The role of workplace support systems in reducing anxiety among cancer-diagnosed workers across disciplines in Jordanian oncology settings

Abstract

Background:

Assessing and quantifying anxiety levels among oncology professionals across different disciplines, along with evaluating the role of social support networks within healthcare institutions, can inform the development of targeted interventions aimed at enhancing staff engagement, translating research findings into practical workplace strategies, and ultimately reducing anxiety levels.

Objective:

This study aims to examine the perceptions among cancer-diagnosed workers across disciplines of workplace support systems in alleviating anxiety among employees with cancer in oncology settings in Jordan.

Methods:

A cross-sectional study was undertaken at the King Husain Cancer Center in Amman, Jordan. A proportionate sampling strategy was employed to select the sample population of 354 oncology professionals from various disciplines. Data were gathered using self-administered questionnaires on Generalized Anxiety Disorder-7, work-related issues, and work support systems.

Results:

The mean age of participants was 42.3 years. The majority of participants (n = 185, 52.3%) were of stage II cancer. In terms of treatment types received by the patients, the majority received chemotherapy (n = 325, 91.8%), while the remaining patients underwent surgery (n = 13, 3.7%). Pearson correlation was utilized to assess the relationship between anxiety disorders and variables of age and duration of diagnosis with cancer. The results demonstrated a statistically significant correlation with age (r = 0.49, p = 0.037) and duration of diagnosis (r = 0.61, p = 0.027).

Conclusion:

The study highlights the importance of workplace support systems in reducing anxiety among workers with cancer in Jordan, highlighting the need for structured and sustainable interventions to improve their well-being. This study highlights the importance of investing in workplace support programs for oncology workers with cancer, thereby raising job satisfaction, reducing burnout, and improving patient-care outcomes.

Plain language summary

Workplace support systems to reduce anxiety

Background: A workplace support system is considered the most effective method for reducing anxiety among cancer patients, involving religious coping, optimism, denial, and family support. However, Jordanian literature suggests that patient safety culture is not fully implemented in hospitals. Design: A descriptive study cross-sectional correlational design was used. The study uses a cross-sectional design to gather data on nurses’ perceptions of support systems. Conclusion: The lack of high-quality research addressing the mental health of cancer survivors, the possible influence of long-term and late effects of cancer treatment, and the limited studies attentive to prevention. It emphasizes the importance of workplace support systems in reducing anxiety among oncology nurses.

Introduction

Cancer is the world’s second biggest cause of mortality, with an anticipated 10 million deaths by 2022. ¹ Low- and middle-income nations account for over 70% of cancer fatalities. ² One-third of cancer fatalities are caused by the five leading behavioral and dietary risks: high body mass index, lack of physical exercise, alcohol consumption, and inadequate fruit and vegetable intake. ³ Tobacco use is the leading cause of cancer fatalities, accounting for around 22%. ⁴ The field of oncology nursing is extremely demanding since health professionals often treat patients with life-threatening illnesses, observe their suffering, and oversee intricate treatment plans. ⁵ The psychological and emotional toll of caring for cancer patients has been well documented; studies have shown that cancer-diagnosed workers across disciplines experience significant levels of stress, anxiety, and burnout.^6,7 In oncology settings, anxiety has an impact on cancer-diagnosed workers across disciplines, health, and patient care, possibly resulting in decreased job performance, poor decision-making, and lower-quality treatment. ⁸

It has been acknowledged that workplace support systems, such as professional development programs, peer support, counseling services, and managerial encouragement, are essential for reducing work-related anxiety in high-stress healthcare settings. ⁹ Little is known about oncology professionals’ perceptions of support systems in Jordan and their effectiveness in managing anxiety. Given the increasing cancer burden in the country, ensuring the psychological well-being of oncology cancer-diagnosed workers across disciplines is essential to maintaining high standards of care. ¹⁰

