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M. S, A. WL, J. L. H, K. A, E. F. Interventions regarding physicians' sickness certification practice - a systematic literature review with meta-analyses. Scand J Prim Health Care 2022; 40:104-114. [PMID: 35254203 PMCID: PMC9090374 DOI: 10.1080/02813432.2022.2036420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE A variety of interventions aiming to influence physicians' sickness certification practice have been conducted, most are, however, not evaluated scientifically. The aim of this systematic literature review was to obtain updated knowledge about interventions regarding physicians' sickness certification practice and to summarize their possible effects, in terms of sickness absence (SA) or return to work (RTW) among patients. METHODS We searched PubMed and Web of Science up through 15 June 2020 and selected peer-reviewed studies that reported effects of controlled interventions that aimed to improve physicians' sickness certification practice and used SA or RTW among patients as outcome measures. Meta-analyses were conducted using random-effect models. RESULTS Of the 1399 identified publications, 12 studies covering 9 interventions were assessed as relevant and included in the review. Most (70%) were from the Netherlands, two had a controlled, and seven a randomized controlled study design. All interventions included some type of training of physicians, and two interventions also included IT-support. Regarding the outcomes of SA/RTW, 30 different effect measures were used. In the meta-analyses, no statistically significant effect in favor of the interventions was observed for having any RTW (i.e. first, partial, or full) nor full RTW. CONCLUSIONS The individual studies showed that physicians' sickness certification practice might be influenced by interventions in both the intended and non-intended direction, however, no statistically significant effect was indicated by the meta-analysis. The included studies varied considerably concerning intervention content and effect measures.KEY POINTSThe knowledge is very limited regarding the content of interventions directed to physician's sickness certification practiceThe identified interventions included some type of training of physicians, and some of them also included IT-support for physiciansThere was a great heterogeneity among the interventions concerning effect measures used regarding return to work among patientsThe individual studies showed that physicians' sickness certification practice might be influenced by interventions in both intended and non-intended directions, however, the overall meta-analysis did not indicate an effect.
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Affiliation(s)
| | - Wennman-Larsen A.
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | - Hoving J. L.
- Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, and Research center for Insurance Medicine, Amsterdam, The Netherlands
| | - Alexanderson K.
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Friberg E.
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- CONTACT Friberg E Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, StockholmSE-171 77, Sweden
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Zegers AD, Coenen P, Bültmann U, Retèl V, Kieffer JM, van der Beek AJ, Duijts SFA. Supporting participation in paid work of cancer survivors and their partners in the Netherlands: protocol of the SusTained Employability in cancer Patients and their partnerS (STEPS) multi-centre randomized controlled trial and cohort study. BMC Public Health 2021; 21:1844. [PMID: 34641839 PMCID: PMC8506084 DOI: 10.1186/s12889-021-11865-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many cancer survivors experience physical and/or psychosocial problems affecting return to work (RTW) and work retention. Current interventions on RTW lack evidence regarding effectiveness, while interventions for work retention are missing. Partners of cancer survivors may also experience work- and health-related outcomes; yet, these consequences are not well understood. Here, the protocol of the STEPS study is described. The study aims are to: 1) evaluate the (cost-)effectiveness of a rehabilitation program for RTW and work retention in cancer survivors, and 2) assess health- and work-related outcomes among cancer survivors' partners. METHODS In a multicentre Randomized Controlled Trial (RCT), 236 working-age cancer survivors with an employment contract will be randomly allocated to a usual care group or an intervention group receiving a multidisciplinary rehabilitation program, combining occupational therapy facilitating work retention (e.g., energy management and self-efficacy training) and reintegration consultation addressing work-related issues (e.g., RTW planning and discussing workplace or task modifications with the supervisor). Alongside the RCT, a prospective cohort study will be conducted among cancer survivors' partners (n = 267). Participants in the RCT and cohort study will be asked to complete questionnaires at baseline, and after six and 12 months, assessing work- and health-related outcomes. Generalized estimating equations will be used to assess intervention's effectiveness, compared to usual care, regarding primary (i.e., working hours per week) and secondary outcomes. Also economic and process evaluations will be performed. For the cohort study, logistic or linear regression modelling will be applied assessing work- and health-related outcomes (primary outcome: working hours) of cancer survivors' partners, and what factors predict these outcomes. RESULTS The study is planned to start in September 2021; results are expected in 2023. CONCLUSION Compared to usual care, the STEPS intervention is hypothesized to be (cost-)effective and the intervention could be a valuable addition to standard care helping cancer survivors to sustain employment. Further, it is expected that living with a cancer survivor has a substantial impact on work and health of partners, while specific groups of partners that are at particular risk for this impact are likely to be identified. TRIAL REGISTRATION Dutch Trial Register ( NTR;NL9094 ; 15-12-2020).
