Perspectives of People with a Chronic Disease on Participating in Work: A Focus Group Study

Patients' Needs Regarding Work-Focused Healthcare: A Qualitative Evidence Synthesis

PURPOSE

To identify, appraise, and synthesize qualitative research evidence exploring patients' needs regarding work-focused healthcare.

METHODS

A systematic review was conducted in accordance with the PRISMA statement guidelines to identify studies reporting patients' needs regarding work-focused healthcare. Four databases (MEDLINE, Embase, PsychInfo and Web of Science) were systematically searched from January 2000 until May 2023 and screened in duplicate by pairs of two reviewers. Inclusion criteria were qualitative data collection method, and patients' perspectives regarding healthcare focusing on work when experiencing work-related problems due to chronic medical conditions. Data extraction and synthesis was executed by means of an inductive thematic analysis approach. The quality of the included studies was assessed using the CASP Qualitative Study checklist. Confidence in the review findings was assessed through the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach.

RESULTS

Out of 23,677 records, 97 qualitative studies were included. Needs regarding four main themes were identified: (1) Substantive guidance, which comprises the specific content of work-focused healthcare; (2) Clear and continuous process, which comprises clarification and optimization of the work-focused healthcare process; (3) Supportive attitude and behavior, which comprises a positive and supportive attitude and behavior from professionals towards the patients; and (4) Tailored approach, which comprises the delivery of tailored care to the individuals' needs. 17 subthemes were identified.

CONCLUSION

The broader insight in patients' needs in work-focused healthcare can help (occupational) healthcare professionals adopt a more patient-centred approach in practice.

Towards person-centred work-focused healthcare for people with cardiovascular disease: a qualitative exploration of patients' experiences and needs

PURPOSE

To explore the experiences and needs concerning work-focused healthcare of patients experiencing problems with work participation due to cardiovascular disease based on all facets of person-centred care.

METHODS

Nineteen patients who experienced or continue to experience problems with work participation due to cardiovascular disease participated in semi-structured interviews preceded by preparatory written assignments. The transcripts were analysed by means of directed qualitative content analysis. Adapted principles of the Picker Institute for Person-Centred Care provided a template for the analysis.

RESULTS

28 experiences and needs emerged and were grouped into the eight principles for person-centred work-focused healthcare. Randomly presenting one theme for each of the eight principles, the themes included: (1) frequent encounters with occupational healthcare professionals; (2) substantive work-related advice; (3) transparency in communication; (4) support for family; (5) information provision on the work-focused healthcare process; (6) personal control during the process; (7) empathy for the personal situation; and (8) tailored work-focused support.

CONCLUSIONS

The identified experiences and needs for work-focused healthcare of patients experiencing problems with work participation due to cardiovascular disease clearly indicate the need to improve the delivery of person-centred work-focused healthcare to better meet the individual needs of patients.

Work-focused healthcare from the perspective of employees living with cardiovascular disease: a patient experience journey mapping study

BACKGROUND

People living with cardiovascular diseases (CVD) often experience work participation problems. Good work-focused healthcare, defined as the received advice, treatment, and guidance focusing on work participation, can support the patient and work place. However, experiences with work-focused healthcare are generally not always positive which is a barrier for work participation. Therefore, the objective of this study is to gain insight into the work-focused healthcare journey from the perspective of patients with work participation problems due to CVD, to understand their experiences and needs, and to derive opportunities for improving work-focused healthcare service at a system level.

METHODS

Semi-structured interviews, preceded by preparatory assignments, were conducted with 17 patients who experience(d) work participation problems due to CVD. The patient experience journey map (PEJM) approach was used to visualize the patients' work-focused healthcare journey, including experiences and needs over time and place, from which opportunities to improve work-focused healthcare from the patient's perspective were derived.

RESULTS

An aggregated PEJM consisting of six phases was composed and graphically mapped. The first phase, working, represents a period in which CVD health problems and subsequent functional limitations occur. The next two phases, short- and long-term sick leave, represent a period of full sick leave. The last three phases, start-, partial-, and full vocational reintegration, focus on the process of return to work that takes place ranging from a few months up to several years after sick-listing. For each phase the touchpoints, timespan, stakeholders, activities, experiences and needs from the perspective of the patients were identified. Finally, for better work-focused healthcare nine opportunities for improvement were derived from the PEJM, e.g. emphasize the need for work adjustment prior to the medical intervention, provide more personalized advice on handling work limitations, and putting more compelling pressure on the employer to create suitable work positions for their employees.

DISCUSSION/CONCLUSION

This paper contributes insights to provide a more patient-centered work-focused healthcare trajectory for patients employed in paid jobs when living with CVD. The PEJM provides an understanding of the patients' perspectives throughout their work-focused healthcare journey and highlights opportunities for improvement towards a better suited and seamless patient journey, Although this research was conducted within the Dutch healthcare system, it can be assumed that the findings on integrated work-focused healthcare are largly transferable to other healthcare systems.