Literature review

Cancer is a significant global health challenge, with lifetime risks of 21% for males and 18% for females worldwide, influenced by population dynamics and socioeconomic factors. ¹¹ In Jordan, the incidence of cancer is rising steadily, placing increasing demands on healthcare systems, particularly oncology care. ¹² Cancer-diagnosed workers across different disciplines, who provide frontline care to cancer patients, face unique occupational challenges due to the emotionally and physically demanding nature of their work. Oncology nursing involves managing high patient acuity, complex treatment regimens, and frequent patient mortality, all of which contribute to elevated levels of work-related stress and anxiety. ⁹ In oncology settings, cancer-diagnosed workers across disciplines are particularly vulnerable due to the emotional toll of caring for patients with life-threatening illnesses. ¹³ The intense workload and repeated exposure to patient suffering can lead to burnout and anxiety disorders, which impair cancer-diagnosed workers’ well-being and quality of care. ¹⁴ In Jordan, the healthcare system faces additional challenges, including resource constraints and a rising cancer burden, which exacerbate workplace stress for cancer-diagnosed workers across disciplines. ¹⁵ Limited implementation of patient safety culture in Jordanian hospitals further compounds these issues, as inadequate safety protocols can heighten cancer-diagnosed workers across disciplines by increasing their responsibility for patient outcomes. ¹⁶

Workplace support systems, including emotional, social, and organizational resources, are crucial for healthcare workers, particularly cancer-diagnosed workers across disciplines. ¹⁷ These systems can enhance resilience, reduce anxiety, and improve job satisfaction. Emotional support from colleagues and supervisors buffers the psychological impact of high-stress environments. ¹⁸

However, the effectiveness of workplace support systems in reducing anxiety among oncology professionals in Jordan remains underexplored. While studies have examined support systems for cancer patients, less attention has been given to the needs of cancer-diagnosed workers across disciplines, particularly from their perspectives. Existing Jordanian literature highlights gaps in organizational support and patient safety culture, suggesting that cancer-diagnosed workers across disciplines may lack adequate resources to cope with occupational stress. ⁸ This gap is critical, as unsupported cancer-diagnosed workers across disciplines may experience higher anxiety levels, leading to reduced job performance and increased turnover.

This study hypothesized that (1) there are differences in workplace support systems, work-related issues, and levels of generalized anxiety disorder (GAD) across different demographic groups; (2) there are differences in workplace support systems, work-related issues, and levels of GAD based on cancer-related characteristics; (3) workplace support systems and work-related issues are associated with levels of GAD.

This study will answer the following research questions:

1. What is the relationship between workplace support systems, work-related issues, and GAD according to demographic information (age, sex, marital status, education, and job role)?

2. What is the relationship between workplace support systems, work-related issues, and GAD according to cancer disease information (diagnosis time, stage of cancer, type of cancer, and treatment type)?

3. What is the impact of workplace support systems and work-related issues on GAD?

4. What is the relationship between workplace support systems (dimensions), work-related issues (dimensions), and GAD?

Materials and methods

Design

A descriptive, cross-sectional, correlational design was used. According to Polit and Beck ¹⁹ this design is used to gather data on cancer-diagnosed workers across disciplines, allowing for a single point of observation without requiring long-term follow-up. This design is practical, cost-effective, and efficient for hospital settings, allowing quick data collection from a large sample.

Participants

The target population includes cancer-diagnosed workers across disciplines in Jordan. A proportional stratified sampling method was employed to ensure representation from various healthcare settings, particularly from regions with higher concentrations of such workers. Hospital administrations and nursing departments facilitated participant recruitment, with the number of participants selected in proportion to each unit’s representation within the overall population of oncology-related healthcare professionals. In this study, the eligibility criteria were (1) Cancer-diagnosed workers across disciplines, (2) Age of 18 years and above, and (3) Participation in the study is voluntary.