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Affiliation(s)
- Amber D Zegers
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, location VUmc, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, location VUmc, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - Ute Bültmann
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, the Netherlands
| | - Valesca Retèl
- The Netherlands Cancer Institute, Department of Psychosocial Research and Epidemiology, Amsterdam, the Netherlands
| | - Jacobien M Kieffer
- The Netherlands Cancer Institute, Department of Psychosocial Research and Epidemiology, Amsterdam, the Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, location VUmc, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - Saskia F A Duijts
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, location VUmc, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.,The Netherlands Comprehensive Cancer Organization (IKNL), Research & Development, Utrecht, the Netherlands
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Wennman-Larsen A, Svärd V, Alexanderson K, Friberg E. Factors of decisive importance for being in work or not during two years after breast cancer surgery: content analysis of 462 women's open answers. BMC WOMENS HEALTH 2021; 21:332. [PMID: 34521383 PMCID: PMC8438964 DOI: 10.1186/s12905-021-01468-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022]
Abstract
Background Paid work is one of the most important aspects in life among working-aged women diagnosed with breast cancer. Despite several attempts, no previous study provides a comprehensive overview from the women’s perspective about factors of importance for being able to work or not. Therefore, the aim of this study was to gain knowledge about factors that women themselves state are of decisive importance for being able to work or not during the first two years after breast cancer surgery. Methods Data was collected in a two-year follow-up questionnaire within the frame of a prospective cohort study of working-aged women who had undergone breast cancer surgery. 749 were included in the questionnaire study and of the 616 (82%) responding women, 462 (75%) wrote statements on an open-ended question about factors of decisive importance for being able to work or not work during the past two years. The statements were analyzed with content analysis. Results Five categories of factors of importance for being able to work or not were identified, each covering several sub-categories: Health and wellbeing, Contacts and encounters, Flexibility and adjustment possibilities, Socioeconomic consequences from working/not working, and Own motivation and characteristics. A wide variety of factors were mentioned by the women and the findings give a multifaceted picture of many single but interrelated factors of decisive importance for being able to work/not work. The importance of flexibility in the return-to-work process was stressed, as well as the importance of supportive encounters from, e.g., colleagues, managers, as well as relatives. Conclusions The results give a comprehensive overview over a variety of different types of factors for being able to return to/remain in work or to not work after breast cancer surgery, adding new knowledge about e.g. the importance of colleagues, and the women’s own preferences or characteristics. These are factors that different stakeholders, both from healthcare but also from the work place and the insurance office, need to be aware of and collaborate around to support women with breast cancer during the period of treatment, rehabilitation and return to work.
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Affiliation(s)
- Agneta Wennman-Larsen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden. .,Department of Nursing Science, Sophiahemmet University, Box 5605, 11486, Stockholm, Sweden.
