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Article History

Received: 8 January 2025

Accepted: 20 February 2026

First Online: 11 March 2026

Competing interests

: The authors declare no competing interests.

: This study was approved by the Ethics Committee of the Faculty of Medicine, University of Tübingen (approval number 327/2021BO2, approved on 17/05/2021). The study was conducted in accordance with the principles of the Declaration of Helsinki and applicable national regulations governing research involving human participants. Ethical approval covered the collection and analysis of clinical and demographic data, administration of standardized questionnaires, audio recording, transcription and analysis of interview data, and the use and publication of anonymized data and images. Ethical approval was obtained prior to the commencement of participant recruitment and data collection.

: All participants provided written informed consent prior to enrollment in the study between 2022 and 2023, including consent for the use and publication of anonymized images. Participants were informed verbally and in writing about the purpose of the study by a physician of the study team, the voluntary nature of participation, their right to withdraw at any time without consequences for their medical care, and the intended use of their anonymized data for scientific publication. Consent covered participation in the study, completion of questionnaires, audio recording of semi-structured interviews, use of anonymized quotations, and publication of anonymized images. All participants were adults (≥18 years of age). Participants were informed that all data would be pseudonymized prior to analysis and that confidentiality would be maintained in accordance with data protection regulations.