of barriers that fell into distinct but interconnected categories. The most significant was simple lack of awareness: many survivors simply did not know the survivorship clinic existed or what services it offered. This was compounded by avoidance—a psychological reluctance to confront cancer again after treatment had ended—and by lack of time, as young adults juggle careers, education, caregiving responsibilities, and the reestablishment of normal life. For a population at the busiest and most transitional stage of adulthood, an additional medical appointment that they had never heard of and did not fully understand carried little apparent urgency.

The interviews also illuminated what would have made a difference. Participants identified referrals from their oncology care teams, concrete information about the services the clinic provides, and the availability of telehealth as factors that would have facilitated them seeking survivorship care. In other words, the barriers were not primarily about motivation or health literacy alone; they were structural and communicative. Survivors needed a trusted clinician to tell them, at the end of treatment, that a survivorship clinic exists and why it matters. They needed to know what would happen during a visit—what late effects would be screened, what symptoms could be addressed, what psychosocial support was available. And they needed flexible access options compatible with the realities of young adult life, including remote participation.

The study arrives at a moment when survivorship care is being formalized at the national level. The National Standards for Cancer Survivorship Care propose health system policies to develop survivorship programs, and the National Comprehensive Cancer Network’s survivorship guidelines, updated in 2025, call for structured follow-up care including survivorship care plans. Yet this research shows that the existence of a clinic, even within a comprehensive cancer center, does not guarantee uptake. Prior work has documented low attendance among childhood cancer survivors and among Hodgkin lymphoma survivors, and studies of rural childhood cancer survivors have similarly pointed to awareness and access as limiting factors. The new study extends that evidence into the adolescent and young adult population, which is demographically and clinically distinct from both pediatric and older adult populations.

That distinctiveness is part of why the gap matters so much. Adolescents and young adults diagnosed with cancer face decades of life after cure, during which late effects—cardiac dysfunction, secondary malignancies, infertility, endocrine problems, cognitive changes, and psychosocial distress—may emerge and progress. Research has consistently shown that this age group experiences unique biology and unique psychosocial burdens, and that their survival gains have historically lagged behind those of children and older adults. Survivorship clinics are designed to catch these late effects early, coordinate surveillance, and connect survivors with interventions. When fewer than five percent of eligible survivors walk through the clinic door, the potential of that model goes largely unrealized, and preventable morbidity may accumulate silently for years.

The implications drawn by the authors are pointed. Lack of awareness of the survivorship clinic was the most significant barrier, and a referral from their oncology care team would have facilitated them scheduling a visit. This suggests a relatively low-cost, high-impact intervention: embedding an explicit survivorship referral into the standard end-of-treatment workflow, paired with clear patient-facing information about what the clinic offers and telehealth options to reduce logistical friction. The study’s connection to the INSPIRE digital health trial also hints at a broader strategy—meeting young survivors where they already are, on their phones, rather than waiting for them to find a clinic they have never heard of. As health systems implement national survivorship standards, the lesson of this study is that building clinics is only half the task; the other half is making sure the patients who need them know they exist.

For survivors themselves, the message is equally practical: late effects are real, monitoring is worthwhile, and help is available beyond the end of treatment. For oncology teams, the message is that the handoff from active treatment to survivorship care cannot be left to chance. A single sentence from a trusted oncologist—a referral, an explanation, an invitation—may be the difference between a young survivor who falls through the cracks and one who receives the long-term surveillance that modern cancer care promises. With 4.5 percent utilization as the baseline, there is enormous room for improvement, and this study offers a clear, evidence-based map of where to begin.

Subject of Research: Utilization of survivorship clinics by adolescent and young adult cancer survivors

Article Title: A mixed methods study of adolescent and young adult cancer survivors and their utilization of a survivorship clinic: Barriers and facilitators

Article References: Yi, J. C., Ballard, S., Artim, E. J., Walsh, C., & Baker, K. S. (2026). A mixed methods study of adolescent and young adult cancer survivors and their utilization of a survivorship clinic: Barriers and facilitators. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-02125-y

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02125-y

Keywords: adolescent and young adult oncology, cancer survivorship, survivorship clinic, late effects, mixed methods, qualitative interviews, telehealth, health care utilization, barriers and facilitators, cancer survivorship care standards, Fred Hutchinson Cancer Center, digital health intervention

The study, led by Peck Tiang Joanna Yeo, Rayner Kay Jin Tan, and Miho Asano of the National University of Singapore, with Asano also affiliated with the University of British Columbia, is notable for a simple but consequential framing decision. Whereas the vast majority of successful-aging research canvasses people who are already old, Yeo and her colleagues turned the lens on the cohort that will become Singapore’s next generation of elderly citizens. The rationale is straightforward: expectations, anxieties, and support needs formed in midlife may differ substantially from those of today’s 75-year-olds, shaped as they are by different economic conditions, family structures, and cultural attitudes toward health and money. If aging policy is built only around the experiences of current elders, it risks addressing yesterday’s needs rather than tomorrow’s.

