Tailoring work participation support for cancer survivors using the stages of change: perspectives of (health care) professionals and survivors

Including 'Work as a Treatment Goal' in the Care for Patients with Chronic Diseases : The Development of a Generic Care Model-A Descriptive Study

BACKGROUND

The Netherlands faces 60% prevalence of chronic conditions by 2040, impacting societal participation and quality of life. Current clinical care inadequately addresses these consequences, and most hospitals do not integrate occupational health in their care.

OBJECTIVES

To develop a generic person- and work-oriented medical care model (WMCM) based on real life experiences with work-oriented care and supporting the chronically ill in active societal participation.

METHODS

A qualitative research project with a participative approach in one hospital (November 2019 until March 2020). In an expert meeting, a schematic representation of a work-oriented care model was developed. Subsequent discussion rounds, with professionals from different patient groups, iteratively refined the model to a WMCM.

RESULTS

Consensus was reached after seven rounds of discussion, defining the model's core elements (1) a combination of biomedical and biopsychosocial approaches, (2) involvement of a clinical occupational physician in the treatment team, (3) a coordinating role for nursing specialists, and (4) incorporation of a work-oriented intervention plan (WoIP) into the treatment plan. Advocating early attention to societal participation, the model emphasises the WoIP and consensus on monitoring indicators. The final goal is a sustainable return to societal participation, considering both quality of life and work.

CONCLUSION

It is feasible to develop a generic person- and work-oriented care model for patients with chronic illness within a hospital care setting. Collaboration between healthcare professionals and a specialised occupational physician, with a central role for nurses, is deemed crucial.

Effects of a self-managed return to work intervention for colorectal cancer survivors: A prospective randomized controlled trial

PURPOSE

The present study aims to assess the efficacy of stage-matched, self-managed Return to Work (RTW) interventions in enhancing RTW outcomes among colorectal cancer (CRC) survivors.

METHODS

This trial, conducted in South Korea, enrolled 58 unemployed survivors of colorectal cancer. Participants were randomly assigned to either an experimental or a control group. The experimental group received a self-managed return-to-work intervention based on the trans-theoretical model, while the control group received an educational booklet. Assessments were conducted at baseline and at 3, 6, and 12 months to measure changes in various factors including return-to-work status and HRQOL.

RESULTS

In the experimental group, 28 participants were randomly assigned, while 30 individuals were allocated to the control group. The experimental group exhibited a higher proportion of individuals achieving RTW (64.5% vs 39.3%, p = 0.013) and demonstrated greater improvements in work ability (p = 0.001), RTW self-efficacy (p = 0.035), readiness for RTW in the prepared-for-action (p < 00.0001), uncertain maintenance (p = 0.033), and proactive maintenance (p < 00.0001) stages, quality of working life (p = 0.003), HRQOL (p < 0.05), and illness perception (p < 0.05) compared to the control group at the 12-month follow-up.

CONCLUSIONS

Stage-matched self-managed RTW interventions incorporating TTM principles may effectively enhance RTW outcomes and work ability among CRC survivors.

Work-related experiences and unmet needs of patients with a malignant glioma and relevant professionals: the BrainWork study

PURPOSE

Many patients with a malignant (i.e., grade II-IV) glioma are of working age, yet they are rarely included in "cancer and work" studies. Here, we explored (1) the work-related experiences and unmet needs of patients with a malignant glioma and (2) the experiences and needs of relevant healthcare and occupational (health) professionals ("professionals") in providing work-related support to this patient group.

METHODS

Individual semi-structured interviews were held with patients with a malignant glioma who were of working age and had an employment contract at diagnosis, and relevant professionals. Interviews were transcribed verbatim and analysed thematically.

RESULTS

Patients (n = 22) were on average 46 ± 13 years of age (64% male) and diagnosed with a grade II (n = 12), III (n = 4), or IV glioma (n = 6). Professionals (n = 16) had on average 15 ± 9 years of relevant work experience with the patient group. Four themes emerged from the data: (1) having a malignant glioma: experienced consequences on work ability, (2) communicating about the consequences of a malignant glioma at work, (3) distilling the right approach: generic or tailored work-related support, and (4) accessibility of work-related support.