Data collection

Data were collected from those who worked with cancer in assigned oncology settings between October 2019 and January 2020. A self-reported questionnaire was used for data collection. A panel of experts was involved in the questionnaire development through a panel of experts set up for the project. The ethics committee evaluated the questionnaire and made some changes to its language. The readability of the questionnaire was assessed using the Flesch Reading Ease Score in Microsoft Word. The scale ranges from 0 to 100, with higher scores indicating greater ease of comprehension. A score between 80 and 90 corresponds to a sixth-grade reading level, which is considered easy to understand for the participants. The questionnaire had a Flesch Reading Ease Score of 82.0. This questionnaire contained five segments. This questionnaire was developed based on the available literature related to workplace support systems, work-related issues, and GAD among workers with cancer. Firstly, literature mining was carried out in PubMed (Medline) and Cochrane Library to find out work and information related to workplace support systems, work-related issues, and anxiety among workers with cancer. The second target population or respondent was defined as workers with cancer. The personal interview method was chosen as the best way to reach the target respondents (in my case, the workers with cancer) since the intended respondents should constitute part of the questionnaire design process. Thirdly, the questionnaire content and wording were also based on the literature, and the questionnaire was put into a meaningful order.

Instruments

This study used a self-administered questionnaire composed of five sections: (1) sociodemographic information, (2) cancer-related data, (3) workplace support systems, (4) work-related issues, and (5) GAD. The target population included cancer-diagnosed workers across disciplines.

The questionnaire was partially adapted from existing validated tools and partially developed by the authors. The development process involved an extensive review of the literature and expert consultation in oncology nursing and occupational health. The instrument was piloted with a small group of eligible cancer-diagnosed workers across disciplines of workplace support systems (n = 354) to assess clarity, relevance, and internal consistency. Minor modifications were made based on their feedback. Section 1: Collected sociodemographic data, including age, sex, marital status, educational level, job role, and position. Section 2: Gathered cancer-related data, such as duration since diagnosis, stage of cancer, and types of treatment received. Section 3: Focused on the Workplace Support System. This section was adapted from a questionnaire originally validated in a study by Challinor et al., ⁹ which demonstrated high internal consistency (Cronbach’s α = 0.96 for the full scale; 0.82–0.93 for subscales). It consists of 25 items covering work schedule and job demands, employment security, financial and social support, and the physical work environment. Responses were rated on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). Based on the scoring range (1–7), support levels were categorized as follows: 1.0 to ⩽3.0 = Disagreement, 3.1 to ⩽5.0 = Neutral, 5.1 to 7.0 = Agreement. Section 4: Addressed Work-Related Issues was developed by the authors using themes identified in previous literature on occupational functioning among workers with chronic illnesses. This section includes 17 items evaluating work absences, performance, motivation, stress, and emotional well-being. Items were scored on a 7-point Likert scale, similar to Section 3. The scale has been referenced in prior research on workplace accommodations and psychological challenges among employees with medical conditions.^19–21 Section 5: Measured GAD using the well-established GAD-7 scale developed by Spitzer et al. ²⁰ It includes seven items rated on a 4-point Likert scale (0 = not at all to 3 = nearly every day), yielding a total score between 0 and 21. Anxiety severity is categorized as follows: 5–9 = Mild; 10–14 = Moderate; 15–21 = Severe.

The GAD-7 has demonstrated strong psychometric properties, including high internal consistency (α = 0.92) and test-retest reliability (Intraclass Correlation Coefficient (ICC) = 0.83). It has been widely used in oncology and nursing populations.

Ethical considerations

The King Hussein Cancer Center (KHCC) Institutional Review Board granted permission and clearance with a reference number of (19/KHCC/112). The University Ethics Committee for Research Involving Human Subjects, Faculty of Medicine and Health Sciences (FMHS), University Putra Malaysia (UPM) also provided ethical approval with a reference number of (UPM/FPSK/JKPP/A0426). Written informed consent was obtained from participants after the study’s details were thoroughly considered and its ethical implications were properly addressed. Privacy and confidentiality were maintained for all participants. The study ensured participant confidentiality by anonymizing personal information, securely storing survey responses, and de-identifying data.