To capture those forward-looking perspectives, the team conducted semi-structured qualitative interviews with 30 middle-aged Singaporeans, probing how participants understood successful aging, what they believed they would need to achieve it, and whether existing state initiatives aligned with those needs. Interview data were subjected to thematic analysis, a rigorous qualitative technique in which researchers systematically code transcripts to identify recurring patterns of meaning across respondents. This method does not quantify how common a view is; instead, it maps the conceptual terrain, revealing the dimensions along which ordinary people organize complex life goals. From the transcripts, four dominant themes crystallized: physical, financial, social, and psychological health, each subdivided into finer subthemes that together paint a granular portrait of what a good old age means to Singapore’s midlife generation.

The physical health theme, perhaps unsurprisingly, centered on staying functional. But the study’s most provocative finding lies in how participants related to disease and disability. Rather than imagining successful aging as the complete avoidance of age-related illness—an ideal long associated with the influential Rowe and Kahn model, which defined successful aging as low probability of disease, high cognitive and physical function, and active engagement with life—many middle-aged respondents felt that accepting age-related diseases and functional disabilities as an expected part of later life was itself a marker of aging successfully. In other words, success was reframed not as the absence of decline but as the capacity to anticipate, absorb, and adapt to it. This echoes a broader shift in gerontology away from rigid biomedical definitions, which studies have repeatedly shown describe only a small fraction of older adults, toward multidimensional and self-rated conceptions in which people managing chronic conditions can still consider themselves aging well.

The financial theme proved equally emphatic, and arguably the study’s most actionable finding. Participants consistently identified early financial preparation as a prerequisite for the old age they envisioned. Middle-aged Singaporeans described the need to save, plan, and acquire financial literacy decades before retirement, viewing later-life security as something constructed incrementally through the working years rather than patched together at their end. This aligns with a substantial empirical literature linking financial literacy to retirement planning outcomes across countries, from the United States to Finland, and to financial resilience in middle and older adulthood. It also reflects a distinctly Singaporean context: the city-state’s retirement income architecture, built around the Central Provident Fund and personal responsibility, places considerable weight on individual foresight, making the timing of financial preparation a genuine determinant of later-life welfare.

Social and psychological dimensions rounded out the picture. On the social front, participants emphasized maintaining relationships, staying connected to family and community, and guarding against the loneliness that decades of prospective research have linked to declining health in old age. Psychologically, respondents spoke of cultivating resilience, realistic expectations, and a sense of purpose—capacities that gerontological research suggests buffer well-being against the inevitable losses that accompany aging. Notably, studies on expectations have found that neither blind optimism nor corrosive pessimism serves people well when health deteriorates; instead, a calibrated realism about what lies ahead appears protective. The middle-aged Singaporeans in this study seemed to intuit precisely that, describing a stance toward the future that was neither denial nor dread but pragmatic preparation.

The second half of the study is what elevates it from descriptive to prescriptive. The researchers systematically compared their identified themes and subthemes against the Singapore 2023 Action Plan for Successful Ageing, the government’s national framework of initiatives spanning health promotion, lifelong learning, senior employment, and age-friendly environments. This audit revealed two distinct categories of misalignment, which the authors label temporal and contextual mismatches. Temporal mismatches are cases where the Action Plan already offers the right kind of support, but at the wrong life stage—initiatives aimed at current seniors that would serve middle-aged adults equally well if accessed later, requiring no redesign of the initiatives themselves. Contextual mismatches are more demanding: needs expressed by future older adults that current initiatives simply do not address in their present form, and which would require genuine tailoring or entirely new provision.