CONCLUSIONS

Glioma-specific consequences on patients' work ability necessitate better communication between, and tailored guidance for, patients, relevant professionals, and the workplace. Suggestions for improvement, e.g., the periodic use of comprehensive neuropsychological assessments, are provided in the article.

IMPLICATIONS FOR CANCER SURVIVORS

Patients with a malignant glioma would benefit from tailored and proactive outreach about work-related issues bv relevant professionals.

Cancer survivors and adverse work outcomes: associated factors and supportive interventions

INTRODUCTION

The number of cancer survivors in a working age is rising. An awareness of factors associated with adverse work outcomes, and of supportive interventions, is needed.

SOURCES OF DATA

A narrative review of research obtained via several databases, including Medline and PsycINFO, was conducted.

AREAS OF AGREEMENT

A range of factors is associated with adverse work outcomes such as prolonged sick leave, delayed return to work, disability pension and unemployment in cancer survivors. They include the cancer type and treatment, fatigue, cognitive functioning, work factors and elements of health care systems. Effective supportive interventions encompass physical and multicomponent interventions.

AREAS OF CONTROVERSY

The role of behaviour determinants and legislative and insurance systems is unclear. It is furthermore uncertain what the optimal timing of delivering supportive interventions is.

GROWING POINTS

Further focus on vulnerable groups, including specific cancer types and those with lower income, lower educational level and in precarious employment, is needed.

AREAS TIMELY FOR DEVELOPING RESEARCH

Recent developments are tailored and timely interventions.

Work resumption and retention in patients with advanced cancer: Experiences and perspectives of general and occupational health care professionals

OBJECTIVE

The objectives of this study were to explore the experiences and perspectives of general and occupational health care professionals regarding work resumption and work retention of patients with advanced cancer, and to identify barriers and facilitators these professionals may encounter.

METHODS

A qualitative design was applied, and individual semistructured interviews were conducted. General and occupational health care professionals were eligible to participate if they were involved in the work participation guidance of patients with advanced cancer, and were recruited through the network of the research team. Interview data were transcribed verbatim and analysed thematically via ATLAS.ti 9.

RESULTS

Interviewees (N = 17) had various occupational backgrounds, for example, occupational physician, reintegration consultant, and general practitioner. Four main themes emerged from the data: (1) Assumptions and hesitations, (2) Patient initiates stakeholder communication, (3) Role dispersion: who is in charge of what? and (4) Experience with legislation creates opportunities.

CONCLUSION

Whereas most interviewees had positive experiences with, and/or optimistic expectations of, the work resumption and work retention of patients with advanced cancer, several barriers to the work participation guidance of these patients were identified. Suggestions for improvement include creating widespread awareness of the possibility of work participation of patients with advanced cancer and developing reintegration guidelines for advanced cancer.

Supporting the Return to Work of Breast Cancer Survivors: From a Theoretical to a Clinical Perspective

Promoting the return to work of breast cancer survivors is of major interest to patients, healthcare and occupational health professionals, companies, governments, and researchers worldwide. We previously conducted a French consensus study resulting in a model describing the multifactorial process of the return to work of breast cancer survivors (the REWORK-BC model). Other work has identified the transtheoretical model as a relevant theoretical framework for interventions to promote the return to work of cancer survivors. In this opinion paper, we provide a theoretically-based clinical framework describing how to support breast cancer survivors at each stage of the return-to-work process. This clinical framework considers several essential aspects of supportive care for breast cancer survivors returning to work, such as: (i) helping the patient actively self-manage, by considering her to be the main decision-maker; (ii) respecting and adapting to the patient’s choice of professional project; (iii) respecting the temporality of the patient’s choices; (iv) proposing tailored interventions; (v) implementing simple tools to promote the return to work, shared representation between the patient and a multidisciplinary team, and improvement of working conditions and the knowledge of health and occupational professionals, and managers or employers; and (vi) maintaining certain flexibility aimed at proposing, but never imposing, changes in practices. This clinical framework, specific to breast cancer survivors, could be extrapolated to other tumor types, offering a practical guide for healthcare and occupational health professionals to better understand the return-to-work process of cancer survivors. This clinical framework aims to be a usable tool for any hospital or cancer care center wishing to implement a patient-centered intervention that promotes returning to work, regardless of the country.