Articoli scientifici
13/07/2026

The lived experience of cancer screening healthcare workers during the COVID-19 pandemic: an Italian multiregional survey

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Introduction

The COVID-19 pandemic emerged in early 2020, posing unprecedented challenges to healthcare systems worldwide. Among the most affected workers there were healthcare professionals, who continued working in the early stages of the emergency, facing intensified workloads and professional uncertainty, exacerbated by the initial lack of scientific understanding. 
The available literature on the impact of the pandemic on healthcare professionals’ psychological well-being shows that such overload caused significant distress, including post-traumatic stress disorder, anxiety, depressive symptoms, insomnia, as well as feelings of anger and fear.1-4 Most studies focused on frontline workers, such as those in COVID-19 or intensive care units, where patient mortality was extremely high.5-10 From the pandemic outset, it was clear that protecting healthcare workers’ mental health was essential for managing the epidemic and safeguarding  their long-term health.11
Many countries, including Italy, suspended non-urgent medical services to reduce the virus transmission, and reallocate resources to critical care.12-17 Also oncological screening programmes were temporarily halted during the pandemic first wave.18-20 In Italy, cancer screening programmes were interrupted from March to April 2020, following ministerial directives. This affected first-level services, which target a clinically asymptomatic population. On the other hand, second-level services were not paused due their non-deferrability, as clarified by a note from the Italian Ministry of Health.16,17 The timing, intensity, and pace of the recovery, however, varied across and within regions.21,22
While the effects on patients from delayed diagnoses and treatments have been widely reported,19,21-26 the specific impact on screening workers remains underexplored, although some evidence exists on the well-being of cancer healthcare workers in general.27-29 This project was carried out within the framework of the Italian Ministry of Health CCM 2021 multiregional programme “Development of strategies to promote healthy lifestyles and implement recovery interventions for delays in oncology screening programmes to counteract the effects of the COVID-19 pandemic on chronic non-communicable diseases”, programmatic line 5, coordinated by the Emilia-Romagna Region. The Institute for Cancer Research, Prevention, and Clinical Network (ISPRO) of Florence was responsible for objective 3, aimed at developing a training plan for cancer screening professionals to deepen emergency issues and maintain high preparedness. In order to achieve this, ISPRO conducted a self-administered survey assessing the training needs and experiences of oncology screening operators during the pandemic. The questionnaire also identified best practices used to manage this crisis. This approach enabled the design of a training plan tailored to the participants’ specific needs, providing an opportunity to critically analyse pandemic experience and draw lessons for the future.  
This paper reports the results of the survey conducted for this purpose. 

Materials and methods

Study Design and Participants

ISPRO developed an anonymous online questionnaire on Google Forms. A convenience sampling approach was used. The survey link was distributed by regional managers of Toscana, Emilia-Romagna, and Basilicata Regions to all people who were professionally involved in organized cancer screening programmes (including front office staff, administrative personnel, and healthcare operators providing screening services). Participation was voluntary and anonymous. All questionnaire items were mandatory to minimize missing data, except for conditional open-ended questions.
The three Regions participating in the study differ significantly in population size and in the organization of cancer screening programmes. Emilia-Romagna has 4,465,678 inhabitants, Toscana 3,660,834, and Basilicata 529,897 (ISTAT data as of 01.01.2025).30 Emilia-Romagna comprises 8 local health units, Toscana 3, and Basilicata 2, resulting in substantial differences in the catchment area size. Organizational models for cancer screening also vary: Toscana and Emilia-Romagna rely on publicly employed healthcare staff with partially outsourced services, whereas Basilicata service delivery is largely outsourced.  
The questionnaire was disseminated between May and June 2023.