| | - Veronica Svärd
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden.,Department of Social Work, Södertörn University, 14189, Huddinge, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
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Söderman M, Wennman-Larsen A, Alexanderson K, Svärd V, Friberg E. Oncologists' experiences of and prerequisites for sickness certification tasks: A nationwide questionnaire study. Eur J Cancer Care (Engl) 2021; 30:e13414. [PMID: 33529474 DOI: 10.1111/ecc.13414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 11/28/2020] [Accepted: 01/12/2021] [Indexed: 12/01/2022]
Abstract
Oncologists frequently have sickness certification (SC) consultations, however, little is known about their experiences of such tasks. OBJECTIVE To investigate oncologists' experiences of organisational prerequisites for SC tasks, and if lack of resources was related to experiencing SC as problematic. METHOD Questionnaire data from 342 oncologists in Sweden were used for descriptive statistics and to calculate odds ratios (OR) with 95% confidence intervals (CI). RESULTS The majority (92.2%) had SC consultations weekly; 17.8% of the oncologists experienced such consultations as problematic weekly. About a third appreciated the national guidelines for SC (34.5%) and had joint routines/policies regarding SC at their clinic (29.7%). Experiencing SC consultations as problematic was associated with stating not having enough resources for such work (OR 3.47; 95% CI 1.92-6.25). Lack of resources was associated with: experiencing lack of competence in insurance medicine (3.34; 1.92-5.82), conflicts with patients regarding SC (4.22; 1.96-9.07), finding it problematic to manage the two roles as medical expert and as the patient's treating physician (3.31; 2.04-5.34), or to assess work capacity (2.28; 1.46-3.56). CONCLUSION Although oncologists often had SC tasks, most did not experience them as problematic weekly. However, lack of resources for SC tasks was associated with experiencing SC as problematic.
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Affiliation(s)
- Mirkka Söderman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Mälardalen University, Eskilstuna, Sweden
| | - Agneta Wennman-Larsen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Svärd
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Zegers AD, Coenen P, van Belzen M, Engelen V, Richel C, Dona DJS, van der Beek AJ, Duijts SFA. Cancer survivors' experiences with conversations about work-related issues in the hospital setting. Psychooncology 2020; 30:27-34. [PMID: 33037828 PMCID: PMC7894286 DOI: 10.1002/pon.5529] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/11/2020] [Accepted: 08/16/2020] [Indexed: 01/22/2023]
Abstract
Objective Early access to work‐related psychosocial cancer care can contribute to return to work of cancer survivors. We aimed to explore: (a) the extent to which hospital healthcare professionals conduct conversations about work‐related issues with cancer survivors, (b) whether cancer survivors experience these conversations as helpful, and (c) the possible financial implications for cancer survivors of (not) discussing their work early on. Methods The Dutch Federation of Cancer Patient Organizations developed and conducted a cross‐sectional online survey, consisting of 27 items, among cancer survivors in the Netherlands. Results In total, 3500 survivors participated in this study (71% female; mean age (SD) 56 (11) years). Thirty‐two percent reported to have had a conversation about work‐related issues with a healthcare professional in the hospital. Fifty‐four percent indicated that this conversation had been helpful to them. Conversations about work‐related issues took place more frequently with male cancer survivors, those aged 55 years or below, those diagnosed with gynecological, prostate, breast, and hematological or lymphatic cancer, those diagnosed ≤2 years ago, or those who received their last treatment ≤2 years ago. There was no statistically significant association between the occurrence of conversations about work‐related issues and experiencing the financial consequences of cancer and/or its treatment as burdensome. Conclusions Although conversations about work‐related issues are generally experienced as helpful by cancer survivors, early access to work‐related psychosocial cancer care in the hospital setting is not yet systematically offered.
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Affiliation(s)
- Amber D Zegers
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mirjam van Belzen
- Dutch Federation of Cancer Patients Organizations (Nederlandse Federatie van Kankerpatiëntenorganisaties, NFK), Utrecht, The Netherlands
| | - Vivian Engelen
- Dutch Federation of Cancer Patients Organizations (Nederlandse Federatie van Kankerpatiëntenorganisaties, NFK), Utrecht, The Netherlands
| | - Carol Richel
- Dutch Breast Cancer Organization (Borstkankervereniging Nederland, BVN), Utrecht, The Netherlands
| | - Desiree J S Dona
- Department of Human Resources, Radboud university medical center, Nijmegen, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Saskia F A Duijts
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Netherlands Comprehensive Cancer Organization (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
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