Data analysis

The Statistical Packages for Social Sciences (IBM SPSS Statistics, Version 27) was used to analyze the data. Data was checked for missing values, outliers, and normality. The demographic data of the participants was examined and compiled using the following metrics: mean, standard deviation, frequency, and percentage. Inferential statistics was used in addition to the Pearson correlation, which was set as statistically significant at p ⩽ 0.05.

Results

Sociodemographic characteristics

A total of 354 workers with cancer were approached in the KHCC during the period of data collection. The study had a 100% response rate. Table 1 illustrates the respondents’ sociodemographic characteristics. The respondents’ mean age was 42.3 years. The bulk of responders were married (n = 279, 78.8%). The majority of them held a bachelor’s degree (n = 203, 57.3%), whereas 44 (12.4%) had a high school diploma. In terms of job roles, the biggest percentage worked in business (n = 106, 29.9%), followed by teachers (n = 73, 20.6%), and the lowest was drivers (n = 8, 2.3%). Among the 71 health professionals, 45 (63.4%) were nurses, 15 (21.1%) physicians, 6 (8.5%) laboratory technicians, and 5 (7.0%) other health professionals.

Table 1.

Sociodemographic characteristics of participants (n = 354).

Variable	Frequency	Percentage (%)
Age group (years)
18–30	49	13.8
31–40	111	31.4
41–50	118	33.3
51–60	76	21.5
Sex
Male	215	60.7
Female	139	39.3
Marital status
Single	51	14.4
Divorced/Widowed	24	6.8
Married	279	78.8
Educational level
Primary school	16	4.5
Intermediate school	19	5.4
High school	44	12.4
Two years of college	36	10.2
Bachelor	203	57.3
Postgraduate	36	10.2
Job role
Business	106	29.9
Civil servant	63	17.8
Driver	8	2.3
Engineer	33	9.3
Health professionals
Nurses	45	12.7
Physicians	15	4.2
Lab technicians	6	1.7
Other HPs	5	1.4
Teachers	73	20.6

Workplace support system dimension

Table 2 shows the results of the workplace support system and its dimensions. The results have shown neutral (neither agree nor disagree) and disagreement, as they fluctuated between 2.53 and 4.99. The social support dimension came first with an average of (4.99 ± 1.09), then the physical work environment (4.75 ± 1.48), and the work schedule (4.69 ± 1.45). The training and return to work program (2.53 ± 1.72) was the lowest rank on the workplace support system.

Table 2.

Workplace support system dimension (n = 354).

Rank	Dimension	Mean ± SD	Degree of approval
3	Work schedule and job demand	4.69 ± 1.45	Neither agree or disagree (neutral)
5	Employment opportunities and job security	4.34 ± 1.80	Neither agree or disagree (neutral)
6	Training and return to work program	2.53 ± 1.72	Disagree
4	Financial support	4.65 ± 1.26	Neither agree or disagree (neutral)
1	Social support	4.99 ± 1.09	Neither agree nor disagree (neutral)
2	Physical work environment	4.75 ± 1.48	Neither agree nor disagree (neutral)
	Workplace support system	4.32 ± 0.95	Neither agree or disagree (neutral)

M: mean; SD: standard deviation.

For more details about the workplace support system, answers for the first dimension (work schedule and job demand) ranged from neutral to agree, with the mean ranging from 3.98 to 5.32. The highest rank was related to the item “The leave system/policy is good for me” with an average of (5.32 ± 1.69), followed by the item “I do not have problems taking a break from my work” with an average of (4.83 ± 1.66). The last item was related to “I do not feel pressured to complete my task” with an average of (3.98 ± 1.91; Table 3).

Table 3.

Work schedule and job demand item (n = 354).

Rank	Paragraph	Mean ± SD	Degree of approval
4	The job demand is reasonable for me	4.63 ± 1.90	Neither agree or disagree
5	I do not feel pressured to complete my task	3.98 ± 1.91	Neither agrees or disagree
3	The current working hours/schedule suit me	4.68 ± 1.71	Neither agrees or disagree
1	The leave system/policy is good for me	5.32 ± 1.69	Agree
2	I do not have problems taking a break from my work	4.83 ± 1.66	Neither agree nor disagree
	Work schedule and job demand	4.69 ± 1.45	Neither agree or disagree

M: mean; SD: standard deviation.