Questionnaire structure

The questionnaire was designed as an exploratory tool tailored to the objectives of the CCM 2021 project. Two researchers (GM, EB) compiled a preliminary list of items inspired by international key documents on workplace well-being31,32 and qualitative interviews conducted by GM with screening staff as part of previous research. The conceptual domains guiding item development included: 1. psychological well-being and perceived stressors; 2. organizational communication and support; 3. team dynamics and collaboration; 4. professional recognition and motivation; 5. preparedness and training needs for future emergencies. The draft list was reviewed by 4 senior cancer screening experts who suggested modifications where appropriate. This review process strengthened the content validity and comprehensibility of the final instrument. The final version comprised 36 items organized into three sections (see Questionnaire – online Supplementary Materials):

  • First section, “Experiences during the pandemic”, focused on communication, organizational changes, team dynamics, interaction with cancer screening users, work-life balance, professional recognition, and motivation, aiming to capture the professionals’ day-to-day challenges;
  • Second section, “organizational support”, examined support measures implemented by healthcare organizations for employees, best practices adopted to manage the crisis, the consequences determined by the pandemic, and perceived preparedness for future emergencies; its goal was to identify effective strategies that could enhance resilience and improve readiness for similar events;
  • Third section, “Socio-demographic characteristics of participants”, collected detailed information on participants’ age, gender, roles within screening programmes, years of professional experience, and regional affiliations.

Responses were self-reported using a combination of five-point Likert scales (strongly agree, agree, neither agree nor disagree, disagree, strongly disagree), multiple-choice questions, and open-ended prompts to allow both quantitative and qualitative analysis.  

Analyses

Descriptive analyses were performed using Stata/SE version 16.1 (StataCorp LP, College Station, TX) to summarize quantitative data. Likert-scale and multiple-choice responses were analysed through frequency distributions, while open-ended answers underwent thematic analysis using an inductive coding process to identify recurring patterns and key themes.33 
Comparisons across subgroups (region, years of experience, and professional role) were explored using chi² tests. To further investigate factors associated with selected key outcomes, multivariable ordered logistic regression models were fitted. Outcomes included in multivariable analyses were selected based on their conceptual relevance and bivariate analyses, retaining those showing variability across key covariates. Variables included in the models (professional role, region, and years of experience) were selected for their theoretical relevance.

Results

A total of 317 responses were collected. Response rate was not calculable as the exact number of invited workers is unknown. As all questionnaire items were set as mandatory in the online form, there were no missing data.

Sociodemographic characteristics of participants  

Participants were predominantly female (82.3%), with a mean age of 56 years and an average of 30 years’ experience in screening programmes. Most respondents were based in Emilia-Romagna (65.0%), followed by Toscana (33.1%) and Basilicata (1.9%). Many worked in cervical (38.8%), breast (33.8%), or colorectal (6.9%) cancer screening, while 20.5% held a cross-programme role. Participants’ role varied widely: most were involved in clinical care (63.7%), followed by organizational management (20.2%) and front desk or call centre activities (7.3%) (Table 1).

 

Experiences during the pandemic

Likert-scale responses regarding pandemic experiences and organizational support are summarized in Figure 1.

 

Response to organizational changes

Overall, 58.4% (N. 185) of participants agreed or strongly agreed that organizational changes were communicated clearly and effectively, whereas 21.4% (N. 68) disagreed or strongly disagreed. The remaining 20.2% (N. 64) expressed a neutral stance. Moreover, 34.4% (N. 109) felt involved in organizational decision-making, while 35.0% (N. 111) did not. Most healthcare professionals (81.4%, N. 258) reported adapting quickly to the organizational changes imposed by the health emergency, whereas only 7.6% (N. 24) felt they had not adapted adequately.

Interaction with cancer screening users

Many participants (59.6%, N. 189) believed that changes in screening services’ modalities and timelines were communicated clearly and effectively to the public, whereas 16.4% (N. 52) expressed disagreement. Regarding direct communication with screening users during the emergency, 35.6% (N. 113) reported difficulties, 29.3% (N. 93) disagreed or strongly disagreed with this statement, and 27.1% (N. 86) were neutral. A small proportion (7.9%, N. 25) did not respond, as their role did not involve communication with users.

Team dynamics and support

Most participants (87.1%, N. 276) stated that their workgroups operated in a coordinated and collaborative manner during the COVID-19 emergency, while only 6.7% (N. 21) disagreed. Furthermore, 86.8% (N. 275) shared concerns and difficulties with colleagues, while 3.5% (N. 11) did not. Notably, 41.0% (N. 130) reported that their relationship with colleagues had improved even after the pandemic, whereas 14.2% (N. 45) did not agree. However, many participants found it difficult to position themselves on this issue, with 44.8% (N. 142) selecting a neutral response (neither agree nor disagree).

