Academic journal article Scandinavian Journal of Work, Environment & Health

Breast Cancer Survivors' Views of Factors That Influence the Return-to-Work Process - a Qualitative Study

Academic journal article Scandinavian Journal of Work, Environment & Health

Breast Cancer Survivors' Views of Factors That Influence the Return-to-Work Process - a Qualitative Study

Article excerpt

Objectives Accumulating evidence suggests that most employed breast cancer survivors are able to return to work but often experience difficulties in the process. The objective of this study was to identify: (i) factors experienced as barriers to and facilitators of the return-to-work (RTW) process, (ii) which factors were important during initial and post RTW, and (iii) possible solutions to RTW problems.

Methods Twelve breast cancer survivors participated in semi-structured interviews. Interviews were thematically analyzed using MAXQDA, software for qualitative data analysis. We used the World Health Organization's International Classification of Functioning, Disability and Health as a conceptual framework.

Results Participants experienced many barriers to and facilitators of RTW. In line with previous studies, we found that work environmental factors, such as support from a supervisor, importance of work, and physical or psychological side-effects (such as fatigability), influenced RTW. In addition, we found that barriers included temperament and personality functions, "job lock", and societal attitudes, while facilitators comprised taking care of one's health, skills/coping, and support from family and healthcare professionals. During the initial RTW phase, physical or psychological side-effects hampered work resumption, while during the post RTW phase, a lack of understanding from the work environment was problematic. Participants mentioned that guidance from healthcare professionals and information for supervisors and colleagues should be improved.

Conclusions To enhance RTW among breast cancer survivors, interventions should focus on barriers and facilitators for individuals at different time points in the RTW process. Better guidance from healthcare professionals and information for supervisors and colleagues could also enhance the process.

Key terms experience; oncology; return to work; RTW; qualitative research.

Accumulating evidence suggests that most employed breast cancer survivors are able to return to work (1-3) but often experience difficulties managing their work, for instance due to physical (eg, arm function) or cognitive work limitations (eg, concentration, fatigue), or unreasonable treatment at the workplace (eg, feelings of being discriminated against, unsupportive work environment) (4-6). It is important to understand the difficulties cancer survivors experience in order to develop interventions to better support them in their resumption of work.

Using regression analysis based on self-report questionnaires or administrative data, many previous studies have shown that several factors can enhance or hinder the return to work (RTW) of cancer survivors (3, 7-11). However, the difficulties of managing work depend on a complex interaction of individual and environmental factors and the social security system (4, 12), and these difficulties may change during the course of the disease. This underlying context may not be identified by outcomes based on questionnaires or administrative data. Furthermore, RTW is often defined in quantitative studies as a singular event, but it can also be viewed as a process during which different factors influence RTW in different phases, such as the initial and the post RTW phase (13). Therefore, qualitative research of the initial and post RTW processes may be a better method for studying this problem. In the international literature, a number of studies have applied this qualitative research method by analyzing breast cancer survivors' experiences with the RTW process (6).

This study aims to add to these previous qualitative studies by (i) identifying factors that have been experienced as barriers to or facilitators of the initial and post RTW processes, (ii) classifying these factors according to the World Health Organization's International Classification of Functioning, Disability and Health (ICF) (14), and (iii) asking cancer survivors for possible solutions to their RTW problems. …

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