Employment opportunities and job security

Regarding employment opportunities and job security, it was reported that the first rank was related to the item “I think I can keep my job” with an average of (4.67 ± 1.86), and in the second rank, “I have an equal chance to get promoted with other co-workers” was stated with an average of (4.49 ± 2.19). The last rank for job security was related to “I feel secure about the future of my job” with an average of (3.88 ± 2.07; Table 4).

Table 4.

Descriptive analysis for employment opportunities and job security.

Rank	Paragraph	Mean ± SD	Degree of approval
2	I have an equal chance to get promoted with other coworkers	4.49 ± 2.19	Neutral
3	Full promotional opportunities are available to me	4.34 ± 2.21	Neutral
1	I think I can keep my job	4.67 ± 1.86	Neutral
4	I feel secure about the future of my job	3.88 ± 2.07	Neutral
Employment opportunities and job security		4.34 ± 1.80	Neutral

M: mean; SD: standard deviation.

Training and return to work program

Concerning the training and return to work program, it was revealed that the item related to “The return to work program is beneficial to me” was the first rank with an average of (2.34 ± 1.81), while the item “The return to work program is made available for me” was the last rank in the training and return to work dimension with an average of (2.09 ± 1.73; Table 5).

Table 5.

Descriptive analysis for the training and return to work program.

Rank	Paragraph	Mean ± SD	SD	Degree of approval
4	The return to work program is made available to me	2.09	1.73	Disagree
1	The return to work program is beneficial to me	2.84	2.01	Disagree
3	The training programs provided enable me to cope with my work	2.34	1.81	Disagree
2	The training programs help me to prepare myself to return to work after a long treatment. Training and return to work program	2.84	1.99	Disagree

M: mean; SD: standard deviation.

Relationship between anxiety disorders and Sociodemographic characteristics

Pearson correlation was utilized to assess the relationship between anxiety disorders and variables of age and duration of diagnosis with cancer. The results demonstrated that there is a statistically significant correlation with age (r = 0.49, p = 0.037) and with duration of diagnosis (r = 0.61, p = 0.027).

Discussion

The purpose of this study is to look at the influence of the workplace support system from the perspective of Jordanian employees who are cancer patients. Employees with cancer’s anxiety levels are influenced by factors such as their job title, gender, and educational level. Workplace support systems are critical to employees’ well-being, contentment, and performance. ²⁰

The sociodemographic variables of age and marital status have no significant impact on workers’ cancer anxiety levels. This finding could be related to the fact that workplace stressors and support systems have a more direct influence on anxiety than personal factors, or that marital status does not serve as a significant protective factor. The sociocultural context in Jordan may also influence how marital status interacts with workplace dynamics and mental health. Thus, these variables remain neutral, and the developed mitigation and control strategies can be generalized across any age category regardless of the workers’ marital status. These findings contradicted a study conducted by Di Mattei et al., ²⁰ which discovered that higher state anxiety levels were associated with poorer role, emotional, and social functioning, as well as a lower overall quality of life. Higher trait anxiety levels and peer support were associated with better role functioning. Similarly, being married was linked to greater social, cognitive, and physical functioning. In contrast, the occurrence of relapsed cancer had a negative correlation with these patients’ quality of life.

The investigation of the relationship between GAD-7 and other variables revealed a negative relationship. These variables include the physical work environment, financial support, social support, and training and return to work programs. Conversely, the GAD-7 has a positive association with other measures, including work absenteeism, work capacity, job performance, work motivation, and work-related stress and emotions. This result was consistent with a study performed by Ning et al., ²¹ who found four profiles of cancer-diagnosed workers across disciplines where work-related stress could be distinguished: relatively low, comparatively high, high, and highest. Various profiles were predicted by GAD, job performance, health, and distaste for nursing as a profession. It was concluded that most professionals who were diagnosed with cancer fell into profile 2, and they experienced a comparatively high level of job stress. It may be possible to lessen workers’ job stress by lowering anxiety levels, improving job performance, strengthening workers’ health, and altering professional attitudes toward nursing.