Personal experiences and motivation

Regarding their role and professional skills, 65.9% (n. 209) stated that the pandemic led to the development of new competencies, whereas 10.4% (N. 33) disagreed. Additionally, 76.4% (N. 242) felt useful in their professional role during the pandemic, while 6.6% (N. 21) did not share this sentiment.
Concerning recognition, 62.8% (N. 199) felt recognized for their contribution by screening users, with 11.7% (N. 37) strongly agreeing with this statement, while 13.6% (N. 43) disagreed. Similarly, 65.9% (N. 209) felt recognized by their colleagues, with 16.7% (N. 53) strongly agreeing, while 8.2% (N. 26) disagreed. Organizational recognition was more fragmented: 31.9% (N. 101) felt acknowledged, 25.2% (n. 80) disagreed, and 12.6% (N. 40) strongly disagreed. Neutral responses ranged from 23.7% (N. 75; users) to 30.3% (N. 96; organizational). Motivation results were similarly mixed: 42.9% (N. 136) reported increased motivation during the pandemic, 18.3% (N. 58) did not perceive any increase. A significant 38.8% (N. 123) of participants were unable to position themselves on this issue. Regarding work-life balance, 55.5% (N. 176) reported difficulties maintaining equilibrium, whereas 20.5% (N. 65) did not.

Reflections on screening programmes

Participants were asked about their views on the temporary suspension of first-level screening activities in the event of a future health emergency. Many (46.1%, N. 146) opposed this measure, with 15.8% (N. 50) strongly disagreeing, whereas 34.3% (108) were favourable, including 11.4% (N. 36) who strongly supported it. The remaining 19.9% (N. 63) did not express any preference. There was a strong agreement on the need to reaffirm the importance of cancer screening in society. More than half (62.2%, N. 197) strongly agreed, 30.6% (N. 97) agreed, and only 1.9% (N. 6) disagreed. A similar level of agreement was observed regarding the need to reinforce the role of screening within the healthcare system, with 57.1% (N. 181) strongly agreeing, 32.2% (N. 102) agreeing, and only 2.8% (N. 9) disagreeing. Regarding post-pandemic changes in work practices, 34.4% (N. 109) reported changes in their roles, 41.3% (N. 131) were unable to determine whether their work had changed, and 24.3% (N. 77) had not experienced such changes. 
Participants who experienced changes were asked to elaborate. Their responses were categorized thematically, revealing several positive developments, including the introduction of technological simplifications, greater adaptability to change, and enhanced teamwork. At the same time, many reported increased fatigue, stress, and concern about the possibility of another pandemic wave. Difficulties in communicating with screening users were highlighted, with users described as more impatient, distrustful, and dissatisfied. Several organizational changes were perceived as detrimental to service quality, including more complex and unclear procedures, increased workloads, staff reductions, and a reduced focus on community engagement initiatives.

Organizational support

Cancer screening workers’ responses to the questionnaire section “Organizational support” (open-ended answers excluded) are summarised in Figure 2.

 

Support received

The second section of the questionnaire explored organizational support provided to employees during the emergency. Multiple-choice answers are summarized in Figure 2. The results indicated that the main interventions were emergency-related training, received by 36.0% (N. 114) of participants, followed by group support interventions, reported by 23.7% (N. 57). Only 3.5% (N. 11) received psychological counselling. Almost half (49.8%, N. 158) stated that they did not receive any form of organizational support during the health crisis.

Preparedness for future health emergencies

A total of 54.3% (N. 172) of participants reported feeling prepared or somewhat prepared for future pandemics, while 8.8% (N. 28) felt unprepared or very unprepared. The remaining 36.9% (N. 117) expressed no strong opinion on their preparedness. Most considered the development of a structured pandemic plan the most valuable tool for managing future emergencies, with 63.1% (N. 200) selecting this as their preferred option. Other highly valued strategies included emergency-related training (53.6%, N. 170), team support interventions (49.8%, N. 158), and the establishment of psychological counselling services (25.6%, N. 81).

