Both sides of the couch: a qualitative exploration of the experiences of female healthcare professionals returning to work after treatment for cancer

"Returning beyond cancer"-a journey of professional reinvention for nurses

PURPOSE

Nurse cancer survivors (NCSs) face significant challenges in adapting to returning to work (RTW) and require special attention and support. Little is known about the meaning NCSs attribute to their work, the changes in their personal feelings, and their needs in coping with these changes after RTW. This interpretive phenomenological study aimed to explore NCSs' feelings and experiences after RTW in greater depth to help improve their quality of working life (QWL).

METHODS

Semi-structured interviews were conducted with 15 NCSs in China between March 2023 and August 2023. The transcripts were analyzed using interpretative phenomenological analysis (IPA).

RESULTS

The data was categorized into four themes: (1) psychological odyssey, (2) accessing social support, (3) benefiting from professional background, and (4) realization of professional values.

CONCLUSION

This study uses IPA to explore the work experiences of NCSs and ways to improve their QWL. It is recommended that managers pay attention to the psychology of their RTW, enhance support, encourage the use of professional strengths, and value their insights and professional development.

Nurses' returning to work after cancer: A focus group study

BACKGROUND

Nurses diagnosed with cancer face unique challenges when returning to work, yet there is limited understanding of their transition.

PURPOSE

To explore nurses' return-to-work experiences post cancer diagnosis and clarify related facilitators and challenges.

METHODS

This focus group study employed a content analysis with constant comparative approach and member checking. This study recruited nurses treated for any type of cancer who had experience returning to clinical positions.

FINDINGS

Five focus groups with 17 female nurses (mean age=51.8) were performed; 47.1% had breast cancer. Four main themes were identified: (a) motivation, incentives, and the need to return to work; (b) setbacks hindering the return; (c) navigating new work dynamics; and (d) evolving professional role during the return to work.

DISCUSSION

This study illustrates personal and professional growth and struggles that attend returning to work as a nurse with cancer. This insight informs strategies to support continuing these nurses' careers.

Quality of working life and adaptability of returning to work in nurse cancer survivors: a cross-sectional study

OBJECTIVE

To explore the relationship between quality of working life (QWL) and adaptability of returning to work (RTW) among nurse cancer survivors (NCSs).

METHOD

We conducted a cross-sectional study on nurses previously diagnosed with cancer. QWL was quantified using the Quality of Working Life Scale (QWL7-32), and the level of RTW adaptability was assessed using the Adaptability of Returning to Work for Cancer Survivors (ARTW-CS) scale. Multiple linear regression analysis was used to control for confounding factors, and a simple effect analysis was performed on the interaction term.

RESULTS

After controlling for sociodemographic, work-related, and health-related factors, the findings indicated a significant correlation between "adaptation and planning" and QWL score (p < 0.05). Further analysis revealed that "RTW gradualness" and "support seeking" had an interaction effect (p = 0.021). The simple effect analysis demonstrated that when the "RTW gradualness" score was ≥ 16 points, nurses with a high "support seeking" score (≥ 7 points) exhibited a significantly better QWL than those with a low "support seeking" score (< 7 points) (p < 0.001).

CONCLUSION

The interaction between "RTW gradualness" and "support seeking" in the ARTW-CS scale significantly impacted the QWL of the NCSs, underscoring the importance of implementing a gradual career plan and seeking support to enhance QWL.

Return to work after chronic disease: A theoretical framework for understanding the worker-employer dynamic

OBJECTIVES

Return to work after chronic disease is important for workers, employers and society. The process, however, is challenging. This article provides an analytical and theoretical framework for explaining this process informed by the person-environment fit theory.

METHODS

This article uses a narrative method to (1) review the key concepts, benefits and influencing factors in the literature on return to work after chronic diseases, (2) analyse and critique the most important theoretical models used for explaining return to work after chronic diseases, and (3) review the person-environment fit theory and how it has been used so far.

RESULTS

The existing models highlight different aspects, but they overlook the relationship between the worker and the employer. An analytical and theoretical framework is proposed to comprehensively explain the worker-employer dynamic. The framework also considers the role of broader factors (policy, labour market) and other stakeholders (health professionals, civil society actors) emphasising the idea that return to work is a phased and cyclical process.

DISCUSSION

The framework can be used to guide future qualitative and quantitative studies, or as a map for identifying problematic areas related to the worker or the work environment. The model should be empirically tested in future studies.

Moving beyond the patients’ views on the process of return to work after cancer: A qualitative evidence synthesis on articles published between 2008 and 2017

BACKGROUND: Important qualitative findings have accumulated on return to work after cancer from the perspective of various stakeholders. OBJECTIVE: The aim of this paper was to critically appraise the evidence produced between 2008–2017 on several key stages of the return to work process against the key stakeholders identified in the articles included. METHODS: A systematic search was done on four databases to identify relevant papers. Papers were selected based on pre-defined selection criteria. A qualitative evidence synthesis was performed on the articles included. RESULTS: A total of 57 articles were included in the analysis. Using the secondary thematic analysis, this study identified three categories of articles relative to the stakeholders included: articles focusing on patients’ experience (n = 41); articles dealing with multiple stakeholders, including patients (n = 12); and articles drawing on stakeholders other than patients (n = 4). The analysis also revealed five key stages of the return to work process which follow a sequential order and provide a comprehensive image of the process. CONCLUSIONS: More research is required on how employers view and are able to facilitate the return to work process after cancer. New forms of support must be planned and delivered by health professionals for patients who return on the labour market. The five stages model proposed in this study can help employers and policymakers to plan and deliver tailored legislation and guidance for RTW facilitation. All stakeholders must be further trained to embrace the idea that return to work is a complex process which continues long after the survivor returns to work.

