Current practices, needs, and expectations of discussing work with a medical specialist from a patient's perspective: a qualitative 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.

Employment-related Education and Support for Cancer Survivors: a Content Analysis of Employment Resources Offered on National Cancer Institute-Designated Cancer Center Websites

High rates of employment changes and associated concerns among cancer survivors following diagnosis and treatment suggest a need to examine what employment-related educational resources and support are currently being offered to cancer survivors and what gaps exist in those resources. In 2023, we conducted a content analysis of employment resources described on the websites of the NCI-Designated Cancer Centers that provide clinical care (N = 64) through a systematic review procedure using predetermined search terms and a standardized process to examine the availability and accessibility of such resources. Descriptive analyses were conducted to characterize the employment resources identified. In total, 175 employment resources were identified across 49 cancer center websites; 102 (58%) provided patient-facing education/information, 58 (33%) offered a consultation, 14 (8%) offered support groups/classes, and 1 (1%) was classified as "Other." Most (76%) resources were provided internally by the cancer center, and often, more than one discipline was involved, most commonly social work and medicine. These findings are encouraging as they suggest that most (77%) NCI-Designated Cancer Centers recognize employment support as a component of survivorship care. The multidisciplinary nature of the resources identified is supported by moderate evidence that multidisciplinary interventions appear to have the greatest potential to foster a return to work for cancer survivors and align with suggestions made by recent expert groups and guidelines regarding employment support for cancer survivors. Ongoing work is needed to assess the utilization, impact, and equity of available employment resources to optimize work outcomes among cancer survivors.

Clinical Work-Integrating Care in Current Practice: A Scoping Review

PURPOSE

Clinical work-integrating care (CWIC) refers to paying attention to work participation in a clinical setting. Working patients may benefit from CWIC. The purpose of this study is to explore the extent and nature to which medical specialists provide CWIC and what policies and guidelines oblige or recommend specialists to do.

METHODS

A scoping review was conducted. The databases MEDLINE, EMBASE, Psychinfo, CINAHL, and Web of Science were searched for studies on the extent and nature of CWIC and supplemented by gray literature on policies and guidelines. Six main categories were defined a priori. Applying a meta-aggregative approach, subcategories were subsequently defined using qualitative data. Next, quantitative findings were integrated into these subcategories. A separate narrative of policies and guidelines using the same main categories was constructed.

RESULTS

In total, 70 studies and 55 gray literature documents were included. The main findings per category were as follows: (1) collecting data on the occupation of patients varied widely; (2) most specialists did not routinely discuss work, but recent studies showed an increasing tendency to do so, which corresponds to recent policies and guidelines; (3) work-related advice ranged from general advice to patient-physician collaboration about work-related decisions; (4) CWIC was driven by legislation in many countries; (5) specialists sometimes collaborated in multidisciplinary teams to provide CWIC; and (6) medical guidelines regarding CWIC were generally not available.

CONCLUSION

Medical specialists provide a wide variety of CWIC ranging from assessing a patient's occupation to extensive collaboration with patients and other professionals to support work participation. Lack of medical guidelines could explain the variety of these practices.

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.