The distinction matters practically. If the gap between what future elders need and what the state provides is purely temporal, policymakers can simply extend the runway—communicating earlier, enrolling earlier, and encouraging midlife engagement with programs already on the books. But contextual mismatches signal genuine blind spots. The study’s findings suggest, for example, that supporting people to psychologically reframe disease and disability as a normal part of aging, and to begin serious financial preparation in their thirties and forties, may not be adequately covered by initiatives calibrated to the current elderly population. Closing those gaps, the authors argue, is essential if the Action Plan is to serve the people who will actually depend on it in the coming decades.

The demographic stakes could hardly be higher. Singapore’s population is aging at a pace few nations have experienced, compressing into a single generation a transition that took European societies a century. Ongoing research has documented the country’s rapid shift, with rising life expectancy, falling fertility, and a shrinking ratio of working-age adults to seniors. Globally, life expectancy has climbed continuously for over 150 years, and extending healthspan—years lived in good function, not merely years lived—has become a central goal of public health. For Singapore, a young nation confronting an old-age profile, the question is not whether its population will age but whether its institutions will anticipate the needs of those aging.

By filling a genuine gap in the literature—the perspectives of future rather than current older adults—the study offers service providers and policymakers evidence-based targets for intervention. Its recommendations are unsentimental: help people internalize realistic expectations about bodily decline, and help them build financial buffers early. Neither message is glamorous, and neither fits the aspirational tone that has sometimes drawn criticism to the successful-aging concept, which scholars have argued can moralize aging and shift blame onto individuals who fail to meet unrealistic standards. Yet the middle-aged Singaporeans interviewed here offer a grounded counterpoint—a vision of success built not on defying age but on preparing for it, financially, socially, and psychologically, long before it arrives.

Subject of Research: Perspectives on successful aging among middle-aged future older adults in Singapore and their alignment with national aging policy

Article Title: Successful Aging in Singapore: An Exploration of Perspectives Among the Future Older Adults

Article References: Yeo, P. T. J., Tan, R. K. J., & Asano, M. (2026). Successful Aging in Singapore: An Exploration of Perspectives Among the Future Older Adults. Ageing International, 51(3), Article 36. https://doi.org/10.1007/s12126-026-09674-8

Image Credits: AI Generated

DOI: 10.1007/s12126-026-09674-8

Keywords: successful aging, future older adults, Singapore, gerontology, qualitative interviews, financial preparation, ageing policy, physical health, psychological health, Action Plan for Successful Ageing, middle-aged adults, thematic analysis

The research emerged from the Erasmus+-funded ELPIS project, short for E-Learning on Palliative Care for International Students, a European collaboration aimed at strengthening palliative care education across borders. In 2023, the team led by Miriam Wegmann of the Department of Palliative Medicine at RWTH Aachen University offered medical students two voluntary training formats designed to build communication skills around the wish for hastened death. The first was a drama seminar, an in-person, theatre-based exercise in which students enacted difficult clinical scenarios in front of their peers. The second was an online tool, a structured digital module that allowed students to rehearse conversations at their own pace and away from the gaze of an audience. Both formats were deliberately unconventional by the standards of traditional medical curricula, which have historically privileged factual knowledge over the subtle craft of dialogue.

To understand how students experienced these formats, the researchers conducted qualitative interviews with fifteen medical students from RWTH Aachen University. Semi-structured interviews were transcribed in full and then analysed using qualitative content analysis, a method that combines inductive coding, in which themes emerge from the material itself, with deductive coding, in which predefined categories drawn from theory and prior literature are applied to the data. The dual approach allowed the team to capture both unexpected emotional responses and systematically anticipated themes such as realism, safety, and perceived learning gain. Supplementary tables published alongside the article document participant characteristics and exemplary quotations, and a supplementary figure details the final coding system, offering an unusually transparent window into the analytical process.

The drama seminar emerged in the interviews as an experience of remarkable emotional intensity. All fifteen students described it as immersive, and central to their accounts was the demand for genuine empathic engagement: to portray a patient pleading for help in dying, or a physician struggling to answer, students had to inhabit perspectives that most had never seriously considered. Participants reported that this embodied role-play triggered deep self-reflection, forcing them to confront their own attitudes toward death, autonomy, and professional duty. Crucially, the seminar also provided a rare opportunity to practise communication skills under pressure, articulating responses in real time rather than merely reading about them. In the vocabulary of medical education research, the drama format functioned as an affective and behavioural simulator, engaging dimensions of learning that lectures and textbooks rarely touch.