Barriers to and Facilitators of Sustained Employment: A Qualitative Study of Experiences in Dutch Patients With CKD

RATIONALE & OBJECTIVE

Although patients with chronic kidney disease (CKD) are at risk for work disability and loss of employment, not all experience work disruption. We aimed to describe the barriers to and facilitators of sustained employment experienced by Dutch patients with CKD.

STUDY DESIGN

Qualitative study using semistructured interviews.

SETTING & PARTICIPANTS

27 patients with CKD glomerular filtration rate categories 3b-5 (G3b-G5) from 4 nephrology outpatient clinics in The Netherlands.

ANALYTICAL APPROACH

Content analyses with constant comparison of interview data based on the International Classification of Functioning, Disability and Health framework.

RESULTS

Participants were 6 patients with CKD G3b-G4, 8 patients receiving maintenance dialysis, and 13 patients with functioning kidney transplants. We identified health-related barriers (symptoms, physical toll of dialysis/transplantation, limited work capacity) and facilitators (few physical symptoms, successful posttransplantation recovery, absence of comorbidities, good physical condition), personal barriers (psychological impact, limited work experience) and facilitators (positive disposition, job satisfaction, work attitude, person-job fit), and environmental barriers and facilitators. Environmental barriers were related to nephrology care (waiting time, use of a hemodialysis catheter) and work context (reorganization, temporary contract, working hours, physical demands); environmental facilitators were related to nephrology care (personalized dialysis, preemptive transplant), work context (large employer, social climate, job requiring mental rather than physical labor, flexible working hours, adjustment of work tasks, reduced hours, remote working, support at work, peritoneal dialysis exchange facility), and support at home. Occupational health services and social security could be barriers or facilitators.

LIMITATIONS

The study sample of Dutch patients may limit the transferability of these findings to other countries.

CONCLUSIONS

The wide range of barriers and facilitators in all International Classification of Functioning, Disability and Health components suggests great diversity among patients and their circumstances. These findings underline the importance of personalized nephrology and occupational health care as well as the importance of individually tailored workplace accommodations to promote sustained employment for patients with CKD.

Shared decision making from reintegration professionals' perspectives to support return to work: a qualitative study

Background

Work participation is an important determinant of public health; being unemployed leads to a decrease in an individual’s health. In the Netherlands, people with a work disability can apply for disability benefits, in which people also receive support to return to work (RTW). A method, currently used in the medical sector, that can include both the perspective of the reintegration professional and of the individual in the process of RTW, is shared decision making (SDM). In this article we explore to what extent reintegration professionals currently use SDM, and to what extent they prefer to use SDM in their ideal interaction with clients.

Methods

We performed semi-structured interviews with fourteen reintegration professionals from four different municipalities. The transcripts were coded according to content analysis, applying open and axial coding.

Results

Reintegration professionals emphasised the importance of having a good relationship with clients, of building trust and collaborating as a team. They did not inform their clients that they could be part of the decision-making process, or discussed a shared goal. Although professionals did emphasise the importance of aligning their approach with the preferences of the client and though they tried to offer some choice options, they did not mention available options, discussed the pros and cons of these options or evaluated decisions with their clients. Furthermore, they did not mention any of these aspects in their ideal interaction with clients.

Conclusions

SDM has a potential value, because all professionals underline the importance of having an alliance with clients, collaborating as a team, and striving to align their approach with the preferences of the client. However, professionals currently perform a limited set of SDM steps. Additional knowledge and skills are needed for both reintegration professionals and municipalities so that professionals can consider and reflect on the value of using SDM, or SDM steps, in supporting RTW. Providing clients with knowledge and skills seems necessary to facilitate both self-management and SDM.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10365-z.

Development of an Intervention to Create a Supportive Work Environment for Employees with Chronic Conditions: An Intervention Mapping Approach

Purpose This study describes the development of an evidence-based intervention to create a supportive work environment for employees with chronic conditions. Occupational physicians (OPs) play an important role in guiding organizations in this process of organizational change. Supportive work environments can aid in preventing work-related problems and facilitate sustainable employment. Current workplace interventions for employees with chronic conditions are mainly focused on return to work or a reduction in sick leave at the individual worker's level. This study contributes to the literature an organizational-level intervention which utilizes a preventive approach. Methods Intervention mapping (IM) is a six-step, structured protocol that was used to develop this intervention. In step 1, a needs assessment was conducted to define the problem and explore the perspectives of all stakeholders involved. The program outcomes and the performance objectives of employees with chronic conditions and occupational physicians were specified in step 2. In step 3, appropriate methods and practical applications were chosen. Step 4 describes the actual development of the intervention, consisting of (1) a training for occupational physicians to teach them how to guide organizations in creating a supportive work environment; (2) a practical assignment; and (3) a follow-up meeting. The intervention will be implemented in a pilot study in which occupational physicians will put their acquired knowledge and skills into practice within one of their organizations, which is delineated in step 5. Conclusions IM proved to be a valuable and practical tool for the development of this intervention, aiming to facilitate sustainable employment for employees with chronic conditions.