Consequences of the pandemic and implemented best practices

Participants were asked to identify areas that had experienced negative and positive consequences due to the pandemic. The most frequently reported negative consequences concerned psychological well-being, cited by 63.1% (N. 200). Other affected areas included communication with screening users (26.8%, N. 85), internal organization (25.6%, N. 81), and professional motivation (20.2%, N. 64); only 10.7% (N. 34) reported a negative impact on teamwork. Finally, 16.1% (N. 48) indicated no negative consequences. Positive impacts were most often reported in teamwork relationships (40.4%, N. 128), followed by internal organization (28.4%, N. 90), professional motivation (23.7%, N. 75), and communication with screening users (18.3%, N. 58). However, 26.8% (N. 85) perceived no positive consequences. 
In this section, participants described best practices implemented in their workplaces during the pandemic as free text. Regarding user management, the reported measures included enhancements of the electronic health record system (fascicolo sanitario elettronico), implementation of online booking systems, dedicated telephone hotlines, extended operating hours, and mailing of colorectal cancer screening kits.
New communication strategies were introduced, such as phone calls or SMS for appointment confirmations and reminders, telephonic counselling for screening-positive patients, pre-examination nurse consultations by phone, and telemedicine services. The instructions to access the services were disseminated via institutional websites, COVID-19 information centres, SMS, emails, and social media platforms. 
Organizational modifications also involved workforce management, including staff redistribution and reassignment, equitable shift rotation, review of work plans, identification of pandemic management coordinators, and adoption of remote working for specific roles. To maintain team collaboration, some workplaces increased the frequency of staff meetings to facilitate information sharing, decision-making, and mutual support, and expanded training programmes to enhance professional development.  
Finally, participants were asked which best practices remained in place after the emergency period. Many responses highlighted the continued use of technological innovations, including remote working, online meetings and training courses, and telemedicine services for patients. Respondents also emphasized organizational measures, such as screening invitations without a pre-arranged appointment, multiple examinations in a single access when possible, and colorectal cancer screening kit sent by mail.

Stratified analyses

Exploratory subgroup analyses were conducted to assess whether experiences differed according to professional role, region, and years of experience. No consistent differences emerged according to years of experience. Regional comparisons were limited by the very small number of respondents from Basilicata (N. 6), and analyses were therefore restricted to Emilia-Romagna and Toscana. No meaningful differences were observed among these regions. Differences across professional roles were observed for selected outcomes (Tables S1 and S2, online Supplementary Materials). Multivariable analyses confirmed that these differences persisted after adjustment, but were consistent with expected role-related perspectives.