The mental health of cancer patients at all stages is a key and growing scientific and clinical focus. In the current study, the prevalence of anxiety is higher than in the general population, but estimates vary due to a variety of factors, including cancer type and stage. Patients frequently do not receive psychological assistance or treatment. This is most likely due to a combination of reasons, including a lack of understanding and recognition of psychiatric symptoms, a lack of availability or assistance, a lack of information regarding effective treatments, stigma, and patient desire. These findings were consistent with studies performed by Niedzwiedz et al., ²² and Więckiewicz et al. ²³ who reported that numerous personal, psychological, social, and contextual factors, as well as traits associated with cancer and the treatment received, may have a part in the growing anxiety levels and depression in cancer patients. Cancer patients with mental health issues face increased socioeconomic risks, including augmented healthcare expenses, reduced treatment adherence, and reduced quality of life. Physicians can mitigate these risks by adopting integrated care strategies, providing proactive measures, personalized support, and tailored interventions to improve outcomes and overall well-being.

Furthermore, the current study discovered that people with cancer have higher rates of anxiety and depression than the general population, though estimates vary depending on a variety of factors such as disease type, treatment environment, and time after diagnosis. This finding was consistent with a study conducted by Jang et al., ²⁴ who stated that not only can cancer patients experience anxiety and despair after receiving a diagnosis, but female family members are more likely to experience depression if the cancer patient’s condition worsens. It also reported that families with cancer patients must provide mental health care for all members of the family; family members are crucial in helping patients cope with cancer treatment. Finally, this study evaluates anxiety among cancer employees and the impact of social support systems in enterprises, aiming to develop strategies for staff engagement and potentially reduce anxiety levels. In addition, our findings enable supervisors to create work conditions that lead to improved engagement among cancer patients, where the information can be utilized for the execution of similar studies. The study on cancer workers of workplace support systems in reducing anxiety in Jordanian oncology settings has limitations. Its cross-sectional design limits causal inferences, and future research should consider a longitudinal design. The sample may not accurately represent the diversity of Jordan, regional differences, or the variety of support systems; therefore, the generalizability is limited to one specialized cancer center. Self-reported data could introduce biases, and external factors like personal life stressors might influence anxiety levels.

Implications and recommendations

The study recommended the following points in the palliative care settings:

• Human resources-led support groups can serve as psychological buffers for palliative care workers frequently exposed to grief and terminal illness.

• Such support systems can also enhance team cohesion and patient-centered care, ultimately improving the quality of palliative services.

• Encouraging staff participation in emotional support programs may also translate to better patient-family communication and improved continuity of care for those in advanced stages of illness.

To address the absence of formal support programs for workers with cancer in Jordan, the study recommends the following structured actions:

• Establish organization-based support programs

• Allocate institutional resources

• Engage human resources (HR) departments

• Design inclusive and scalable support structures.

Conclusion

This study highlights a critical gap in the existing literature regarding the mental health of cancer survivors, particularly concerning the enduring psychological impact of long-term and late effects of cancer treatment. Despite growing recognition of these challenges, few studies have thoroughly explored preventive strategies or workplace-based interventions aimed at reducing anxiety among employed cancer survivors. The findings of this study underscore the perceived value of workplace support systems—such as flexible scheduling, managerial empathy, and psychological counseling—in mitigating anxiety and enhancing emotional well-being. Furthermore, participants emphasized the role of integrative and alternative therapies, including yoga, spiritual programs, music therapy, and mindfulness, in fostering emotional resilience and promoting a more supportive and health-conscious work environment. Accordingly, hospitals and healthcare institutions should consider embedding these support strategies into occupational health programs, as doing so not only benefits workers with cancer but may also enhance overall patient care through improved staff well-being and retention.