Facilitators, barriers and support needs for staying at work with a chronic condition: a focus group study

BACKGROUND

Working with a chronic condition can be challenging. Providing support to workers with a chronic condition can help them to stay at work and prevent work-related problems. Workers with a chronic condition who successfully stay at work can provide valuable input for the development of effective supportive interventions to prevent exit from work and facilitate sustainable employment. The aim of this study is to explore the lived experiences of workers with a chronic condition and identify existing barriers, facilitators and possible support needs for staying at work.

METHODS

Four focus groups were conducted between August and December 2017 with workers with one or more chronic conditions (n = 30). Participants included employees and (partially) self-employed workers. All focus group data were transcribed verbatim and thematically analyzed.

RESULTS

Disclosure and expressing one's needs were considered important personal facilitators for staying at work. Environmental facilitators included receiving practical information on working with a chronic condition and social and employer support. Environmental barriers were identified in the work environment, the health care system and service provision, e.g., manager and co-worker's lack of knowledge about working with a chronic condition, a lack of focus on work in the course of treatment for a chronic condition, dissatisfaction with occupational physician support, and the absence of support for self-employed workers. Provided support should be available to all workers, and be proactive and tailored to the workers' specific support needs.

CONCLUSIONS

A variety of facilitators, barriers and support needs were identified in various domains. By addressing environmental barriers (e.g., by integrating work in the course of treatment and creating supportive work environments), sustainable employment by workers with a chronic condition can be promoted.

Organizational justice and illness reporting among Japanese employees with chronic diseases

Purpose

This study examined the association between perceived organizational justice (i.e., procedural justice and interactional justice) and reporting of illness to one's company (illness reporting) among Japanese employees with chronic diseases.

Methods

This online cross-sectional survey included 1,134 employees (aged 18–65 years) who required workplace support to combine work with disease treatment. Participants were classified into tertiles of perceived organizational justice (low, moderate, and high). Multiple logistic regression analyses were conducted to examine sex differences in the associations between perceived justice and illness reporting.

Results

Males reporting perceived high levels of procedural and interactional justice had significantly higher odds of illness reporting than those with perceived low levels of procedural (odds ratio [OR] 2.62, 95% confidence interval [CI]: 1.47–4.66) and interactional justice (OR 4.34, 95% CI: 2.28–8.27). Females with perceived high levels of interactional justice had significantly higher odds of illness reporting than those with perceived low levels of interactional justice (OR 1.74, 95% CI: 1.08–2.80). There was no significant association between procedural justice and illness reporting among females.

Conclusion

The findings indicate that high perceived organizational justice is positively associated with illness reporting among Japanese employees who require workplace support to combine work and disease treatment.

How Can Supervisors Contribute to the Return to Work of Employees Who have Experienced Depression?

Background In Western countries, work disability due to depression is a widespread problem that generates enormous costs. Objective The goal of this study was to determine the types and prevalence of supervisor contributions during the different phases of the return-to-work (RTW) process (before and during the sick-leave absence, and during the RTW preparations) of employees diagnosed with depression. Moreover, we sought to determine which contributions actually facilitate employees' RTW, and to identify the work accommodations most frequently implemented by supervisors at the actual time of their employee's RTW. Methods Telephone interviews were conducted in Québec (Canada) with 74 supervisors working with employees who were already back at work or still on sick leave due to depression. A sub-sample of 46 supervisors who had already taken measures to facilitate their employees' RTW was questioned about the work accommodations implemented. Results Most of the supervisors got along well with their employees before their sick leave and 72% stayed in contact with them during their leave. Nearly 90% of the supervisors encouraged their employees to focus primarily on their recovery before their RTW, but 43% pressured their employees to RTW as soon as possible. Cox regression analyses performed for the entire sample revealed that "the supervisors' intention to take measures to facilitate their employees' RTW" was the only significant predictor of the RTW at the time of the interview. The Kaplan-Meier survival curve showed that 50% of the employees were expected to RTW within the first 8 months of absence. Four of the most frequently implemented work accommodations were actions directly involving the supervisor (i.e. providing assistance, feedback, recognition, and emotional support to the employee). Conclusions This study shed light on the less explored point of view of the supervisor involved in the RTW process of employees post-depression. It highlighted the most frequent and effective supervisor contributions to the process. These results can be used to develop concrete action plans for training supervisors to contribute to the sustainable RTW of employees on sick leave due to depression.