That intensity, however, carried a cost. Several students reported experiences of emotional overload when performing in front of their peers, a finding that speaks to a well-documented vulnerability in simulation-based education. Improvisational theatre in front of an audience of fellow students, particularly on a subject as intimate as a request for hastened death, can heighten performance anxiety to the point where the educational value is partially eclipsed by distress. The authors did not conclude that the drama seminar should be abandoned; rather, the interviews suggest that its benefits and its emotional risks are two sides of the same immersive coin, and that thoughtful pedagogical scaffolding is needed to keep the experience within a productive learning zone rather than a harmful one.

The online tool presented a nearly inverted profile. Students valued its flexibility, noting that they could engage with the material at times and in settings of their own choosing, and they praised its structured design, which guided them through conversational scenarios in a predictable, stepwise fashion. Most strikingly, the digital environment was perceived as emotionally safe: no peer was watching, no mistake was witnessed, and students with limited prior exposure to end-of-life conversations could experiment without social consequences. For novice learners in particular, this psychological safety appeared to lower the barrier to first engagement with a topic that many find intimidating. The format thus functioned as a gentle entry point, building familiarity and vocabulary before the stakes of live interaction were introduced.

The limitations of the online tool were, in the students’ assessment, the mirror image of its strengths. Because the interaction was mediated and scripted, participants described a reduced sense of realism, an absence of non-verbal interaction, and a diminished feeling of authenticity. A screen cannot frown, hesitate, or begin to weep; it cannot convey the tremor in a patient’s voice that makes a request for assisted dying so hard to meet. Communication in real clinical encounters is saturated with non-verbal signals, and a purely digital rehearsal inevitably strips away part of that complexity. The students were not rejecting the tool but recognising its proper place: excellent for preparation, insufficient on its own for mastery.

Perhaps the most actionable insight from the study is the students’ own proposal for how the two formats should be combined. Participants suggested a hybrid or blended learning approach in which the online tool serves as a preparatory phase before the drama seminar. In this sequence, the digital module would supply foundational knowledge, structured language, and emotional acclimatisation, while the drama seminar would then provide the high-fidelity, embodied practice that only live role-play can offer. The researchers note that such a blended design may reduce the emotional barriers that currently make drama-based training intimidating for some students, supporting a stepwise approach to communication training that mirrors how other complex clinical skills, from surgery to resuscitation, are progressively taught.

Beneath the pedagogical findings lies a more sobering discovery. The interviews revealed a marked lack of knowledge among the students regarding the legal framework governing assisted suicide in Germany. Even though the legal situation places direct ethical and communicative demands on practising physicians, many students could not accurately describe what the law permits, requires, or prohibits. The authors argue that this gap reinforces the need to integrate legal and ethical education into the medical curriculum alongside communication training, so that graduates can ground their conversations in accurate legal understanding rather than uncertainty. Communication skills and legal literacy, the study suggests, are not separable competencies in this domain; a physician who listens beautifully but does not know the law cannot guide a patient responsibly.

Taken together, the findings from Aachen sketch a template for how medical schools might prepare the next generation of physicians for one of the most difficult conversations in medicine. The drama seminar supplies immersion, empathy, and authentic practice, while the online tool supplies safety, structure, and accessibility, and the students themselves have articulated a sensible blueprint for combining them. As assisted dying becomes legally recognised in a growing number of jurisdictions worldwide, the demand for conversations about hastened death will reach an ever-larger share of clinicians, making preparation not a luxury but a professional necessity. The Aachen study, conducted within a European palliative care education network and published open access, indicates that neither technology nor theatre alone is sufficient, but that a carefully sequenced blend of the two, embedded within legal and ethical teaching, may finally give medical students the right words when patients need them most.

Subject of Research: Medical students' perceptions of drama-based and online communication training for conversations on the wish for hastened death

Article Title: Finding the right words: preparing medical students for communication on the wish for hastened death – medical students’ perceptions of drama-based and online communication training

Article References: Wegmann, M., Lemos, M., Fink, D., Scherg, A., & Elsner, F. (2026). Finding the right words: preparing medical students for communication on the wish for hastened death – medical students’ perceptions of drama-based and online communication training. BMC Medical Education. https://doi.org/10.1186/s12909-026-10403-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10403-7

Keywords: medical education, assisted suicide, hastened death, communication training, drama-based learning, online learning, hybrid teaching, palliative care, medical ethics, legal education, qualitative interviews, RWTH Aachen University