Barriers to and facilitators of labor market engagement for individuals with chronic physical illnesses in their experiences with work disability policy: a qualitative systematic review

OBJECTIVE

The objective of this review was to identify and synthesize the best available evidence to address two questions. From the perspectives of individuals with chronic physical illnesses: i) what are barriers in work disability policies with respect to labor market engagement? and ii) what are facilitators in work disability policies with respect to labor market engagement?

INTRODUCTION

Chronic physical illnesses have a high and increasing prevalence worldwide and are associated with significant disability in the working-age population. Individuals with chronic illnesses and disability have low employment and high unemployment rates, and low wages. Work disability policies have important role in reducing negative labor market impacts, but inadequate policies may also pose barriers to work engagement.

INCLUSION CRITERIA

This review included studies of individuals who were of working age, had one or more chronic physical illness, and had experience relevant to disability policy and work engagement. The phenomena of interest were perceived barriers and perceived facilitators in work disability policies with respect to labor market engagement. The context was any study setting globally. Studies considered for this review had qualitative data from a variety of methodologies.

METHODS

This review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. A literature search involved academic databases (ie, CINAHL Plus, MEDLINE, PsycINFO, AgeLine, SocINDEX, Social Work Abstracts, Sociological Abstracts, Social Services Abstracts) for published studies; gray literature sources (ie, ProQuest Dissertations and Theses, MedNar, Google Scholar, OpenGrey, OAIster, Google, and relevant websites) for unpublished studies; and reference lists of retrieved records. No language, date, or country limiters were applied to the searches. Retrieved records from the database and gray literature searches were screened, with potentially relevant records then examined in full against the inclusion criteria. Eligible studies were critically appraised for methodological quality and those included in this review were subjected to data extraction of descriptive details and the study findings that were relevant to the review questions. Study findings were synthesized and were assigned confidence scores.

RESULTS

Forty-four studies of various qualitative designs and varied methodological quality (from low to high) were included in this review. The study samples represented a number of different chronic physical illnesses. There were 301 credible and unequivocal study findings, which were aggregated into 20 categories and 5 synthesized findings. Persons with chronic physical illnesses perceived barriers and facilitators relevant to the adequacy of disability policies in meeting their needs for returning to work after leave due to illness and for sustaining ongoing work engagement. They also perceived barriers and facilitators relevant to stakeholders' communication, help, and support respecting workers' efforts toward work engagement.

CONCLUSION

Although confidence in the synthesized findings is low due to limitations in the methods and research findings across primary studies, the evidence suggests that both the adequacy and implementation of work disability policies need to be improved to meet the needs of workers with chronic physical illnesses, for their labor market engagement.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42016033476.

Supporting the Return to Work After Cancer in Romania: Exploring Employers' Perspectives

Purpose Evidence shows that employers play a key role in facilitating the return to work of employees with cancer, yet little is known about the employers' experiences in settings where no policies or regulations are available to guide this process. Against this background, we aimed (1) to understand how employers experience and manage the process of having employees with cancer and (2) to explore their reflections regarding their role in returning to work. Methods Twenty employers from various types of organisations and sectors were interviewed. Inductive thematic analysis was performed using NVivo 11. Results Employers experienced having employees with cancer as a process with three distinct phases reflected in three emerging themes: disclosure of the diagnosis and absence from work; returning to work; post-returning to work. A fourth theme emphasizes the employers' reflections on how they conceive their own role. In the absence of a normative framework for dealing with employees with cancer, employers used commonsensical rules of thumb and immediate solutions based on ad-hoc decisions and were often compelled to innovate. They offered accommodations only if requested by the employee after returning to work. The return to work process was neither planned nor phased. Conclusion Employers need information and guidelines for effectively assisting employees with cancer. Better channels of communication and collaboration with health professionals are essential for more adequate support for the long-term consequences of cancer. A detailed return to work policy is required to tackle the inconsistencies in the support offered and this policy must also rethink how diagnosis disclosure takes place in Romanian organisations.

Beyond vulnerability: how the dual role of patient-health care provider can inform health professions education

In order to prepare fully competent health care professionals, health professions education must be concerned with the relational space between patients and providers. Compassion and compassionate care are fundamental elements of this relational space. Traditionally, health professions educators and leaders have gone to two narrative sources when attempting to better under constructs of compassion: patients or providers. Rarely have there been explorations of the perspectives of those who consider themselves as both patients and providers. In this study, we interviewed nineteen health care providers who self-disclosed as having had a substantive patient experience in the health care system. We engaged with these participants to better understand their experience of having these dual roles. Anchored in Foucault's concepts of subjectivity and Goffman's symbolic interactionism, the interviews in this study reveal practices of moving between the two roles of patient and provider. Through this exploration, we consider how it is that providers who have been patients understand themselves to be more compassionate whilst in their provider roles. Rather than describing compassion as a learnable behaviour or an innate virtue, we theoretically engage with one proposed mechanism of how compassion is produced. In particular, we highlight the role of critical reflexivity as an underexplored construct in the enactment of compassion. We discuss these findings in light of their implications for health professions education.