Discussion

This study explored the training needs and experiences of personnel involved in Italian cancer screening programmes during the COVID-19 pandemic. The CCM 2021 programme of the Italian Ministry of Health offered a unique opportunity to examine organizational challenges, staff impact, and best practices implemented during the crisis.  
Impaired psychological well-being was the most frequently cited negative consequence (63.1%). Regarding organizational support, almost half of the participants (49.8%) did not receive any form of support, and only 3.5% had access to psychological counselling during the pandemic. However, managers are required to address workforce needs and acknowledge members who are vulnerable to mental health difficulties,34,35 especially during crisis. Direct access to psychological services ensure that all healthcare workers receive the assistance they need promptly and effectively.36 Adequate training enhances adaptive coping skills and provides staff with a toolkit to manage challenges.37,38 For instance, informing staff in advance about common psychological reactions to emergency stress facilitates their recognition.39 Most participants (86.8%) reported collaborating and sharing concerns with colleagues, although structured group support initiatives were reported by only 23.7%. Integrating psychological support into workplace emergency plans in a structured manner is crucial,40,41 highly valued initiatives include peer support and daily group sessions.42 
Although participants were not frontline workers, difficulties in maintaining work-life balance emerged in the questionnaire (55.5%). Ensuring such equilibrium during health emergencies is essential to prevent and mitigate psychosocial risks and mental health problems,35 including through appropriate workload management and rest.31,43
Consistent with other studies,44,45 some participants reported feeling excluded from organizational decision-making and lacking institutional recognition, even though feeling supported and listened to by one’s organization is a protective factor in reducing adverse psychological outcomes during crises.37 While emergencies often necessitate rapid top-down actions, practical measures such as regular streamlined multidisciplinary briefings can support a participatory approach, foster a sense of agency, and preserve workforce trust.46
Another notable finding was the strong consensus on the need to reaffirm the importance of cancer screening both within the healthcare system (89.3% agreeing or strongly agreeing) and in society (92.8% agreeing or strongly agreeing). These results likely reflect participants’ concerns about reduced participation in screening programmes following the pandemic, which may exacerbate delays in cancer diagnosis and prevention.21 Lastly, nearly half of participants (46.1%) disagreed with the suspension of first-level screening in the event of a future pandemic. This may reflect a shared expectation for improved preparedness, potentially through a structured pandemic plan, claimed by 63.1% as the most valuable tool for managing future emergencies. 
The strength of this study lies in its focus on the lived experience of organized screening operators during the pandemic, a population that has received limited attention in existing research. Another key strength is the inclusion of diverse professional roles within the cancer screening field. However, it is important to acknowledge its limitations. The CCM 2021 programme involved only a few regions, and the survey includes only three of Italy’s 21 regions/Autonomous Provinces: one from the North (Emilia-Romagna), one from the Centre (Toscana), and one from the South (Basilicata). Significant differences exist in healthcare organization and delivery, with a North-South gradient influencing national care provision, including cancer screening programmes.47 Moreover, most responses came from Emilia-Romagna and Toscana (65% and 33.1% respectively), while Basilicata was underrepresented (1.9%). In this Region, the low level of participation may partially be explained by the difficulties in reaching screening professionals, considering the extensive outsourcing of screening services. Furthermore, the convenience sampling strategy may have introduced selection and participation bias, as individuals who chose to respond might have had stronger opinions, more intense experiences, or greater engagement with the topic. Consequently, caution is warranted when generalizing the results beyond the study sample.
Finally, it is important to consider the timing of the study. The proportion of neutral responses may partly reflect the time elapsed between the acute phase of the pandemic and the survey administration. Beyond a possible recall bias, emotional intensity may have attenuated over time, leading to less polarized retrospective evaluations. In addition, changes in working conditions following the acute phase may have reshaped participants’ perceptions. Nevertheless, retrospective meaning-making remains valuable even if it does not perfectly reflect real-time experience. Individuals reinterpret past experiences in the light of present perspectives as part of ongoing sensemaking and professional identity construction, which is relevant for organizational learning.48,49 Such observations highlight that continuous monitoring of personnel’s psychological well-being within occupational health surveillance is essential.50-53

Conclusions

The pandemic aftermath highlighted the importance of providing healthcare professionals with the knowledge and tools to manage unforeseen challenges, especially in contexts like oncology screening, which relies heavily on careful planning. This aligns with longstanding principles in Medical Education, especially the psycho-educational perspective, which emphasizes the development of professionals who can adapt to changing environments and recognize the value of meaningful experiences encountered throughout their professional careers.54-56
The findings of this paper highlight that effective crisis management requires a systems-level approach integrating psychological support with key organizational elements, including workload management, institutional recognition, and participatory decision-making, as emphasized in international recommendations.31,32,46 Supporting healthcare professionals’ well-being is therefore not merely a reactive measure, but a core requirement.
The oncology screening operators’ training programme, based on the results of this survey, was held in May 2024, providing an opportunity to share experiences and best practices implemented across regions during the pandemic. However, many of these best practices were not maintained over time, representing a missed opportunity and a loss of valuable tools. Future healthcare policies should incorporate these insights to ensure that oncology screening services remain robust and effective against future health emergencies.

Conflicts of interest: none declared.

Funding: this work was supported by the Italian Ministry of Health – Centre for Disease Prevention and Control (CCM) 2021 multiregional programme “Development of strategies to promote healthy lifestyles and implement recovery interventions for delays in oncology screening programmes to counteract the effects of the COVID-19 pandemic on chronic non-communicable diseases”.

Acknowledgement: the Authors sincerely thank all the cancer screening workers who participated in the survey for their contribution. 

References and notes

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